How to treat an umbilical hernia in a child

An umbilical hernia is a disease that can affect children of all ages. It is important for parents to know what measures can be taken to self-heal from this disease in childhood, given the need for surgery in case of complications.

An umbilical hernia is a common disease characterized by the formation of a protrusion under the skin in the navel.

This defect is formed as a result of the exit of the peritoneum through the non-obliterated aponeurosis of the umbilical ring with the formation of a hernial sac. The contents of the sac are often bowel loops and the greater omentum.

This is one of the most common pathologies of early age, and the treatment of umbilical hernia in children is performed surgically.

Why does a hernia occur

According to statistics, this type of hernia is found in 20% of newborns, that is, in every fifth. This figure rises to 30% among premature babies. In girls, the frequency of occurrence is slightly higher.

Reduced tone of the abdominal muscles with a defect in the aponeurosis is the main cause of the formation of an umbilical hernia. Shallow healing of the skin after the umbilical cord falls off and frequent inflammation in the navel area can contribute to this, which interferes with normal scarring.

Predisposing factors:

genetic predisposition;
factors that increase intra-abdominal pressure (cough, anxiety, flatulence, colic);
decrease in the tone of the abdominal muscles (rickets, malnutrition).

Previously, there was a widespread opinion about the “incorrectly tied navel” in the maternity hospital, leading to the mandatory formation of this pathology. At present, such a factor is completely excluded, which was confirmed by the modern technique of applying staples to the umbilical cord, which is not related to the mechanism of hernia formation.

How does it manifest

Clinic:

protrusion of the umbilical region, spontaneously reducible inward in a horizontal position, or with pressure;
protrusion appears or increases with tension of the abdominal muscles (crying, crying, coughing);
an open umbilical ring is palpated;
the absence of pain in an unstrapped hernia.

An umbilical hernia is usually discovered during the first month of a child's life. At a later age, a hernia appears with a small defect in the umbilical ring, when the static load increases (the child begins to walk).

Diagnosis of this pathology is not difficult, and is carried out by a pediatric surgeon during a visual examination. In difficult situations, an ultrasound method is used to detect a defect in the umbilical ring.

An umbilical hernia is complicated by infringement of the contents of the hernial sac. This is specific to adults. For children, this is extremely rare. Symptoms of strangulated hernia: vomiting, sudden paroxysmal pain in the abdomen, lack of stool and gas, soreness and irreducibility of the hernia itself. If these symptoms appear, you should immediately consult a doctor.

Methods of treatment

Expectant management of the patient with the possibility of self-closure of the defect of the aponeurosis of the umbilical region is applicable to children under the age of 5 years.

In 60% of cases, children self-heal. You can even remove the supra-umbilical, umbilical and para-umbilical hernia even with folk remedies, but the cure for this approach is extremely rare, and is often associated with completely different factors (gymnastics with the child, proper nutrition, absence of comorbidities of the gastrointestinal tract).

How to treat an umbilical hernia without surgery ( effective for children in the first year of life):

general strengthening gymnastics;
use of a special bandage;
massage aimed at strengthening the abdominal muscles;
laying the baby on the stomach;
adhesive therapy;
swimming;
physiotherapy.

The main goal of conservative therapy is aimed at increasing the tone of the abdominal muscles and strengthening the abdominal press. This contributes to the reduction or complete closure of the aponeurosis defect.

Massage can be done after the umbilical wound has healed. This does not require special skills, parents can perform the usual circular movements in a clockwise direction, rubbing the skin and pressing on the formations. The movements should be light, and in no case should you massage the stomach when the hernia is not reduced and the child feels unwell.

Physical therapy already needs to be done under the supervision of a specialist, because many movements are contraindicated in case of a hernia of the umbilical ring. With children up to a year old, you can practice on a fitball, do flips from the tummy to the back. After a year, squats, bends, back arches and similar exercises that involve the abdominal muscles will be useful.

Surgical treatment is performed for children aged 5 years with a persistent diagnosis of umbilical hernia. Up to 5 years, surgery is possible with a significant expansion of the umbilical ring and the absence of positive dynamics. Herniotomy is performed under anesthesia.

Outpatient treatment under local anesthesia is possible in specialized departments. A skin incision is made in the navel, access to the hernial sac is made. The bag is dissected, its contents are placed back into the abdominal cavity, and it is removed. The hernial ring is sutured. 1-2 sutures are applied to the skin.

An uncomplicated operation leads to recovery without a cosmetic defect.

The protrusion, as a rule, is not dangerous and does not affect the quality of life, but is only a cosmetic defect. With age, it tends to infringe with the further development of intestinal obstruction, which in turn can lead to peritonitis and sepsis with a fatal outcome.

In children, hernia treatment is necessary to prevent complications in the future.

What is dangerous hernia of the umbilical ring

If the hernia is not cured in a timely manner, that is, the hernial sac is not removed, followed by muscle strengthening, this will be a factor in the occurrence of complications. And even when it was possible to eliminate the defect without surgery, the hernia in the baby may appear again, and then it is removed exclusively surgically.

Possible complications without surgery:

inflammation - when a lot of feces accumulate in the intestinal loops, a rupture of the intestine can occur, its contents enter the abdominal cavity, peritonitis develops, which will be a life-threatening condition;
intestinal obstruction, coprostasis - a frequent complication, when there is an intestinal loop in the hernial sac, a complication manifests itself in the absence of stool, intoxication of the body, weakness;
infringement is the most frequent and dangerous complication, when a hernia in a child is compressed in the area of the gate or sac, the organs suffer from a lack of blood circulation, ischemic changes begin, then tissue necrosis occurs, and without an urgent operation there is a possibility that it will not be possible to return the function of the organ, and will have to carry out its partial or complete removal.

Surgical treatment of umbilical hernia in children excludes such conditions, but there are risks after surgery. Relapse is a complication that is characterized by the recurrence of the disease in the same place; ventral postoperative hernia can also occur - a protrusion in the area of the surgical scar.

To minimize the risk of postoperative hernia and recurrence, parents should monitor the activity of the child, eliminate high loads on the operated area for the first few weeks.

In the late period after the operation, it will be important to engage in physiotherapy exercises with the child to strengthen the muscles of the anterior abdominal wall. If this is ignored, the pathology can return after a few months and even years.

Can a hernia be prevented?

Prevention of hernia in children is needed in case of predisposition to pathology, prematurity, low weight and muscle weakness. In such cases, it is recommended to exclude risk factors from the birth of the baby, namely a strong cry, crying.

As the baby develops, age-appropriate health procedures should be carried out: swimming, exercise, healthy eating. It is equally important to prevent rickets, because often these pathologies are combined.

Proper nutrition is essential for the prevention of hernias.

Ideally, children up to a year are breastfed, and the mother follows a strict diet. If circumstances force mixed or completely artificial nutrition, mixtures should be chosen with a pediatrician.