We receive a lot of emails from women who have not been taken seriously when they realise they have an umbilical hernia. “Just push it back in” – is what they are told in many cases.
Is that how it should be?
What is an umbilical hernia?
Diastasis recti (DR – also called ‘abdominal separation’), umbilical hernias and prolapses can all be caused by the same kind of problem: excessive pressure in the abdomen. This pressure builds up inside the belly and has nowhere to go but outwards and downwards.
Any activity that increases abdominal pressure can aggravate prolapses, DR and umbilical hernias. Examples of such activities include heavy lifting done incorrectly, coughing or even sitting on the toilet doing a number 2. Imagine a cylinder with a hole in the bottom and a balloon that is inflated inside the cylinder. Part of the inflated balloon will bulge out through the hole. The balloon that pokes out through the hole can be compared to the tissues of the abdomen being pushed out through a hernia.
Or:
A hernia is when a piece of your body that’s supposed to be inside (like part of the intestine or bowel) actually sticks out through a weak point in your abdominal wall (usually in the linea alba, the tissue that holds your abs together). You will see a lump or your belly button will stick out. It may feel tender to the touch, you may sometimes be able to gently push it back in, and you’ll be more aware of it when you lift something heavy, cough or sneeze.
Umbilical hernias are most commonly associated with pregnancy and childbirth.
But what causes the pressure? This is the most important part.
There are a few factors that can make the pressure inside the abdomen high: multiple births (having more than one baby at a time), frequent pregnancies, even obesity can be a contributing factor, as well as any exertion such as heavy lifting, or heavy coughing. But having multiple children or moving heavy furniture around doesn’t cause hernias per se. Your body is perfectly capable of doing these things if your abdominal muscles are working properly. How you carry your body each day and the strength (or lack thereof) of your core muscles, which support the entire abdominal and pelvic region, is the part you can influence most to minimise the risks and effects of hernias.
You can start by looking at the appearance of your belly button: has it changed during pregnancy? Is it inside out now? Do you feel that there is a small gap and ‘something’ sticks out when you stand, lie on your side or get down on all fours? (The hernia disappears when you lie down on your back as there is nothing pressing against it). When you lie on your side, the hernia should be pushed out, as the abdominal pressure increases slightly compared to lying on your back. When you stand, you should be able to feel the hernia. It may also feel a little tender and uncomfortable to touch the area around your belly button.
How can you fix a hernia?
You will probably need surgery (depending on the size of the hernia) if the hernia causes pain or gets bigger. But since I’m not a doctor, all I can do is explain the basics and give you some pointers to help you along the way.
Tips to relieve or prevent hernias:
The first thing you can do to relieve the pressure inside your belly is to stand correctly. If you hold your body in a neutral position and look at yourself from the side, you should be able to draw a straight line through your ear, shoulder, hip and ankle, which minimises pressure in the diaphragm. You also need to think about how you move when carrying and lifting heavy objects, dragging furniture or doing pretty acrobatic moves with a child on your hip. The core muscles must be engaged and controlled at all times.
The second thing you need to do is strengthen your core muscles, including your pelvic floor. You need to learn how to do the right abdominal exercises but also how to use these effectively and optimally during each workout. The third thing you can do is stop doing certain things, such as exercises that put too much pressure on your belly and pelvic floor, like sit-ups or crunches. AND – go and get checked by your GP.
Abdominal separation or umbilical hernia – what’s what:
• The linea alba is thin in the case of abdominal separation/DR, in the case of umbilical hernia there is a gap/tear
• DR can be sensitive but it does not hurt, whereas an umbilical hernia does
• DR can be along the whole linea alba, but this isn’t always the case for umbilical hernias
• DR is not life threatening, but with an umbilical hernia the internal organs can protrude
• DR can be treated without surgery, but umbilical hernias usually require surgery + core rehab.