Symptoms and treatment of umbilical hernia in children

Umbilical hernia in children is a fairly common phenomenon, especially in the first year of life. Why it is dangerous, how to recognize such a pathology in a child and how to treat it, we will tell in this article.

What it is

An umbilical hernia is a bulging of internal organs outside the abdominal cavity through the umbilical opening. During pregnancy, the umbilical cord ensures a close bond between the child and the mother, nourishes the baby, delivers oxygen and everything necessary for development. When the little one was born, and he had his own pulmonary respiration, the ability to take food through the mouth, then there is no more biological need for the umbilical cord.

It is cut off in the delivery room, tied or sealed with a special clothespin (at the discretion of the obstetrician). Ideally, the umbilical cord, part of which remains inside the baby's tummy, should be overgrown with dense connective tissue for about 30 days. By the end of the neonatal period, the navel should heal.

However, in practice, not everything is so rosy - quite often it happens that the cord is not completely overgrown, the formation of connective tissue is too slow, and this becomes the cause of the development of a hernia. There are other reasons for this pathology - from congenital malformations of the abdominal wall to the inept and illiterate actions of the obstetrician when cutting the umbilical cord. At a later age, the prerequisites for the appearance of a hernia are completely different - more traumatic.

The prevalence of the problem is extremely wide. According to statistics, every third premature baby suffers from a hernia of the navel to one degree or another.

Among children who were born on time, the problem is found in about 20% of toddlers. In about 4% of children, the hernia remains up to 6-7 years old.

Kinds

All umbilical hernias are usually divided into congenital and acquired. In the first case, doctors suggest that the problem began long before the baby was born, even during the period of intrauterine development. These are various umbilical cord pathologies and an incorrectly formed abdominal wall.

Acquired hernias are either oblique or straight. Direct hernias are associated with changes in the fascia in the region of the umbilical space. This leads to the exit of the hernia immediately through the umbilical ring. With an oblique hernia, the path is slightly longer - the hernial nodule itself does not appear on the navel, but next to it, more often between the site of wall thinning and the transverse fascia and the white line of the abdomen. And only after that, the hernial sac appears in the umbilical ring.

Depending on the complexity of the hernia pathology, they are divided into those that can be corrected, and those that are not subject to mechanical stress. Complex hernias often lead to infringement of the hernial sac, acute pain.

Causes of occurrence

Children who were born with a hernia, according to most modern physicians, underwent intrauterine suffering. The cause of a congenital hernia may be a violation of the formation of the peritoneum at the cellular level, this can occur with fetal hypoxia, with some genetic diseases.

Newborns may be diagnosed with this because the umbilical ring grows too slowly after cutting the umbilical cord. As a result, in the supra-umbilical region or directly under the navel, an empty space is formed, where, with tension of the abdominal muscles (with strong crying, for example), an intestinal loop can come out.

In newborns, by the way, there are a lot of risk factors for the appearance of a hernia:

private loud crying;
constipation;
increased gas formation;
hereditary weakness of the umbilical ring;
acute and chronic respiratory diseases associated with the appearance of a strong cough.

In older children, a hernia may appear due to heavy lifting, weakness of the abdominal muscles. Very often, parents themselves provoke the appearance of hernias after 1 year by putting the child on its feet too early, placing it in various verticalizing devices like jumpers and walkers. Until the abdominal muscles are ready for vertical load, the child should crawl, this is how he strengthens both the back and the tummy, and only then - get up. If the natural sequence of development is violated, often after a year, signs of a growing hernia appear.

In children 6-7 years of age and older, the appearance of a hernia can be affected by obesity, as well as scars that are present on the abdomen as a result of previous surgical operations. A strong, prolonged cough increases the chances of a child getting a hernia at any age. Increased physical activity, especially after a long period of lack of physical training, also triggers a starting mechanism for the formation of an abdominal hernia.

Symptoms and Signs

Almost all babies have their navel sticking out. Some have more, some have less. By itself, a protruding and strong protruding navel in a baby cannot be considered a hernia. Therefore, a hernia, like a well-defined pathology, has its own clinical symptoms, among which a protruding navel is far from the main symptom.

Severe embryonic malformations of the peritoneum, which are accompanied by large hernial sacs, into which sometimes several internal organs (liver, intestines) go out, are noticeable even during pregnancy. A specialist who will do a planned ultrasound to the expectant mother will definitely pay attention to them. These children are considered practically unviable. They rarely live up to 3 days in intensive care, although isolated positive outcomes are known to medicine. Most often, a fetus with such a hernia has a serious genetic disorder.

Hernias that a healthy baby acquires after birth, for example, during the neonatal period, rarely bother him. They worry his relatives much more. The kid does not experience severe pain. The nodule itself is small - from 1 to 5 centimeters in diameter, and is "shown" only when the child screams, cries, and strains with constipation or intestinal colic. When the child is calm, asleep, relaxed, the bulge disappears, becomes invisible.

One of the initial symptoms of the development of a real abdominal hernia in a child can be considered some swelling in the area of the umbilical ring. At first, it is easy to set it back with your finger, but then, as adhesions appear, reduction becomes difficult, if not completely impossible. The presence of a hernia does not affect the child's behavior; this does not impair his sleep, appetite, and stool. Attempts to write off colic, constipation and the child's capriciousness for the presence of an umbilical hernia do not stand up to criticism. After all, 90% of all children are screaming, naughty and suffer from a stomach, especially in rain or snow, with and without hernias.

A symptom such as nausea, which is often attributed to the abdominal hernia of children in the first year of life, is no longer associated with this pathology, but with the banal overfeeding of the child. The hernial sac does not affect the work of the gastrointestinal tract in a child, unless it is pinched. It is always a medical emergency, but fortunately, pinching is extremely rare in childhood.

In most babies, from 1 month to 1 year, the hernia goes away on its own, as the abdominal muscles grow and strengthen. A hernia acquired at a later age (at 5,7,10 years) requires a more thorough examination and the choice of a method of surgical treatment. For such children, mild nausea, a tendency to constipation is an indirect symptom of the development of a hernia. The main way to cope with ailments at an older age is considered to be surgery, since other methods are considered ineffective.

Danger

A hernia in the umbilical and peri-umbilical space is dangerous only because it can cause infringement of the internal organs that fall into the hernial sac. Most often this is the intestinal ring. As already mentioned, this risk in young children is considered minimal. But in older children, it rises.

Signs of infringement are:

severe, sudden, sharp, almost unbearable pain in the area of the hernia spreading to the entire tummy;
severe nausea, frequent vomiting;
the child has a feeling of fullness in the abdomen, the passage of gases is difficult or absent;
in the feces, pronounced blood impurities can be noticeable;
the hernial sac looks inflated, tense, changes its color to a darker one. If the child is placed in a horizontal position, the hernia does not "go away" as usual, but remains outside.

Infringement usually occurs when the hernial orifice is narrow. In children with wide hernia orifices, it usually does not reach an acute state. In any case, the symptoms suggesting that the hernial sac may be infringed cannot be ignored. Parents should lay the child on its side, call an ambulance and take the child to the surgical department of the nearest children's hospital.

In more than 95% of babies at this age, hernias are successfully "set" on their own, but there are also difficult cases. It is clear that waiting should not be synonymous with inaction. In addition to regular visits to the surgeon for the purpose of intermediate control over the condition of the hernia, parents will be given other recommendations that it is advisable to strictly follow.

It is strictly forbidden to give him a lot to drink, try to relieve pain with any painkillers, apply a warm heating pad or cold to his stomach. And you shouldn't try to fix the hernia back on your own. It can work out. More precisely, the parents will think that everything worked out. After all, visually, the hernia will disappear, and the pain will subside. In fact, it can go into the intermuscular space, and when the pain returns after a while, the surgeon will be able to detect signs of peritonitis, necrosis of a part of the intestine and other very undesirable problems.

Diagnostics

A pediatric surgeon can make a diagnosis. Parents should contact this specialist with their suspicions of a hernia. He will carefully examine the baby's navel, feel it, read the medical card, ask many questions about the course of pregnancy, postpartum features of the healing of the umbilical wound.

If a child, due to his age, is able to cough at the doctor's request, then such a test will also be included in the initial examination. An experienced surgeon will be able to determine the hernia and its approximate characteristics even by touch, but to make an accurate diagnosis and make a decision about treatment, it will take several more tests. First, parents are given a referral for an abdominal ultrasound. Such diagnostics allows to confirm the presence of a hernia, to determine its size, the exact location of the dislocation. Then you may need an abdominal x-ray and an irrigoscopy. For its implementation, a contrast solution is injected into the intestine with an enema, which allows you to see all parts of the intestine on the finished X-ray image and determine whether there are defects, perforation, adhesions and other complicating factors in the hernia area.

Sometimes the child is shown an endoscopic examination of the EGD. You will definitely have to pass traditional blood and urine tests for a general clinical study.

Treatment

The main and most effective method of treatment is considered to be a hernia surgery. But with children, things are not so simple. Since the hernia can still regress on its own, usually babies are not sent to the operating table without an urgent need. Pinching of the hernial sac is considered an acute need. According to established practice, the most often chosen tactic of waiting. If the hernia has not retracted in a child before the age of 5, then an operation can be performed.

Parents' actions

The best exercise that is shown to absolutely all babies from birth is daily laying on the tummy. It is better to do this 10-20 minutes before meals so as not to provoke regurgitation. It should be laid out not on a soft sofa or parent's bed, but on a hard, flat surface. This exercise not only allows your baby to learn to hold the head faster, but also effectively strengthens the abdominal muscles, including the obliques. And also promotes a more rapid passage of gases from the intestines and a decrease in the intensity of intestinal colic.

The first laying on the tummy should not exceed 2-4 minutes, then the time is increased and the procedure is gradually brought to 15-20 minutes. For older children, a special massage to tone up the abdominal muscles is recommended.

Massage. Massage does not require special medical skills; all parents, without exception, can master its technique. For babies, the procedure can be started immediately after the umbilical wound heals and dries, usually by 1 month. Massage movements should be carried out with the thumb, making circular movements around the navel in a clockwise direction.

For older children, you can complicate the massage by adding a massage to the oblique muscles of the abdomen, passing along their anatomical path from the bottom up (from the pubis to the ribs) with the index and middle fingers, as well as making horizontal movements in the supra-umbilical region. For children from one year old, massage is done using the same techniques, only light tapping movements with fingertips on the abdomen in the press area are added to the manipulations.

Bandage. Special devices - bandages for umbilical hernias are used both as a means of conservative therapy and in the postoperative period. The bandage allows you to keep the muscles of the peritoneum in the correct fixed position. Due to a small constant pressure on the area of bulging of the hernial sac, a state is achieved in which the exit of the bag through the hernial gate becomes impossible.

A child's bandage is different from an adult's; it is made of a soft elastic band that is worn over the naked body. Average sizes for children: 42-54 cm long and 5 cm wide. The bandage can be put on immediately after the umbilical wound heals. The device should not be used in case of severe skin lesions in the abdomen (for example, atopic dermatitis, eczema, chickenpox, measles, when there is a rash on the abdomen). For small hernias, the bandage is considered the most effective method of conservative therapy. Wearing it must be agreed with the surgeon observing the child.

Gymnastics. Gymnastics can be started after the baby is 1 month old. For the smallest, it must necessarily include flips from tummy to side, from back to side. From 3 months, you can do the same coups, but also in the opposite direction. In order for the baby to turn, you need to pull it by the right handle to the left, then a flip to the left side will occur. Another great exercise is tucking your legs into your stomach. They should be brought in, held for about 30 seconds, and then brought in and straightened alternately.

It is useful for children over six months to exercise on fitball.Crawling should be encouraged, since it is during it that the abdominal muscles develop most anatomically correctly. Exercises with a crossbar in a prone position are useful.

For children under 5 years of age with an established diagnosis of abdominal umbilical hernia, it makes sense to install a wall bar in the children's room and teach him how to properly strengthen the abdominal muscles. To do this, use the exercises "Corner" (legs at right angles to the stomach in a hanging position on the bar) and "Pendulum" (swinging the body in a hanging position on the bar).

Treatment with folk and non-traditional remedies

Since up to 5 years old doctors try to wait for the development of events, all kinds of clinics that offer non-traditional treatment of a child's problem for a completely traditional national currency begin to feel most at ease. Parents who are trying with all their might to prevent surgery are ready to do anything. And now a specialist in the field of energy massage does a tummy massage to their baby and takes a lot of money for it.

If you look closely, the tummy is massaged in the same way as any mother does at home, and, from this point of view, nothing new is happening for the child. It is good if the specialist does not harm, but sometimes it happens exactly the opposite. Traditional medicine and grandmother's methods of getting rid of a baby from such an unpleasant "sore" are few and well known. It is difficult to talk about their benefits, there is a question of faith in a miracle, but what can be potentially dangerous, it is necessary to say:

Piglet on the navel. The advice to tie or glue a five-ruble coin to the child's umbilical ring with a plaster can come not only from the mouth of a grandmother or a neighbor, but also from a district pediatrician, especially if this doctor himself is at the age of a grandmother and studied at a medical university for a very, very long time. Modern doctors have found no use whatsoever for a coin on the navel. If the hernia exists only in the understanding of the parents, then there is no point in the patch at all, and if the hernia is real, then the patch is powerless.

But what really happens sometimes in reality is the development of local inflammation in the navel, infection of the navel with bacteria, prickly heat. In addition, the hernia itself does not bother the baby, but a coin glued to the delicate skin can deliver a lot of unpleasant minutes.

Patch... There is nothing wrong with this method, and it really allows you to maintain the navel and the hernial sac, if any, in a fixed, correct state. There are two nuances, adherence to which will ensure successful treatment. Firstly, the patch must be good (it is better to take the products of manufacturers who make a high-quality sterile patch for use in surgical hospitals or a special children's hypoallergenic Porofix, Chikko.

Secondly, only the surgeon should apply the plaster to the child. Independent attempts by proactive parents to manually correct a hernia can end in a very deplorable way - an infringement of the intestinal ring and the need for an urgent operation. Correctly entrust the first application to the doctor, ask him to show and explain the process, so that later you can change the patch on the navel on your own without the risk of crippling the child. The navel sealed with a plaster should be shown to the doctor at least twice a month. If the hernia begins to increase in size, its presence under the plaster becomes dangerous for the baby's health.

Ointments and compresses. The homemade ointment recipe, which is very popular with connoisseurs of traditional medicine, which must be applied to the navel area at night, includes butter, propolis tincture and iodine. The navel is smeared with a mixture of oil and propolis, a compress is applied, and then in the morning an iodine mesh is made around the hernia. Official medicine is silent about how the oil acts on a hernia, since no cases of healing with oil and propolis have been registered.

However, propolis, and even more so its alcoholic tincture, can cause a serious allergic reaction in a baby, which will require a very real traditional treatment. And frequent overlays of an iodine mesh lead to a very serious condition - an overdose of iodine, because children's skin, delicate and sensitive, absorbs it completely.

Broths and drinks. Traditional medicine is ready to offer a lot of recipes for making decoctions and tinctures from rhubarb, shepherd's purse and other herbs and roots against hernia. It is difficult to discuss such treatment seriously, since it is somehow strange in the 21st century to expect that a hernia will retrace and resolve after drinking herbal decoction for ten days.

If you want to water your child with herbs, you can also water it. But you should definitely agree on a set of herbs with a pediatrician, because many medicinal plants are quite strong allergens. Also, do not expect a miracle from such a "treatment". It won't happen.

Surgical intervention

After 5 years, if the signs of a hernia have not disappeared, it exceeds 1.5 centimeters in size, if there is a tendency for the growth and enlargement of the hernial sac, if there is a high risk of pinching due to narrow hernia orifices, a decision is made to surgically remove the hernia. The operation is called "hernioplasty". With this surgical manipulation, the excised bag is replaced either with a fragment of the body's own tissues, or a mesh implant is inserted, which takes the load on itself and minimizes the likelihood of hernia recurrence.

For this reason, the tension-free hernioplasty method is best suited for children, in which special implantable meshes are used. During the operation, the surgeon will not necessarily have to excise the hernia. If it is possible to reposition it and it is possible to fix it in its natural position in the right place, then there is absolutely no need to remove it.

The mesh implant can be placed both above the umbilical ring and below it, depending on the size of the hernial orifice. The final stage of the operation is always the suturing of the hernial orifice. Quite often, in recent years, with uncomplicated hernia, such operations are performed using laparoscopy. This minimizes the traumatic impact and helps to recover faster. Operations for excision and reduction of hernial sacs are also carried out using modern technologies, for example, with a laser.

Any type of anesthesia can be used for the operation and this is a great advantage in treating children. By the way, not all surgical hospitals practice this kind of surgery for pediatric patients; there are doctors who adhere to tension surgery. But in any case, parents should discuss this issue with the attending physician in the process of preparing for the intervention.

Postoperative period and rehabilitation

If the child underwent surgery by the tension method, without mesh implants, then the recovery period will be longer. It can take from 1 month to half a year. Physical activity will be contraindicated for the child. The risk of recurrence with such an intervention is significantly higher than with surgery using an implant. In the case of tension-free hernioplasty, rehabilitation is shorter. After 3-4 weeks the child will be able to do his usual things without restrictions, he will be able to attend sports sections. And the likelihood of relapse after such an intervention is estimated at no more than 1%.

For children who have undergone surgery to remove an umbilical hernia, it is important to follow the correct diet, which will not cause excessive gas production. You need to temporarily exclude cabbage, peas, carbonated drinks, kefir from the diet. In the event of constipation, such children should be given a mild laxative approved for use by age. You should not do enemas and wait until the child goes to the toilet on his own.

In the first week after surgery, do not give boys and girls solid and thick food. It is advisable to cook gruel, jelly, compotes. You can gradually expand the diet only at the end of the first week. Wearing a children's bandage is encouraged, as well as massage and gymnastics, which were mentioned above. Older children should definitely go in for sports.

Recommendations

For the prevention of umbilical hernia, for its treatment, if the diagnosis takes place, as well as in the framework of rehabilitation after surgical treatment, the child is recommended to go in for swimming. A child from 1 month old can be registered in the pool; now there are such groups for the tiniest swimmers. Swimming contributes to the most rapid strengthening of all muscle groups, especially the abdominal muscles, sides.
For the prevention of hernias in children during the neonatal period some pediatricians do not recommend tight swaddling.
Dad's favorite "fly-fly" when the child is tossed up, it tends to increase intra-abdominal pressure at the time of the toss, which contributes to the appearance of a hernia in a child prone to such a pathology.
An abdominal hernia can only be treated surgically. That is why it is easier and easier to prevent it by following all the doctor's recommendations on time, strengthening the abdominal muscles from childhood.

You can also listen to helpful tips from a professional doctor in the video below.