Umbilical Hernia: Symptoms, Diagnosis, and Treatment Options

Suspected umbilical hernia?

Hello Doctor: Last month, I noticed that there was an increase in the foam in my urine, and it took a long time to dissipate.
Since I had a health check-up scheduled the following week, I did not seek medical attention immediately and decided to monitor my body for any changes.
Last Saturday, after dinner, I noticed that my navel had become more prominent, protruding about 0.5 cm.
There were no wounds or discharge, and it was not painful to the touch, nor did it disappear when pressed; it felt somewhat fluid-filled.
I went to a gastroenterology clinic for an examination, and the doctor informed me that it was inflammation and prescribed anti-inflammatory and pain relief medication.
Upon returning for a follow-up, the situation remained the same, and the doctor prescribed the same medication again and referred me to a general surgeon.
The surgeon visually assessed that it was an umbilical hernia and recommended treatment using the Da Vinci surgical system.
After researching online and reading various articles, I noticed that unlike others who experience a bulge that disappears when pressed or lying down, I have been feeling a persistent sensation of fullness in my abdomen.
I am unsure which specialty I should consult for further examination and what type of instruments the doctor might use to identify the issue.
Thank you.

Axi, 40~49 year old female. Ask Date: 2020/11/16

Dr. Chen Jiaming reply Surgery

In general, a protruding umbilical mass can be evaluated using ultrasound to determine if it is a simple subcutaneous mass (such as a lipoma).
If it is a hernia sac extending from the abdominal cavity, a defect in the underlying fascia can be observed.
After all, most people's initial umbilical hernias can be gradually pushed back when lying flat, temporarily resolving the issue (though a minority may have an incarcerated hernia that cannot be reduced).
A more advanced examination would involve arranging an abdominal CT scan for confirmation (however, health insurance may not cover this, and it could be an out-of-pocket expense).
You may want to discuss this with the clinician who initially recommended robotic surgery, as confirming the diagnosis before proceeding with surgery may provide you with more peace of mind (the cost difference between surgery and diagnostic tests can be significant).
The ability of physicians from various specialties to perform ultrasound assessments also depends on their expertise and skill set.

Reply Date: 2020/11/16

More Info

An umbilical hernia occurs when a portion of the intestine or fatty tissue protrudes through the abdominal wall near the belly button (umbilicus). This condition can manifest in various ways, and understanding its symptoms, diagnosis, and treatment options is crucial for effective management.

Symptoms of Umbilical Hernia
The symptoms of an umbilical hernia can vary, but common signs include:
1. Visible Bulge: A noticeable bulge or swelling near the belly button, which may become more pronounced when standing or straining.

2. Discomfort or Pain: While many individuals may not experience pain, some may feel discomfort, especially when lifting heavy objects or during physical activity.

3. Changes in Urination: Increased foamy urine, as you mentioned, can sometimes be associated with underlying conditions but is not directly linked to umbilical hernias.

4. Feeling of Fullness: A sensation of fullness or pressure in the abdomen, which can be mistaken for bloating or indigestion.

Diagnosis
Diagnosing an umbilical hernia typically involves a physical examination by a healthcare provider. The doctor may look for:
- A bulge in the abdominal wall.

- Changes in the area when the patient coughs or strains.

- Any associated symptoms like pain or discomfort.

In some cases, imaging studies may be recommended to confirm the diagnosis or rule out other conditions. Common imaging modalities include:
- Ultrasound: This is often the first-line imaging technique used to visualize soft tissues and can help confirm the presence of a hernia.

- CT Scan: A computed tomography scan may be used if more detailed images are needed, especially if there are concerns about complications.

Treatment Options
The treatment for an umbilical hernia depends on several factors, including the size of the hernia, the presence of symptoms, and any potential complications. Here are the common treatment options:
1. Watchful Waiting: If the hernia is small and asymptomatic, a doctor may recommend monitoring the condition without immediate intervention.

2. Medications: Anti-inflammatory medications may be prescribed to manage discomfort, but they do not treat the hernia itself.

3. Surgical Repair: If the hernia is large, symptomatic, or at risk of complications (like incarceration or strangulation), surgical intervention is typically recommended. The Da Vinci surgical system, which you mentioned, is a minimally invasive technique that can be used for hernia repair. This method involves smaller incisions and may lead to quicker recovery times and less postoperative pain.

Postoperative Care and Recovery
After surgery, patients are usually advised to avoid heavy lifting and strenuous activities for a period to allow for proper healing. Recovery times can vary, but many individuals can return to normal activities within a few weeks, depending on the extent of the surgery and their overall health.

Conclusion
If you are experiencing symptoms consistent with an umbilical hernia, it is essential to follow up with your healthcare provider for a thorough evaluation and appropriate management. Given your concerns about the bulge and the sensation of fullness, it would be prudent to proceed with the recommended surgical consultation. Additionally, if you have any underlying health conditions, such as thyroid issues, be sure to discuss these with your surgeon, as they may influence your treatment plan and recovery.

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