Umbilical Hernia

Published: 13th December 2011
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For a time very early in the pregnancy, your baby's intestines were so large they couldn't fit inside his abdomen. Where did they go? They went out for a while—through the opening of the navel. There they stayed until the abdominal cavity grew large enough to accommodate their entire length. When the intestines returned, their portal of exit from the abdomen, called the umbilical ring, was sealed by the merging of the midline abdominal muscles. If these muscles failed to meet, the ring remained open, and the contents of the abdomen were free to protrude. This protrusion is an umbilical hernia, a balloonlike painless swelling of the navel.

Slightly less than one fifth of all white newborns have umbilical hernias, as do slightly more than two fifths of black newborns. We also see them more often in premature and in babies with extra-wide umbilical cords. If the defect is small, say the size of your fingertip, it may only show up when the baby cries or strains, since both increase the pressure inside the abdomen. Since crying is so often followed by the belly button's bulging, some parents conclude that the hernia will disappear if they diligently respond to every whimper and prevent the baby from building up to a howl. Unfortunately, what they get instead is a spoiled baby with a hernia. Large umbilical openings allow the intestines to protrude without effort, and when the baby stands up, a short, trunklike section may emerge through the defect. Often the baby will spend long periods pondering this appendage, wondering what pleasurable purpose it has.

As the baby gets older, the defect gradually closes. Most are closed within two years; 85 percent close by six years of age. Larger openings take more time to close than smaller ones, and a very small number never close. Since most umbilical hernias are harmless and heading for spontaneous closure, there's no need to rush the baby to the operating room. Nor is there any need to put tape across the navel, a binder around the abdomen, or tape or a coin over the hernia. The adhesive of the tape and the metal of the coin can easily irritate the skin. Since it's virtually impossible to securely bind the baby's midsection without compressing the lower rib cage in the back, belly binders can per-manently deform the lower rib cage. All this for a condition that's trying its best to go away! When must you repair umbilical hernias? Certainly when the loop of intestine that pokes out gets stuck and can't get back inside. Getting stuck is called incarceration, and if it injures the bowel, it's called strangulation. These conditions occur in only 2 to 5 percent of children with umbilical hernias, but once they happen, it's time to fix the hernia. There's little controversy on this point, but there are many opinions about when it's best to close the hernia that isn't causing trouble. One approach to the question of when to take action on a trouble-free hernia is to base the decision on the size of the defect.

This school of thought holds that umbilical hernias greater than 1.5 centimeters in diameter should be closed surgically in girls when they reach two years and boys when they reach four. I don't favor this approach for several reasons. In the first place, umbilical hernias smaller than 1.5 centimeters are as likely to lead to incarceration as larger ones; and second, adults incarcerate their umbilical hernias at a rate 14 times greater than children. Therefore, it seems logical to leave the trouble-free umbilical hernia of any size alone during childhood. It almost invariably disappears on its own


You can also read artciles written by Rashid javed about health such as Homeopathic History and Treatment of Pregnancy and Birth Problems

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