When my belly button poked out immediately during my recent pregnancy, many people commented how cute it was. Sure, it was a sign my baby bump was growing, but the truth of the matter is that it also meant I had a hernia. Breezy Mama turned to OB Dr. Gafori of IGO Medical Group in La Jolla to get the scoop on how moms can tell if they have a postpartum hernia (and since the belly button doesn’t always poke out, many are unaware they even have one!), what to do about it, what can happen if you do nothing, if you can throw in a tummy tuck (ahem) with repair and more.
How does pregnancy cause a hernia?
First, we should start with a few definitions.
1. Rectus diastasis: This is an acquired condition in which the rectus muscles (the main abdominal muscles that run down the front of your belly) are separated by more than the normal 1 or 2 mm that typically separates them. This very minimal normal separation is made of fascia called the linea alba. Pregnancy and increased abdominal pressure can cause the muscle to separate and cause rectus diastasis. Women may notice a ridge in their central abdomen when they sit up or perform abdominal exercises. Sometimes, you can actually feel the defect.
2. Umbilical hernia: A hernia is the result of weakness or a defect in the fascia that surrounds the muscle. This weakness can result in the contents of the abdomen sometimes protruding out of the cavity through the defect. In the case of an umbilical hernia, the contents include intestine or omentum (abdominal fatty tissue) that is enclosed by the peritoneum( the membrane that lines the abdominal cavity). Infants can have congenital umbilical hernias which may close on their own as the child grows. However, if these hernias are large or they persist past 2 years of age they may need to be surgically corrected. Adult umbilical hernias, on the other hand, are almost always acquired and do not decrease in size on their own. They often need to be surgically corrected unless they are very small and do not cause any adverse symptoms. Pregnancy is one of the major causes of umbilical hernia in adult women. Other causes include anything that can increase intraabdominal pressure including obesity, chronic cough and ascites (fluid collection in the abdomen which may be caused by liver disease, cancer, etc.).
How can a mom tell that she has a hernia?
She may have a small soft mass protruding from the area around her umbilicus (belly button). This area may be tender with increases in pressure (coughing, lifting weights, later stages of pregnancy) or with palpation (touching). It may increase in size when she sneezes, coughs, or bares down.
What is involved in repairing it?
Hernias are repaired surgically. There are different methods that may or may not include placing mesh over the area in question. The procedure type would be determined by the general surgeon or plastic surgeon doing the repair. Most of these procedures are performed outpatient.
How long is the recovery?
The recovery depends on the severity of the defect and the actual procedure performed to repair the defect. In general, heavy lifting is restricted for the first 6 weeks after surgery.
Will moms be able to pick up their children after?
Yes, after the allotted recovery time.
What can happen if a mom does NOT get it fixed?
Many umbilical hernias are small and are difficult to notice and likely to not cause any symptoms. These do not need to be repaired. In the case of severe abdominal pain which may indicate an incarceration (where the bowel gets stuck through the hernia site) or strangulation (when the blood supply to the bowel is cut off) an emergency visit and surgery would be indicated.
Will my belly button ever go back in or only if I have surgery?
After delivery, the uterus does take time to return to its initial size. Once it does, and once the abdominal muscles are strengthened, you may notice a decrease in the protrusion of your belly button. On the other hand, hernias do not improve with exercise and weight loss.
Should I wait to lose the weight before I have surgery?
In the case of a rectus diastasis, exercises can be used to help regain some of the strength of the abdominal wall muscles. Rectus muscle plication (bringing the rectus muscles together centrally with surgery) should be performed once weight loss has occurred and typically only if there are no future plans for pregnancy. This is typically an elective procedure but can often help to improve intraabdominal tone so that it is easier to care for and lift your children. It also can help to decrease back pain that is due to poor abdominal wall tone and strength.
If you had an innie before giving birth, does a new outie generally mean you have a hernia?
Before having the surgery, is it okay to return to doing sit-ups and other exercises?
Yes, though these exercises will not improve the hernia. Abdominal exercises will strengthen the rectus muscles but will not decrease the defect in the fascia.
Are some hernias more mild than others or should all be treated?
There is no need for repair of a hernia that is small and does not cause any pain. Hernias that are large, that cause pain, or that incarcerate or trap bowel or fat in them should be surgically repaired.
If a mom is not done having children, should she wait to have surgery?
Unless the hernia is causing bothersome symptoms, repair should be delayed until childbearing is completed. In rare cases, hernias can cause problems during pregnancy that may necessitate surgery during the pregnancy. A person that has a symptomatic hernia prior to pregnancy may have worsening symptoms during pregnancy and should probably consider repair before they get pregnant.
Can doctors do a tummy tuck while repairing the hernia?
Yes, the medical term is abdominoplasty and this can be performed at the same time as a hernia repair. In most cases the abdominoplasty procedure includes plication (reattachment) of the abdominal muscles centrally so that the rectus diastasis is repaired. If a hernia is indeed present, the general surgeon or plastic surgeon can repair it at the same time.
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About Dr. Gafori:
Valerie Gafori MD, FACOG is a board certified obstetrician/gynecologist. She completed her undergraduate degree in Physics at MIT, her masters degree in Biology at Stanford University, and medical degree at UMDNJ: New Jersey Medical School. She completed her residency in OB/GYN at George Washington University and joined a private practice in Washington DC for one year before she moved to La Jolla. She is now in private practice in La Jolla, California with IGO Medical Group. She has special interests in minimally invasive surgery and gynecology.