Beware! Umbilical hernia is more common in middle-aged and elderly women. Understanding the causes and prevention is the key

Author: Yuan Xin, attending physician at Beijing Chaoyang Hospital, Capital Medical University

Reviewer: Shin Youngmo, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Umbilical hernia, as a type of abdominal wall hernia, has gradually increased in incidence among adults in recent years, especially among middle-aged and elderly women. The formation of umbilical hernia is mostly due to increased abdominal pressure and weak abdominal wall, which not only affects the patient's daily quality of life, but also may bring a series of health risks.

Umbilical hernia in adults most often occurs in middle-aged and elderly women over 40 years old, especially in women who have experienced multiple pregnancies, childbirth, and obesity. The reason for this is that the occurrence of umbilical hernia is related to the physiological structure of the navel. After birth, although the umbilical ring is closed, due to the lack of solid muscle and aponeurotic tissue support, this area becomes one of the most vulnerable parts of the abdominal wall. With age and increased intra-abdominal pressure, such as long-term coughing and constipation, the originally weak umbilical ring is more likely to be squeezed, thus forming a hernia sac. In addition, ascites caused by cirrhosis of the liver will also increase intra-abdominal pressure, causing a mass to appear in the navel area. Although this disease can also be seen in men, women are still the main patient population because their incidence rate is much lower than that of women.

It is worth noting that umbilical hernias in adults and children differ in their manifestations. Umbilical hernias in children are usually located in the center of the umbilical ring, while in adults they are more common at the upper or lower edge of the navel, which is called "paraumbilical hernia". This is because the rectus abdominis muscles of adults meet in this area to form the linea alba, but lack sufficient muscle coverage, making this area a potential weak link.

For patients diagnosed with adult umbilical hernia, surgery is the only effective treatment. Compared with the natural healing of infants and young children, adult umbilical hernias do not have the ability to heal on their own. And over time, the hernia sac tends to gradually increase, which not only affects the patient's quality of life, but also increases the risk of complications, such as emergency situations such as hernia sac incarceration. Therefore, surgery should be arranged as soon as possible once it is discovered.

Figure 1 Original copyright image, no permission to reprint

Currently, the surgical methods for adult umbilical hernia mainly include open surgery and laparoscopic surgery. In open surgery, smaller hernias can be repaired by retaining the navel; for larger or complex hernias, part of the navel tissue may need to be removed to ensure a firm repair. However, the recurrence rate of this type of surgery is relatively high, about 15%. In recent years, with the development of patch materials, the use of patches for repair has become the mainstream practice. Whether the patch is placed in front of or behind the muscle, the recurrence rate can be effectively reduced to a level close to 0.2%.

In contrast, laparoscopic surgery is favored for its advantages such as less trauma and faster recovery. The advantages of laparoscopic technology are particularly obvious when dealing with larger umbilical hernias. This surgery avoids direct operation on the navel skin and reduces the occurrence of postoperative complications by making a hole in the side of the abdominal wall and placing an anti-adhesion patch in the abdominal cavity using special instruments. However, the cost of laparoscopic surgery is relatively high and it must be performed under general anesthesia.

The key to preventing umbilical hernia in adults is to control abdominal pressure, strengthen abdominal wall muscle strength and maintain good living habits. First, patients should actively control diseases that increase abdominal pressure, such as coughing and constipation; second, maintain a healthy weight and body shape through a reasonable diet and moderate exercise; finally, avoid excessive fatigue and strenuous exercise to avoid excessive impact on the abdominal wall.

For patients who have undergone surgery, postoperative care is equally important. Avoid strenuous activities within one month after surgery to prevent the patch from shifting or falling off; at the same time, pay attention to the cleanliness and dryness of the wound to prevent infection. In addition, regular follow-up is also an essential step to detect and deal with potential complications in a timely manner.

For pregnant women who develop umbilical hernia during pregnancy, although in most cases it will not cause squeezing or danger to the fetus, it is still necessary to pay close attention to changes in the condition. Most umbilical hernias can recover on their own within one year after delivery, but if the symptoms persist or worsen, you should seek medical treatment in time.

Figure 2 Original copyright image, no permission to reprint