Adult umbilical hernia

　　Adult umbilical hernia (umbilical hernia in adult) is a hernia formed after the umbilical ring closes, gradually bulging under the increased intra-abdominal pressure and the thrust of abdominal organs, which is an acquired umbilical hernia, more common in middle-aged and elderly women. The incidence of adult umbilical hernia is significantly lower than that of infants, most common in women aged 35 to 50, with a male-to-female ratio of 1:3.

　　Incomplete closure of the umbilical ring, thinning of the umbilical tissue, or atrophy of the abdominal fascia and muscle are the pathological basis of umbilical hernia. Increased intra-abdominal pressure caused by pregnancy, obesity, excessive omental fat, chronic cough, liver cirrhosis ascites, etc., is an important precipitating factor for the occurrence of umbilical hernia.

　　Pathogenesis

　　During infancy, the umbilical ring closes, forming scar tissue locally, which becomes a weak point of the abdominal wall. Middle-aged and elderly people and those with multiple pregnancies may have more fragile abdominal walls due to partial denaturation or degenerative changes in the abdominal muscles. Therefore, when the abdominal pressure is high for a long time and the abdominal muscles are excessively stretched, the viscera may prolapse through the umbilical weak point. The wall and covering layer of umbilical hernia are thin, and the hernial contents are initially mostly omentum, followed by small intestine and colon. Adhesions often occur between the hernial contents and the umbilical hernia sac, forming multi-chambered spaces. Intestinal obstruction may also occur occasionally. Pregnant women or patients with liver cirrhosis and ascites may experience spontaneous or traumatic rupture if they have umbilical hernia.

　　Hernia is a very common disease, which can affect people of any age. Adult umbilical hernia is one of them, mainly manifested as coughing, standing, and disappearance when lying flat. In addition to the above symptoms, other complications may also occur. Let's understand these complications below.

　　The three major complications of adult umbilical hernia

　　1. Rupture of umbilical hernia

　　Pregnant women or patients with liver cirrhosis and ascites may experience spontaneous or traumatic rupture due to excessive stretching of the abdominal muscles, resulting in extreme abdominal wall tension.

　　2. Upper gastrointestinal bleeding

　　If surgery is performed to repair umbilical hernia in patients with liver cirrhosis, it may aggravate the collateral circulation of portal venous blood flow, thus triggering massive upper gastrointestinal bleeding.

　　3. Incarceration and strangulation of hernia

　　The hernial ring of adult umbilical hernia is narrow, surrounded by tough scar tissue, so there are more cases of incarcerated or strangulated umbilical hernias in adults. At this time, sudden severe pain may occur, leading to mechanical intestinal obstruction, acute peritonitis, and systemic toxic symptoms.

　　The contents of adult umbilical hernias are mostly omentum, followed by transverse colon and small intestine.

　　The main clinical manifestations are the protrusion of a circular hernia at the umbilical region during standing, coughing, and straining, which disappears when lying flat. After the hernia is reduced, the edge of the hernial ring can be felt. If there is a large amount of omentum and intestinal protrusion, there may be dull pain and abdominal discomfort. Generally, smaller umbilical hernias may be asymptomatic.

　　The edge of the hernia ring in adult umbilical hernia is tough, with low elasticity and cannot be expanded. There is a higher chance of incarceration and strangulation than in infant umbilical hernia. The clinical manifestations are sudden severe pain, and when the contents are intestines, mechanical intestinal obstruction occurs.

　　Physical examination can be found: There is a soft hemispherical mass at the umbilicus, and a large umbilical hernia can hang down. If the hernia contents are intestines, intestinal peristalsis can be seen; when standing, the hernia protrudes, and when lying flat, the hernia returns; there is a coughing impact, and the umbilical defect and circular hernia ring can be felt when it is returned.

　　Adult umbilical hernia is an acquired umbilical hernia, which is more common in middle-aged and elderly women, often secondary to prolonged increased abdominal pressure and excessive stretching of the abdominal wall. The characteristics of adult umbilical hernia are that it cannot be cured on its own and continues to enlarge, is prone to incarceration or strangulation; secondly, the hernia contents are prone to adhesion to the umbilical scar skin, which usually cannot be returned, and surgery is required.

　　Clinical manifestations

　　1. Symptoms: Umbilical hernia mass, the hernia mass protrudes when coughing and exerting, and disappears when lying flat. Local pain or abdominal discomfort may be accompanied by indigestion. In the case of incarceration, symptoms of incomplete or complete intestinal obstruction may occur.

　　2. Physical examination: There is a soft hemispherical mass at the umbilicus, and a large umbilical hernia can hang down. If the hernia contents are intestines, intestinal peristalsis can be seen; when standing, the hernia protrudes, and when lying flat, the hernia returns; there is a coughing impact, and the umbilical defect and circular hernia ring can be felt when it is returned.

　　Prevention

　　Treat the primary disease and avoid or reduce factors that increase abdominal pressure.

　　Attention 1: Pay attention to the condition of the disease

　　You must observe and pay attention to changes in your body and daily behavior, check if there is a mass at the navel position. Although umbilical hernia is considered a benign symptom, it still needs to be observed. Unlike inguinal hernia, umbilical hernia usually resolves itself and almost never requires surgery, but inguinal hernia almost always needs to be treated promptly to improve symptoms.

　　Attention 2: Pay attention to observation in everyday life

　　There is no need to press the umbilicus every day to observe whether the intestines have slipped out, just pay attention to observe in everyday life.

　　Attention 3: Do not use anything to press

　　Some people press the protruding umbilicus directly with a coin, hoping to improve the condition through pressure. However, experts especially remind that whether pressing with a coin, using tape or wrapping clothes, there is no substantial efficacy for umbilical hernia, and it is easy to develop contact dermatitis, especially in summer, which is more likely to cause itching due to heat and humidity.

　　Attention 4: Pay attention to the correct sensation

　　If it is a normal umbilical hernia, when pressing downwards, the sensation is like piercing a partially inflated balloon, and it can be pressed down smoothly without encountering any resistance in the middle.

　　The main clinical manifestations of umbilical hernia are the visibility of spherical or hemispherical reducible masses at the umbilicus. When abdominal pressure is increased (such as crying, standing, or exertion), the mass will enlarge and become tense. Light pressure on the umbilical mass can cause the hernia contents to return to the abdominal cavity, and the sound of water passing can be heard, as well as the feeling of an unclosed umbilical ring or hernia ring can be felt. Adult umbilical hernias are often large. Umbilical hernias usually do not have自觉 symptoms, and some individuals may have local swelling, discomfort, or even pain, which may be caused by the traction of the falciform ligament on the peritoneum and fat by the hernia sac.

　　Routine physical examination and palpation can be used for diagnosis, and hernia造影and ultrasound examination can help distinguish from other abdominal wall diseases.

　　Adult umbilical hernia is more common in obese people with weak abdominal walls, middle-aged and elderly people, and women who have given birth, and it is also common in patients with chronic diseases that increase abdominal pressure. Therefore, people with weak abdominal walls, middle-aged and elderly people, women who have given birth, and patients with increased abdominal pressure due to chronic diseases should pay attention to the degree of coughing and exertion, and try to take surgical treatment when an umbilical hernia occurs.

　　In terms of diet, it should be regular and reasonable, that is, mainly high-protein and high-vitamin foods. In daily life, eat more dietary fiber to prevent the occurrence of constipation and other symptoms.

　　Adult umbilical hernia cannot heal itself and is prone to incarceration and strangulation, so it should be treated surgically. However, patients with severe liver cirrhosis and ascites who are elderly and have serious cardiovascular and pulmonary diseases and cannot tolerate surgery should be禁忌surgical treatment. However, in the event of incarceration or strangulation, emergency surgery should still be performed.

　　Regarding the drug treatment for adult umbilical hernia, experts point out that it is necessary to tonify Qi and elevate or regulate Qi and resolve knots. Among the drugs used to treat adult umbilical hernia, traditional Chinese medicine has the following prescriptions.

　　One Prescription:Sufficient amount of Mother Star Anise. Method of use: grind into extremely fine powder, seal in a bottle. Take an appropriate amount of the powder to fill the umbilical fossa, apply and fix, change the medicine once every two days. Generally, it takes 4-6 times to take effect. At the same time, it is necessary to actively eliminate pathogenic factors that are easy to cause increased abdominal pressure, such as coughing, constipation, and difficult urination. Pay attention to rest and reduce physical activity.

　　Two Prescriptions:15 grams of Astragalus, 3 grams of Cimicifuga, 15 grams of Jujube. Method of use: decocted in water.

　　Three Prescriptions:60-90 grams of live crucian carp, 10 grams of Anise Seed. Method of use: can be steamed or decocted into soup, without salt, once a day, for 5-6 times consecutively.

　　Four Prescriptions:3 grams of Anise Seed, 5 pieces of Lychee Nucleus, 10 grams of Orange Nucleus. Method of use: grind together, take 6 grams with brown sugar and boiling water each time, twice a day.

　　Five Prescriptions:4 grams of Ginseng (15 grams of Codonopsis), 15 grams of Astragalus, 10 grams of Longan Meat, 3 grams of Cimicifuga, 2 grams of Licorice. Method of use: decocted in water.