The incidence of umbilical hernia in pregnancy is around 0.08% (1). It is a protrusion of an intestinal loop through a small opening in the abdomen around the umbilicus or belly button. The stretching of abdominal muscles in pregnancy could increase the risk of developing an umbilical hernia or belly button hernia. The condition could lead to complications in pregnancy if not treated on time. This post discusses the causes, risk factors, symptoms, treatment, and prevention measures for an umbilical hernia during pregnancy.
What Are The Different Types Of Hernias During Pregnancy?
The following hernias may develop during pregnancy.
- Inguinal hernia: An inguinal hernia occurs in the groin region due to the protrusion of the intestine through the inguinal canal present in the lower abdominal wall (2). Inguinal hernia is often the most common cause of groin swelling among pregnant women (3).
- Paraumbilical hernia: A paraumbilical hernia occurs in the tissues around the belly button. It often occurs due to the protrusion of an intestinal loop through a weak abdominal wall (4).
- Umbilical hernia: Umbilical hernias occur at the belly button (umbilicus) and develop due to a weak spot in the abdominal muscles at the belly button (4).
What Causes Umbilical Hernia In Pregnancy?
Umbilical hernia primarily occurs due to the protrusion of the intestine through a weak section of the abdominal wall. The following factors may increase the risk of this condition during pregnancy (5).
Increased abdominal pressure: The growing uterus can increase intraabdominal pressure, especially as the pregnancy progresses. Some women may have innate weakness in the abdominal wall, such as due to an umbilical hernia during childhood or an incision around the umbilicus due to surgery. The increased abdominal pressure may increase the risk of umbilical hernia in such cases.
Stretched abdominal muscles: The growing uterus causes the abdominal muscles to stretch. In some cases, the abdominal muscles may stretch far enough to stretch the rectus sheath, a connective tissue covering the abdominal muscles. The rectus sheath fibers meet at the midline of the abdomen to form a band called the linea alba. Pregnancy may stretch linea alba, causing an opening or a weak spot where the intestines may protrude out, causing an umbilical hernia (1). The separation of abdominal muscles is known as diastasis recti.
Overweight or obesity: Women who are overweight or obese before pregnancy may be at a higher risk of hernia during pregnancy. Excess abdominal fat (abdominal obesity) may already stretch the linea alba. Pregnancy may further add to this pressure, increasing the risk of umbilical hernia during pregnancy.
Who Is At Risk Of Umbilical Hernia During Pregnancy?
Pregnant women with the following conditions may be at a higher risk of developing belly button hernia in pregnancy (6).
Overweight or obese
Preexisting umbilical hernia Multiple pregnancies (twins or triplets) Preexisting separation of abdominal muscles Presence of fluid in the abdomen (Ascites) Chronic coughing or sneezing ailment Frequent lifting of weights
What Are The Symptoms Of Umbilical Hernia In Pregnancy?
Some women may not experience any symptoms of umbilical hernia during pregnancy (7). Others may experience the following symptoms.
A lump is felt when you press the belly button or when you lie down. A visible bulge on the belly button. A dull pain around the belly button, especially evident when coughing, sneezing, laughing, bending, or moving.
In some cases, the protruded intestinal section may strangulate, affecting its blood supply or causing an obstruction (incarceration). It may lead to the following symptoms (5).
Vomiting Fever Abdominal pain
Discoloration of the lump (red/purple) Constipation Fullness and rounded abdomen
Does Umbilical Hernia In Pregnancy Affect The Baby?
Hernias in pregnancy, including umbilical hernia, usually do not affect the growing baby in the womb (7). If your hernia is asymptomatic or causes only mild pain, it may not affect your pregnancy. However, incarceration and strangulation of hernia may make the mother feel sick, which may affect the baby as well. Therefore, consult your doctor if you notice a hernia, even if asymptomatic, to determine its severity and avoid complications.
How Is Umbilical Hernia In Pregnancy Treated?
Surgery is the only way to treat an umbilical hernia. The following treatment options are usually available for belly button hernia in pregnancy.
1. Surgery during pregnancy
Umbilical hernia repair surgery during pregnancy may only be considered if the hernia has become strangulated or incarcerated (7). In some cases, surgery might be delayed to the second trimester, if possible. Surgical repair of hernia involves the placement of a mesh to reinforce the weak abdominal wall (8). The doctor will return the protruded intestine to its original place and stitch a mesh to the abdominal walls. Tissues will grow over the mesh, and the abdominal wall becomes stronger. Mesh placement may interfere with the expansion of the uterus and the abdominal tissues as the pregnancy progresses. The doctor may use the alternative procedure of suturing or stitching the abdominal wall to make it stronger. However, this procedure may not strengthen the abdominal wall as mesh does. There might also be a risk of recurrence. Discuss with your doctor the best procedure based on your symptoms and stage of pregnancy.
2. Surgery during C-section
The C-section procedure could be used to repair the hernia, making it a combined procedure (1). The doctor will perform the mesh repair procedure when repairing umbilical hernia during C-section instead of sutures. This procedure is considered mostly safe for the mother and the baby and seldom takes any additional time than the standard C-section procedure. If your hernia requires repair, but you can wait till childbirth, you may elect for a C-section to have your hernia repaired as well. If your hernia is asymptomatic, your doctor may suggest mesh repair after a few to several weeks postpartum, so that you have healed adequately after childbirth.
Can You Have A Vaginal Delivery With Umbilical Hernia?
If your hernia is asymptomatic, you may proceed with a vaginal delivery as usual (9). Experienced and qualified obstetricians and midwives can handle the hernia effectively during delivery. Discuss with your doctor the precautions that you may need to take before the procedure.
How Is The Recovery After Treatment?
The post-operative care after umbilical hernia surgery could be similar to any surgery, including a C-section. The recovery care and time may vary based on the severity of your umbilical hernia and whether it was repaired during pregnancy, during C-section, or after childbirth. The following are some salient points about the recovery process after belly button hernia surgery (10).
You may be asked to drink eight to ten glasses of water a day and have high-fiber foods. This is to ensure smooth bowel movement and prevention of straining while using the toilet. You will have to refrain from strenuous activities for several weeks after surgery. You may have to avoid climbing stairs and lifting a weight of over 10lb (4.5kg) for the next six weeks. You may have to avoid lifting heavy weights for the next six months or more. Your doctor may recommend lactation-safe medication to manage any pain at the site of surgery.
How To Prevent Umbilical Hernia In Pregnancy?
It may not always be possible to prevent umbilical hernia during pregnancy. However, you may reduce the risk by observing the following precautions (11).
Avoid lifting heavy weights during pregnancy. Limit climbing stairs as you progress through your pregnancy.
Drink adequate water and have a high-fiber diet to avoid constipation and straining while using the toilet. Do pregnancy-safe exercises to keep your muscles healthy and strong. Provide adequate support to your belly when you lie down to avoid strain. If you have an ailment that causes you to sneeze or cough often, seek treatment for it.
