Author of the article: Victoria Stoyanova, 2nd category physician, head of laboratory at the diagnostic and treatment center (2015–2016).
Pregnancy is a period when long-forgotten diseases often appear or new ones appear. This is understandable, because the woman's body is rebuilt, the load on all systems and organs increases. An umbilical hernia during pregnancy — that is, protrusion of the abdominal organs through the umbilical ring — is not uncommon, because the abdominal muscles always carry an extra load when carrying a child.
Fortunately, in most cases, a hernia is not dangerous for either the expectant mother or the fetus.
Read on: causes, symptoms of illness, how to do without surgery before childbirth.
Seven causes of umbilical hernia in pregnant women
This pathology occurs due to physiological changes associated with pregnancy:
- increase intra-abdominal pressure (on the internal organs of the growing uterus),
- stretching the umbilical ring simultaneously with an increase in the size of the abdomen,
- reduce the tone of the abdominal muscles and the umbilical ring.
But such changes are physiological, that is, they are normal and are observed absolutely in all women who carry a baby. But the umbilical hernia in pregnant women - a pathological phenomenon, and is not formed at all. Here are 7 of its main causes and provoking factors:
Heredity (similar problems with relatives).
The protrusion that existed earlier, even long ago and spontaneously settled down (for example, in childhood). Especially, if before pregnancy there was an unopened and periodically falling out hernia.
The second and subsequent pregnancies (with each time the muscle tone is getting lower, and the navel diameter is increasing).
Plural fertility, polyhydramnios, large fetus (the uterus is larger than during normal pregnancy, and more intense pressure on the internal organs).
The age of a woman is older than 30 years (the tone of the abdominal muscles decreases with age).
Initially weak, untrained abdominal muscles.
An umbilical hernia during pregnancy manifests characteristic, easily recognizable symptoms. The main symptom is a protrusion in the navel, which occurs from 2-3 trimester of pregnancy, that is, when the stomach begins to grow rapidly in size. At first, the size of the formation is small, it has a rounded shape and appears only in a standing position, and in the horizontal position it “leaves” itself.
In the future, there are two options for the development of a hernia:
The growing uterus "squeezes" the abdominal organs from the hernial sac. Although the protrusion remains, it is “empty”, which, when groping or trying to reduce it, is determined by the characteristic sound of “pop” or “bursting bubbles”.
The contents (loops of the intestines or the omentum) are preserved, and with an increase in the duration, the formation is no longer set even in the prone position. When coughing, straining during bowel movements, as well as when the baby moves in late periods, the protrusion erupts and pulsates.
Other unpleasant symptoms join this: pain in the navel or all over the stomach, constipation, belching, nausea. Such hernias are the most dangerous, especially if their contents are loops of intestines - the risk of infringement is high in the 3rd trimester or during childbirth. With large umbilical hernias and pregnancy can occur abnormally, complicated by threats of interruption or false fights.
How to treat? To operate or not?
For adult patients, the only method of treating an umbilical hernia is an operation that is classified as elementary and is performed in any surgical hospital. But during pregnancy, surgical treatment is avoided if there is no risk of injury. The operation is postponed until the woman gives birth and completes breastfeeding of the baby, since the toxic agents used for anesthesia penetrate the baby’s blood (through the placenta or through breast milk).
Delays in surgical treatment are explained by the fact that usually the hernial protrusion is not dangerous for pregnant women or for the fetus. The emergence of umbilical hernia and pregnancy proceeding and ending safely - this is absolutely real. But be sure to be regularly observed not only by an obstetrician-gynecologist, but also by a surgeon who chooses the tactics of pregnancy and childbirth, depending on the size and content of the protrusion.
The choice of tactics for pregnancy and childbirth with different types of navel hernias:
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What is an umbilical hernia?
Hernia on the navel looks like a small rounded tubercle filled with air.
In fact, this is a bulging of the abdominal organs, formed due to the failure of the abdominal muscles. The disease can manifest as in childhood and adulthood.
Hernia almost does not manifest itselfwith the exception of a cosmetic defect. When pressing on the bulge, a soft cotton is heard, and the hernia is temporarily reset.
When a woman is in a horizontal position, the protrusion smooths out by itself. When coughing or lifting weights, the tubercle protrudes even more, giving the impression of a pulsation.
Pain sensations the expectant mother notices only in late pregnancy, when the pressure inside the abdomen increases.
When hernia is strangulated protrusion does not disappear even in a prone position. When a fragment of the intestine gets into the umbilical ring, the situation becomes dangerous.
The woman observed the following symptoms:
The condition requires emergency hospitalization. and surgery, as it threatens bowel necrosis.
Fortunately, pregnant women rarely encounter the incision of a hernia, as the growing uterus lifts the abdominal organs and the navel ring remains empty.
Umbilical hernia - the program "About the most important"
Why is the disease so prone to women in the position? There are several reasons:
- increase in pressure in the abdominal cavity
- stretching with the growth of the belly of the umbilical ring,
- increased load on the muscles of the press.
These reasons are due tothat the muscles that are not able to withstand the internal pressure, diverge, and the hernial bag bulges out into the umbilical ring.
The appearance of a similar defect in the abdominal wall can contribute to various factors:
- manifestation of hernia in childhood
- excess weight,
- multiple births
- repeated pregnancy
- weak abdominals,
- age of pregnant over 30.
In the presence of at least one provoking ailment factor should be done before the pregnancywhich will allow to get rid of the problem in a short time.
If the pregnancy has already come, it is recommended to wear a bandagehelping muscles withstand growing pressure.
Hernia is easy to notice during a routine inspection. To avoid undesirable consequences, you should consult a surgeon and undergo some examinations:
- Ultrasound of the hernial bag,
- computed tomography.
X-ray examination, usually prescribed for the diagnosis of hernia, in the case of pregnancy is contraindicated because of the serious consequences for the child.
After receiving the results of the survey the surgeon will determine the need for surgery and give advice on the nutrition and lifestyle of the expectant mother.
What is dangerous diagnosis?
Umbilical hernia of pregnant women is dangerous only in case of pinching. In such a situation, a woman can be tormented by constipation and belching, the occurrence of vascular thrombosis is possible.
Double hazards are women who have diagnosed uterine fibroids. If part of the body is pinched by the umbilical ring, then an emergency surgical intervention will be necessary.
Since the hernia is caused by weakness of the abdominal muscles, no medicines and herbal decoctions can help in this situation. How to treat the disease? Massage, gymnastics to maintain muscle tone - that's all that can advise the expectant mother.
It is recommended to wear a supporting belly bandage from the twentieth week of pregnancy., which significantly eases the load on the abdominal muscles.
The doctor should help in choosing a bandage, as incorrect fixation can be harmful to health and increase pain.
Surgical treatment in pregnant women is allowed only in extreme cases when the danger to life exceeds the risk of the influence of anesthesia and antibiotics on the child.
A woman should ask the surgeon in advance about what signs she should immediately call an ambulance.
Operation on strangulated hernia is not a reason for abortion.
Births with umbilical hernia
Many mothers who are faced with a similar diagnosis are worried about the question: how to give birth with an umbilical hernia? We answer: in the absence of infringement natural delivery is quite possible.
In the case of large hernia and infringement, only surgical intervention is indicated., because in the process of attempted intra-abdominal pressure increases significantly, and the risk of circulatory arrest in a pinched organ increases sharply.
A cesarean section is usually preceded by an operation to remove a hernia.
Disease can be prevented timely preventive measures taken:
Prevention will reduce the risk of herniait is especially necessary if there are predisposing factors in a woman.
In conclusion, we can say that do not panic at the sight of a protrusion on the abdomen during pregnancy. This condition is quite common among future mothers.
Briefly about umbilical hernia
Umbilical hernia is a pathological process. This is a protrusion of the abdominal organs due to the weakening of the muscles of the umbilical ring.
It should be noted that every pregnant woman is at risk of developing an umbilical hernia. The chances of its occurrence increase with multiple pregnancies and repeated pregnancies, large fetuses and polyhydramnios, as well as at the age of women over 30 years.
But do not panic when you discover an umbilical hernia. If the hernia was before the onset of pregnancy, then you should contact the surgeon before the detection of its symptoms. He will observe you and, if necessary, prescribe therapy to minimize the risk of complications.
Usually in the first trimester, a hernia does not form. The most dangerous in terms of its occurrence are 2 and 3 trimesters. The reason is that the baby grows in the mother’s womb, the uterus increases, and the abdominal pressure rises. Muscles that are weakened by such pressure, do not hold the organs - and so the protrusion of the hernia is formed.
Symptoms of umbilical hernia in pregnant women
Signs of umbilical hernia in pregnant women are very characteristic. This is an oblong or rounded education in the navel zone. Such a protrusion can be easily adjusted with gentle pressure or in a horizontal position of the woman. However, in the later periods such reposition is impossible. Education increases and pulsates when trying, for example, when coughing. Painful attacks are characteristic during periods of fetal movement in the later periods.
Umbilical pathology can occur after childbirth, and during cesarean section. The features of its development should be considered in more detail.
Eliminate the umbilical hernia is possible only with the help of surgical intervention. Moreover, in order to avoid pinching, it will be necessary to perform the operation as quickly as possible. Surgical intervention is performed under local anesthesia, and the duration is about an hour. In the absence of complications, the patient is discharged home the next day.
Postpartum umbilical pathology is not uncommon. Even if the pregnancy was normal and ended in a successful birth, the resulting protrusion does not disappear and can even form immediately after the birth of the child.
What measures should be taken in this situation depends on the nature of the manifestations, the severity of the pathology and the factor that caused it.
Most often, a hernia appears as a result of a divergence of the abdominal muscles after delivery. Its development contributes to the weakening of muscle tone after pregnancy.
After cesarean section
The umbilical protrusion may form after a cesarean section. The probability of its occurrence increases in the first week after surgery. With the load on the muscles, there is a risk of abdominal organs being injured.
The umbilical protrusion may form after a cesarean section.
An umbilical hernia in a woman after cesarean may occur for the following reasons:
- as a result of the spread of infection around the seam,
- in violation of the chair (constipation)
- during the tension of the abdominal muscles,
- in the presence of a hematoma in the suture area, as a result of the formation of which there is a divergence of the muscles,
- during disorders of the digestive system as a result of non-compliance with the rules of nutrition,
- as a result of increased intra-abdominal pressure.
Predisposing factors that contribute to the formation of an umbilical hernia are endocrine disorders, previous surgeries and re-pregnancy. Sometimes unsuitable for the body are surgical sutures, after which, when used in women, suppuration occurs.
Sometimes unsuitable for the body are surgical sutures, after which, when used in women, suppuration occurs.
In rare cases, a complication in the form of an umbilical hernia occurs as a result of an incorrectly performed operation. A common surgical error is a poor-quality combination of muscle tissue after an incision.
What is dangerous umbilical hernia during pregnancy
Pinching an umbilical hernia is a dangerous consequence of this manifestation, which is characterized by a sudden onset. Infringement of the intestine occurs when the umbilical ring enters the intestine. If you do not take action, then it will mortify.
Signs of a hernia are strong pains in the umbilical area and protrusive non-ventilability. In addition, the presence of pathology indicate:
- bouts of vomiting,
- abdominal pain,
- difficulty in the discharge of gas,
- temperature rise,
- feeling unwell,
- tension of hernial protrusion.
Pinching the umbilical hernia requires immediate intervention, as there is a risk of impaired blood circulation and the development of necrosis of the internal organs. Symptoms of infringement are equivalent to signs of an acute abdomen. This diagnosis is not a reason for abortion. If the operation is carried out, the further course of the pregnancy will pass without complications.
Signs of a hernia are strong pains in the umbilical area and protrusive non-ventilability.
The main method of treatment of umbilical hernia during pregnancy is surgery. However, other methods can be used by which it is possible to stop the initial manifestations.
Conservative treatment of navel hernia provides for a special massage, which is done to strengthen the muscular system. Women in a state of pregnancy, this massage is shown only in the first trimester.
The technique of the procedure is simple. It consists in making strokes around the navel, first clockwise and then against. After that, light pressure is applied on the umbilical protrusion, as if setting it back inside. The final part of the massage involves massaging the area under the navel with your thumbs. All movements are done 10 times in three rounds.
Special exercises for pregnant women should not be performed both during the carrying of the child and after his birth.
For the treatment of navel hernia, popular methods are widely used, which are based on the use of medicinal plants. Several effective recipes, the effectiveness of which has been repeatedly tested in practice, it is advisable to consider.
Popular medicinal decoctions, which have long been used in the treatment of hernia:
- Cornflower-blue decoction. Prepared as follows: 1 tbsp. raw materials with the mountain brewed with boiling water in a volume of 0.5 liters. The container is covered with a lid, and the contents are infused to cool completely. The decoction is designed for daily intake. Drink it before meals 3-4 times a day.
- Infusion plakun-herbs. Prepared as follows: take 1 tbsp. the roots of the cudgel are poured with a glass of boiling water and infused for 4 hours, then filtered. A decoction of по cup is taken in 4 doses. The treatment is carried out until the complete disappearance of the umbilical hernia.
- Drink from the leaves of drupe. To prepare takes 1 tsp. spoon of grass, poured 250 ml of boiling water, and then infused for 3-4 hours. You can drink the decoction throughout the day.
- Broth from tavolgovy leaves. 1 tbsp. dry grass is poured boiling water in a volume of 250 ml, infused and filtered. Take medicine ¼ cup 4 times a day.
It is worth noting that not all means are suitable for pregnant women, since they can affect the intrauterine development of the fetus. It is inappropriate here to use compresses and lotions.
A variant of the treatment of umbilical hernia is a postpartum bandage, the wearing of which helps reduce the tension of the muscles of the anterior abdominal wall. For these purposes, can be used and compression garments.
A variant of the treatment of umbilical hernia is a postpartum bandage, the wearing of which helps reduce the tension of the muscles of the anterior abdominal wall.
Indications for surgery
The absolute indication for surgery is the umbilical hernia during pregnancy. The decision on whether to perform the operation or not, the surgeon takes. Intervention may be undesirable because of the negative effects on the body of drugs administered before and after surgery.
In many cases, a hernia in women after childbirth passes independently. In this scenario, there is no need to use medicines.
Signs and symptoms
The first signs of an umbilical hernia can be seen with the naked eye. A bulge appears in the area of the navel, which can hide in a horizontal position of the body. Also, it is easily reset, especially in early pregnancy. Hernia tends to appear in the second and third trimester of pregnancy, when the abdomen begins to grow actively and the child exhibits intrauterine activity (moves, rolls over).
Hernia symptoms in pregnant women:
- pulsation of protrusion when coughing, trying,
- pain in the navel (manifested in late pregnancy when the fetus stirs),
- frequent constipation, nausea, constant rumbling in the stomach.
Read about the main symptoms of female umbilical hernia here.
Types of disease development
During pregnancy, the patient may experience two types of development of the disease. The first is characterized by the extrusion of the organs of the peritoneum from the hernial sac, triggered by an ever-increasing uterus. Visually, the protrusion is noticeable, but inside it is empty. This is easily felt when a click sound is heard when pressing a knob.
The second variant of the course of the disease is more complicated. The contents of the hernial sac (epiploon or intestinal loops) remain unchanged and with an increase in the duration of pregnancy, it is no longer possible to correct it. When changing the position of the body, the hernia does not disappear, while the child moves, the protrusion may pulsate or swell. In addition, a woman may experience significant discomfort: abdominal pain, constipation, nausea, belching.
This type of umbilical hernia is the most dangerous for a woman, especially if there are intestinal loops inside the hernial sac. There is a risk of hernia being strangled in the third trimester of pregnancy or already during labor. If the formation of large sizes, it can cause the onset of premature labor or false contractions.
In rare cases, a hernia in some pregnant girls can take a dangerous form. It is about infringement. The main feature, which is dangerous such a condition, is to squeeze the clamped organ and the possibility of its extinction. Such manifestations are a danger to the health and life of you and your baby.
Some characteristic symptoms may indicate a pinching of the umbilical hernia:
- sharp and severe pain in the navel,
- nausea and vomiting,
- problems with defecation,
- heartburn attacks.
If you find these symptoms, you should immediately consult a doctor. It is best to call an ambulance for the rapid hospitalization of the patient.
During pregnancy, your body is very vulnerable. That is why it is necessary to pay special attention to your condition and well-being. After all, not only your health depends on this, but also your baby’s health.
As a rule, the presence of umbilical hernia in adults involves an operation. During pregnancy, this technique is excluded. This is due to the negative effects of drugs and stress for your body.
What can you do
During pregnancy, the main method of dealing with umbilical hernia is wearing a bandage. Many expectant mothers doctors prescribe the use of such supporting elements. In the later stages of the bandage is very necessary. It ensures the maintenance of the anterior wall of the abdominal cavity, preventing the appearance of stretch marks.
When diagnosing an umbilical hernia, the bandage can support the muscle tone of the anterior wall of the abdominal cavity. It does not allow the internal organs to bulge out and prevents pinching. To cure the umbilical hernia in this way you can not, but to maintain the state before the onset of labor is in your power.
What the doctor does
The main thing that a doctor can do during the entire pregnancy is to keep the patient's condition under control. If any complications occur, the specialist will be able to recognize the dangerous signs and take appropriate measures.
For example, such is the incision of a hernia. The condition carries a certain threat to the health of the future mother and her child. That is why a strangulated hernia should be treated promptly on an emergency basis.
Why pregnant women have an umbilical hernia - risk factors
Umbilical hernia - this is a bulging through the umbilical ring of closely located abdominal organs. It is formed due to weakened abdominal muscles.
In pregnant women, it occurs more often, because during this period an increased load occurs on the muscles of the abdomen. If, before conception, there was an untrained press, chances are high to acquire such a nuisance as a navel protrusion.
There are several reasons why women in the position of the hernial bag comes out:
- increase the pressure of the abdomen,
- stretching the umbilical hole due to the increase in pressure
- increase the load on the abdominal muscles.
It is noticed that in the early stages of pregnancy this symptom almost never worries. And with the increase of the fetus sometimes manifests itself.
There are several factors that influence the occurrence of such a defect:
- genetic predisposition
- disturbed symptom before conception,
- manifestation of this defect in childhood,
- second or third gestation,
- excess weight,
- weak press
- multiple fetus
More often susceptible to the formation of the umbilical protrusion are pregnant women older than 30 years.
How to treat - operate or not
In adults, an umbilical hernia is treated by surgery; during pregnancy, there are several treatment options depending on the degree of danger of the defect for a woman and a baby.
Non-hazardous forms do not need special treatment. During this period it is recommended to wear a bandage, from about the 20th week. It will make the load on the muscles of the abdomen less, spreading it evenly along the sides and lower back.
The choice of bandage for umbilical trouble should be done according to the advice of the doctor, so as not to increase the pain from improper fixation.
Excellent help massage and special gymnastics. But whether it is possible to download the press, the specialist will say this, since in certain cases it is not worth doing this.
Operative intervention is rarely resorted to when there is a fear of infringement. Surgical manipulations on the navel belong to the category of the lungs, so it is done in any inpatient department of surgery. However, pregnant women are trying not to hold it until the baby is born and the end of lactation, because the use of anesthesia, penetrating through the blood or getting with milk, has a negative effect on the baby.
Surgical treatment will be delayed if there is no threat at the current stage. Usually, childbirth with such a hernia occurs safely. But to be observed by a gynecologist with this disease and it is necessary to follow all the recommendations throughout the entire period.
Depending on the type of protrusion and size, the method of pregnancy is chosen, and closer to the end of the term, the tactics of labor are being developed:
- When the contents of the hernial bag are empty, it is recommended to be monitored by an obstetrician-gynecologist, wearing a special bandage for hernia. Childbirth is carried out in a natural way.
- A small bag with the contents also does not require any interventions, only wearing a bandage. The birth process is negotiated with the doctor.
- A big bulge with the contents does not always require instant removal. If the intestinal loop has crawled out, the operation is carried out according to the planned order, choosing a safe period. But giving birth alone is not allowed.
- A strangulated intestinal loop requires emergency surgery, and childbirth is carried out only through a cesarean section.
Pinched umbilical hernia during and after pregnancy is always a threat because it leads to peritonitis - life-threatening inflammation of the peritoneum. Complication can seriously affect the course of labor. Therefore, the removal is carried out, despite the harm of anesthesia to the child, since the drug is less harmful to him than the delay in treatment.
The operation is done under the action of a general anesthetic.
It can be carried out using several methods:
- By Sapezhko. The umbilical opening is sutured using its own tissues, straightened fibers of recti. The disadvantage is a considerable rehabilitation period (up to 1 year), an increased risk of recurrence of the disease, the possibility of carrying out only with a slight bulging.
- Mayo method. Separate adhesions, intestinal rings set inside the peritoneum. The disadvantage is the same as with the Sapezhko method, but the restoration of the press is worse.
- Alloplastic methods. The implant is placed under or above the aponeurosis (umbilical hole). Advantages - rehabilitation takes only a month, the number of relapses is minimal. But the installation of the grid is fraught with many consequences associated with the rejection of the graft - suppuration, accumulation of serous substances, etc.
After the manipulation of the hernia, a rehabilitation period begins, during which the patients are under the constant supervision of the surgeon.
Comments of the expert in this video:
Rehabilitation after surgery
The recovery process depends on the individual abilities of the body, as well as the method of the operation. If an implant was placed with a mesh, wound healing occurs faster, but strict observation on the possibility of rejection of artificial material by the body is necessary.
To prevent discrepancies in postoperative sutures, it is recommended to wear elastic underwear or bandage, do not lift heavy, follow all the instructions of the attending physician. In this case, the child will be born without complications.
Pregnancy after a hernia operation is possible only as a result of complete healing of the stitches and restoration of the body. In order to avoid relapse, the entire period of childbearing should be under the strict control of the obstetrician and the surgeon.
In order for the hernia and all its negative consequences not to be disturbed by all 4 trimesters, it is necessary to take preventive measures even before replenishment planning in the family:
- do gymnastics to strengthen the press,
- balance the diet
- do not lift weights
- lose weight,
- increase physical activity.
These measures will help prevent the development of the disease in all those who are predisposed to its occurrence. Therefore, before the beginning of pregnancy and during the development of the fetus, you need to think about your health.
Another question - is it possible to become pregnant with existing symptoms? And what should be done to reduce the risk of negative consequences?
This should be discussed with a specialist who will diagnose, prescribe certain procedures. If there is a risk of developing the disease, surgery may be necessary.
Only after full rehabilitation, which takes about 6 months, will it be possible to plan a pregnancy. Prior operation is not considered a contraindication to natural childbirth. This is confirmed by the numerous reviews of the enduring and giving birth patients.
Umbilical hernia after pregnancy
Sometimes happy-born mothers face a problem when the hernia does not disappear after pregnancy or occurs as a result of the birth of a child, despite successful pregnancy. No need to panic right away. Just need to consult a surgeon who diagnoses the disease, and identify its severity.
Protruding the navel in the postpartum period is common. It manifests itself due to the divergence of the muscles of the abdominal section, which can not independently regain the necessary tone.
To avoid pinching, prescribe the removal of the defect by the operational method. This procedure is considered to be facilitated, because it is performed under local anesthetic. In the absence of complications, after three hours at the end of the procedure, it is allowed to go home. A daily visit to the hospital for dressings is required for 7 days.
Every pregnant woman is at risk for hernia. But timely prevention and compliance with all medical recommendations will help to avoid this unpleasant phenomenon.
In the formation of protrusion in the navel should immediately contact the surgeon. Delay is fraught with undesirable consequences.