Umbilical hernia after childbirth – does it sound scary? The main reasons for the development of umbilical hernia in women after childbirth.

Childbirth is natural process for every woman, but after it there may be consequences that affect the mother’s health. Umbilical hernia is a postpartum complication that can only be removed surgically.

Pathology develops in 65% of women who had an impressive belly or were delivered by cesarean section.

An umbilical postpartum hernia is a protrusion in the navel area that occurs after childbirth and requires medical care. Location: umbilical region. With this disease, the internal organs are located outside the anterior abdominal wall.

Pathology appears in the form of a protrusion in the umbilical ring, which disappears when the woman is in a lying position.

Symptoms

If you notice following symptoms, go to the doctor immediately:

• persistent protrusion when standing;
• disappearing protrusion when lying down;
• extended umbilical ring;
• abdominal pain that worsens with physical activity;
• nausea and vomiting.

To diagnose the disease, they do:

• radiography (the condition of the duodenum and stomach is examined);
• herniography (examines the condition of the hernia after the introduction of a contrast agent into the abdominal cavity);
• gastroscopy (stomach and duodenum are examined);
• Ultrasound (the doctor visually looks for changes in the intestines);
• examination of the patient, palpation (the condition of tissues and organs is examined by palpation, and the patient’s sensations during this procedure are also assessed).

Do not delay visiting a doctor, this risks complications in the form of inflammation, strangulation and coprostasis (stagnation in the intestines).

Methods of surgical treatment

The only one effective method Treatment for an umbilical hernia is surgical removal. This disease is treated by a surgeon.
If diastasis appears, you should also contact a surgeon. He will prescribe treatment for this pathology.
There are the following types of hernioplasty:

• tension plastic – working with local tissue;
• non-tension plastic – mesh implants are used.

The operation lasts from half an hour to two hours. For two types of plastic surgery, anesthesia is used. The type of anesthesia is chosen by the doctor based on the patient’s vital signs.

Tension hernioplasty

With traditional plastic surgery, the edges are sewn in. The purpose of the operation is to remove the hernial sac, strengthen weak areas of the abdominal wall, and straighten the internal organs.
If the surgeon uses the first method, he stitches the edges of the tissue to hide the hole that appeared after the hernial protrusion. The hernial orifice is removed, and the muscles and aponeurosis (tendon plate) are sutured.

Hernioplasty is done when the hernial orifice reaches 3 cm. If they large sizes, that is, danger.
Postoperative umbilical hernia is performed using the Sapezhko or Mayo method.
According to the Sapezhko method, it is done with a longitudinal dissection of the umbilical ring. It is hemmed with the letter P or with separate interrupted seams.
According to Mayo - in case of transverse dissection, the suture is placed with the letter P.
The doctor makes a vertical, not deep incision at the top above the navel, the dissection goes to the aponeurosis. A probe is inserted and a horizontal incision is made into the ring. A continuous catgut suture is applied.

Suture: sensations and care

The suture site brings noticeable pain for the first two days. painful sensations, so they give pain relief. Catgut sutures are well tolerated by patients. After the tissue heals, the suture dissolves on its own and does not require any special care.

Anesthesia of this method:

This operation uses local or general anesthesia.

If the protrusion is 2-4 cm and there is no danger in the form of complications, then local anesthesia is given. Indicated for those women who have pathology of the lungs or heart. In this case, only the operated area is “frozen”.
The patient is aware of everything, but does not feel pain.
Local anesthesia is used during the operation, which lasts no more than half an hour.
They work hard in such cases novocaine or lidocaine. The entire area is injected, the effect occurs within 7-10 minutes.
Do not use for urgent surgical interventions, when allergic reactions for local anesthetics.
After injection with novocaine or lidocaine, the abdominal area has large swellings. This goes away after 1-2 days.
If a hernia large size, or there are contraindications for local anesthesia, then it is used general anesthesia. Special preparation is required for this type of anesthesia. General anesthesia can be mask or intravenous.

Flaws

The disadvantages of such an operation, in addition to frequent relapses, include long recovery. It sometimes drags on for up to a year. Seams from 3 cm to 8 cm.

Painful sensations

After such an operation, the patient feels abdominal pain from 20 to 70-80 days. It depends on individual characteristics body. Avoid physical activity for three months.

Course of pregnancy

After such surgery, you need to wait six months and then plan a pregnancy. There will be no problems with bearing the fetus. The pregnancy proceeds without pathologies. There is no need to lift weights and you need to wear a brace.

Non-tension hernioplasty

If surgical intervention If it is not carried out using tension plastic, then synthetic implants are used here. Implants are mesh. Mesh implants differ in manufacturer and price.

For example:

It is recommended to place an implant for large hernias. After 6 months they are indistinguishable from tissue. Mesh implants are well tolerated due to modern technologies weaves, patients do not even feel them.
Since such an operation takes a long time, general anesthesia (intravenous or mask) is used. Only 5% of tension hernioplasty operations are performed under local anesthesia.

Anesthesia and side effects.

For intravenous administration use:

1. Kalipsol (has a quick, pronounced, but not long-lasting effect).
2. Ketamine (a narcotic drug, used as an anesthetic, has many side effects).
3. Droperidol (antipsychotic effect, prohibited for psychological disorders and diseases of the liver, kidneys), etc.

For endotracheal (mask) administration, use:

• Halothane (quickly induces anesthesia, used for short and long operations);
• Desflurane (when administered by inhalation, 60% of patients may develop a cough and paroxysmal spasm of the laryngeal muscles);
• Ftorotan (strongest narcotic substance, puts you into deep sleep in 30-60 seconds and gently brings you out of it), etc.

Consequences after anesthesia

• Memory problems;
• Irritability;
• Decreased ability to concentrate;
• Violation of written and oral speech;
• Headache;
• Dizziness;
• Pain in the throat and muscles;
• Nausea;
• Shiver;

Memory problems are associated with a decrease in mental performance due to medications. To restore it, you need to stimulate brain function, eat right and lead healthy image life.

Carrying out the operation

Access carried out through the abdominal wall using a laparoscope.

A laparoscope is a narrow tube with a video camera and lighting elements.

The probe is inserted through a small incision near the navel. In addition to this incision, two more punctures are made for troacors (surgical instruments that penetrate the body cavity). Next, carbon dioxide is pumped in, the hernia is released and reduced. Afterwards, the wound is closed using an endoprosthesis, that is, a mesh.

The positive aspects of this method include:

• fabrics are not stitched or stretched;
• relapses are less common than with tension hernioplasty;
• the procedure lasts no more than an hour;
• short rehabilitation period.

Feelings after surgery

May be observed (purely individually):

• numbness of the wound site for 1-3 days;
• redness is present for 3-6 days;
• pronounced swelling in the wound area for 1-4 days;
• fever 1-2 days;
• pain for 2-4 days.

Postoperative period

Lasts 3-7 weeks, it all depends on the patient. If a woman follows all the doctor’s recommendations, she will soon lead familiar image life. The scar is small and almost invisible.
Pregnancy after surgery
Polypropylene mesh is an excellent barrier to recurrent intestinal fragment prolapse without being felt by the woman. And the self-absorbable material dissolves completely in the tissue, which is suitable for female who is planning a pregnancy. The mesh does not create problems in bearing a child. The pregnancy is proceeding well, without pathologies or complications.

Alas, this phenomenon is not so rare. This is not surprising: during pregnancy, the walls abdominal cavity stretch, muscles weaken. The appearance of an umbilical hernia can be prevented even before conception; for this, a woman needs to lead a healthy lifestyle and regularly do physical exercise, pump up your abs, that is, strengthen your muscles. By the way, this will be beneficial in any case - this way you can quickly restore your figure after childbirth. But let's get back to the topic. If you are in a position, do not neglect the bandage. It prevents the protrusion of the navel and helps prevent the appearance of an umbilical hernia.

In fact, we rarely think about what will happen next, and we always believe that everything will be different for us than for others. Therefore, most often we do not know about certain diseases or do not take them seriously until they affect us directly.

Doctors say that most often an umbilical hernia worsens during the second or subsequent pregnancies, when a woman’s muscles are weakened by previous births. In addition, there is a risk for those mothers who have had multiple pregnancies or polyhydramnios, as well as pathological birth. Heredity is not the last factor. And if a girl’s belly button stuck out early age, it is quite possible that this will happen during her pregnancy at an older age. In women giving birth in mature age– by the age of 40 and after, there is also a risk of prolapse of an umbilical hernia. However, there is a danger for first-time mothers too.

How to recognize this disease in yourself? As a rule, an umbilical hernia is difficult to miss. Usually it has a pronounced symptom - an atypical protrusion in the navel area. Such a protrusion can be easily seen or felt; it is visible when the woman is standing, but in the lying position the hernia can visually decrease or disappear. At first, being small size, it does not bring any particular inconvenience, and therefore may not cause serious anxiety in a woman. Increasing over time, a hernia can cause constipation, nausea and vomiting, abdominal and back pain, and discomfort in the navel area.

An umbilical hernia occurs at the junction of muscle and tendon fibers, which are normally tightly intertwined. Due to the “stretched” tummy, there is no tight fit, as a result of which the abdominal organs (usually the intestines or omentum) exit through the umbilical ring and simply fall out.

An umbilical hernia can be reducible or unreducible. In the first case, the protruding fragment can be removed back with the help of a special massage, but this does not mean that all the problems will end there - the hernia may fall out again. The opening through which the protrusion occurs is called the hernial orifice; they can be wide or narrow. Reduction of the hernia depends on their width; narrow gates interfere with reduction, and this in turn leads to intestinal clamping, which causes problems with digestion and stool. All this happens as the disease progresses, so the disease cannot be started.

Over time, an untreated hernia causes the walls of the hernial sac and its contents to fuse with subcutaneous tissue and the skin so strongly that strangulation occurs, that is, the so-called hernial orifice becomes so narrow that it is impossible to set the intestines back. Accordingly, such a hernia is called uncontrollable.

Incarceration of an umbilical hernia is accompanied by sharp pain when lifting heavy objects, even when laughing and coughing, and requires urgent surgical intervention.

If you suspect an umbilical hernia, or if you notice the corresponding symptoms, you should definitely contact a surgeon. You can’t delay going to the doctor, and it’s not just a matter of unpleasant, to put it mildly, sensations - doctors say that the symptoms of an umbilical hernia are often similar to the symptoms of benign tumors, so making a correct diagnosis on time is especially important. In addition, as with any disease, the sooner you see a doctor, the easier it will be to treat the disease and the easier and it will pass faster rehabilitation period.

The doctor, based on the patient’s complaints, examination, tests and additional studies, will decide on the need and timing of surgical intervention - no matter how unpleasant it may sound, most often a hernia can only be cured by surgery. Usually, umbilical hernia surgery is undertaken 6–8 months after childbirth, when the abdominal wall and the woman’s entire body have recovered from pregnancy and childbirth.

As a rule, a patient who has been diagnosed with an umbilical hernia is advised to wear a bandage and limit physical activity, especially heavy lifting. For a woman who has recently given birth, this is the main problem - few people have a nanny or a relative to help them from the very birth of their baby, who could carry, rock, and pick up the baby. And what mother wouldn’t want to hold her little baby in her arms, especially if she’s crying angrily? After all, children also want to feel their mother nearby, and not another person. Maybe this will become the main reason for someone to quickly get rid of an unpleasant and life-damaging illness?

But after the operation, a woman will be allowed not only to get up on the first day, but also to engage in race walking and jogging after a couple of weeks, and lifting weights can be practiced just a month after surgery. In most cases, the operation to remove a hernia is low-traumatic; after it, only small, almost imperceptible scars remain on the body. This operation takes little time and is possible even under local anesthesia. Doctors do not prohibit getting pregnant almost immediately after such an intervention.

During pregnancy, an umbilical hernia does not pose a danger if it does not cause discomfort or pain, and there is no strangulation. Usually a hernia is not operated on during pregnancy, as this can lead to complications.

With the current development of medicine, nothing is impossible, and nothing terrible about surgery to remove a hernia. In a short time, a woman can not only live a full life, but also look the part. Even if a small scar remains on the stomach, it will look much more aesthetically pleasing than a strongly protruding navel or an expression of pain on the face. The words “hernia” and “operation” just sound scary.

Yulia Abramova

Consultant: Olesya Sergeevna Lifintseva,

gynecologist at the Center for Israeli Medicine

Let's consider such deviations as an umbilical hernia after childbirth. This disease is treatable and correctable. The main thing here is to pay attention in time and not to panic.

This is a disorder in the peritoneum and internal organs. During the period of bearing a child and during pushing, the abdominal muscles and the umbilical ring are very tense and can separate, which, in turn, leads to protrusion.

Strong intrauterine pressure causes the connective fibers to stretch, and the vertical abdominal muscles, which hold the organs inside, gradually diverge. As a result, the lady may have diastasis and various types formations above the navel.

This complication appears gradually. At initial stage the hernial sac is filled with contents. When lifting weights, it falls into the lumen of the umbilical ring. When the reason that provoked it disappears, it also disappears back. But in more advanced cases, it appears even in a standing position, and “hides” back only in a lying position. This does not bring much discomfort, since the formation itself comes back, without additional effort.

If the disease develops quickly, it is removed operative method after the birth of the child.

Complications end with the formation overgrowing and connecting with the protruding tissue. With such symptoms, the protrusion can no longer be reduced. This causes pain. Failure to treat an umbilical hernia in women after childbirth entails serious consequences.

Risks for new mothers

If this disease manifests itself during pregnancy, then the woman develops constipation, intestinal motility worsens and intrauterine pressure increases and the chances of pinching the hernial sac.

If the disease develops after the birth of a child, then:

• there are disturbances in the adequate blood supply in the abdominal cavity;
• often worried about the feeling of fullness in the intestines;
• there is intense pain;
• Internal organs may become displaced (this provokes disturbances in their functions).

Those mothers who have had or have:

1. Multiple pregnancy.
2. Deviations after natural childbirth.
3. Unsuccessful cesarean section.
4. Abdominal injuries.
5. Strip operations up to "position".
6. Connective tissue problems.

The reasons for impaired muscle elasticity can be different: weak muscles that are prone to stretching, widening of the opening in the white line of the abdomen, or increased intrauterine pressure.

Factors that affect intrauterine pressure: constipation and intense cough that lasts a long time.

Signs

Symptoms of umbilical hernia in women:

• A peculiar bulge in the navel area. Its dimensions, depending on the severity and degree of the disease, can range from 2 to 18 cm.
• Pain that gets worse with exercise. Noticeable even when coughing and sneezing.
• Discomfort in gastrointestinal tract. Disturbances associated with the process of emptying and flatulence appear.

If you ignore the first manifestations of this disease after the birth of a child, the following may develop:

• pinching of muscle fibers;
• inflammation of the peritoneum;
• disruption of the movement of feces;
• death of navel tissue when pinched (necrosis).

Necrosis is the most dangerous deviation with this pathology after childbirth. Its signs:

• sharp and sudden pain in the navel area;
• rapid increase in temperature;
• dizziness and weakness;
• vomit;
• loose stools;
• hot hernial sac (if you touch it).

If you notice these symptoms, contact a specialist immediately!

Diagnostics

This disease is easy to diagnose visually and by touch. In order to understand the severity and stage of the disease, the following studies are prescribed:

1. Ultrasound. Helps to consider the size of the umbilical formation and understand the structure of its contents. Can be performed during pregnancy.
2. Tomography. Allows you to determine whether there is a threat to others internal organs.
3. Herniography. Prescribed to confirm an inaccurate diagnosis.
4. Fibrogastroduodenoscopy. Determines the condition of the gastrointestinal tract.

Treatment and therapy

Methods and therapy depend on the severity of the disease. At the initial stage, the disease can be successfully cured using a conservative method and performing light exercises to strengthen the muscles. With more difficult situations, especially if a connective tissue disease is detected, surgery is prescribed.

If you are concerned about similar symptoms, then do not delay and consult a doctor immediately!

Therapy without surgery

These techniques are used only to correct the reducible type of the disease. The treatment is aimed at strengthening muscles naturally. And this is facilitated by individually selected exercises and a massage course. Certain procedures are prescribed to restore the functions of internal organs and to prevent constipation.

It happens that doctors recommend wearing a special bandage. It helps prevent an increase in the size of organ protrusion and the development of complications from strangulation. A bandage is very useful if other types of therapy are prohibited. The doctor will inform you how to put it on correctly.

Wearing the brace incorrectly only complicates the problem.

Surgical treatment

Surgery is recommended for unreducible hernia. If the abdominal area can no longer recover on its own, then it needs to be corrected through surgery. This type of procedure has ceased to be traumatic, since it does not involve abdominal resection.

The formations are removed using laparoscopic hernioplasty. A scalpel is not used and is performed under general anesthesia.

This method has many advantages over abdominal surgery:

1. After laparoscopy there are no stitches left.
2. There is no need to stay in the hospital ward for a long time.
3. The procedure is painless and there is no need for long-term rehabilitation after it.

To remove the protrusion of organs, several punctures are made, trying not to disrupt the integrity of the muscle tissue. After its removal, the patient can return to ordinary life after 2-4 days. This type of treatment eliminates relapse.

But there are certain contraindications for laparoscopy:

• acute diseases of various origins;
• second half of the gestation period;
• lung ailments;
• cardiovascular pathologies.

The laparoscopic method is one of optimal ways treatment.

Exercises

Special therapeutic exercises help strengthen the muscle corset and prevent the development of pathologies. They can be carried out after a successful birth and if women do not have heart problems. Physical exercises must be properly selected and feasible. Under no circumstances should you put too much strain on yourself or rush through gymnastics.

Important information! Doing gymnastics is allowed only after consultation with specialists.

1. While standing, relax your shoulder girdle, lean forward as much as possible, and try to reach your hands towards the floor.
2. First tilt your torso to the left and right, while your arms should be apart.
3. From a lying position on your back (the surface should be hard and level), feet connected, tilt your knees in turn in both directions.
4. Hold the back of the chair with your hands and slowly move your leg back, slightly to the side, repeat the same with the second leg.
5. In the starting position, bend your leg at the knee and do circular movements each leg.
6. Holding onto the support, squat.
7. While lying down, raise and lower your pelvis.
8. In a lying position, take dumbbells in your hands, spread them to the sides, raise and lower them.

Remember about breathing correctly: first a full inhalation, then a jerky exhalation.

Active walking strengthens the abdominal muscles well. Yoga and swimming have a beneficial effect. But that's just aids, not the main therapy.

As you can see, umbilical hernia occurs frequently in women after childbirth, but it is treatable. Don't self-medicate, stick to medical recommendations and pay attention to health more attention. Be healthy!

Umbilical hernia (hernia umbilicalis) is pathological process protrusion of abdominal organs or peritoneum, through weakened muscles of the umbilical ring.

During pregnancy, almost every woman is at risk of developing an umbilical hernia. And when repeated, multiple pregnancy, polyhydramnios or large fruit, over the age of 30, the chance of “acquiring” a hernia doubles.

An umbilical hernia during pregnancy should not be a cause for panic expectant mother, but you cannot be negligent about its presence and consultation with a specialist is necessary. In the 1st trimester, an umbilical hernia does not form in pregnant women.

But you should consult a doctor if you had a hernia before pregnancy. The surgeon will observe and, if necessary, select correct methods effects in order to minimize the risk of hernia complications.

The most dangerous are the 2nd and 3rd trimesters. The baby is growing - the uterus increases in volume, intra-abdominal pressure gradually increases throughout 9 months, and during pushing it increases several times; muscles weakened by such an “onslaught” do not hold the organs, and a hernial protrusion forms.

Symptoms of umbilical hernia during pregnancy (after childbirth)

For an umbilical hernia in pregnant women, the symptoms (signs) are very typical. There is a round or slightly oblong formation in the navel area. The protrusion can be easily reduced with gentle pressure or horizontal position, but for more later no realignment occurs.

The formation increases in size, as if pulsating when straining or coughing - a symptom of a cough impulse. Attacks of pain are typical during fetal movements, mainly in the later stages. With an umbilical hernia during pregnancy, symptoms (signs) further depend on the size of the hernial protrusion and its contents.

If it is a large omentum, then the woman, at first, is only bothered by the hernia defect; the pain comes on much later. If these are intestinal loops, there may be complaints of constipation, rumbling, nausea, aching or nagging pain in or near the navel, as well as other discomfort.

The uterus, growing along with the baby, displaces the organs of the abdominal cavity upward, leaving the hernial sac virtually empty, so in the later stages, when you feel the bulge, a feeling of emptiness is created in it, and when pressed, a pop is heard. For this reason, strangulation of the hernia during childbirth, as a rule, does not occur. An existing umbilical hernia in pregnant women is not an indication for a cesarean section.

Treatment of umbilical hernia during pregnancy (after childbirth)

The main treatment for umbilical hernias is surgery. For umbilical hernia in pregnant women, treatment by elective surgery is undesirable due to negative influence medicines, used during and after manipulation.

In addition, the hernia may go away on its own after delivery. Therefore, the main option for treating pathology remains wearing special compression (support) underwear. It contributes to less tension in the muscles of the anterior abdominal wall.

The bandage is used only after consultation with a specialist, as it requires a certain technique of fixation and wearing.

Otherwise, the bandage may cause developmental pathology or improper placement of the fetus in the uterine cavity.

Why is an umbilical hernia dangerous during pregnancy?

Most dangerous complication if there is an umbilical hernia during pregnancy - strangulation of the hernial sac with its contents in the hernial orifice.

The risk of strangulation increases especially during physical activity or frequent constipation. The blood supply to the pinched area is disrupted, which leads to gradual tissue necrosis. The complication is characterized by an attack of sharp pain in the navel, nausea, vomiting, and a prolonged absence of stool and gas.

Sometimes the symptoms are not so pronounced at the beginning, which can lead to an even greater complication - peritonitis.

In order to avoid dangerous consequences, pregnant women need to consult a surgeon who will explain in detail what you should pay attention to if you have an umbilical hernia, and how to treat it.

If there is an umbilical hernia after childbirth, conservative treatment is used in the first 6-9 months.

To do this you need:

• wear postpartum bandage during physical activity;
• breastfeed your baby, this promotes a faster process of muscle tissue recovery;
• do exercises to strengthen the abdominal muscles;
• at large set weight, control its reduction.

With absence positive results from treatment, if the umbilical hernia persists after pregnancy, a planned operation is prescribed. What to do: hernioplasty open method or laparoscopy, the patient herself decides.

There are two types of hernioplasty:

1. tension, when the hernial sac is sutured due to the tension of its own tissues; applies also in in case of emergency, because only with it is it possible to correctly assess the condition of body tissues when they are infringed;
2. non-tensioned, a special mesh is sutured to the tissues of the body, holding the organs in the anatomically correct place.

Laparoscopy, during the operation, a special video camera is used, inserted into the cavity through several punctures in the abdominal wall. A special “clip” is put on the hernial ring.

The postoperative period lasts up to several weeks, in the absence of hernia complications. On the second day, patients are advised to get up and walk a little (to reduce adhesions).

One cannot turn a blind eye to the imaginary harmlessness of this pathology. It is dangerous due to its consequences and therefore requires timely treatment.

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