A hernia occurs when an internal organ, tissue, or part of the intestine pushes through a weak spot in the surrounding muscle or connective tissue wall. This common condition frequently develops in the abdominal region. Paraumbilical hernias are a specific type of abdominal wall defect that primarily affects adults. Understanding the exact location and contents of this protrusion is the first step toward appropriate management.
Defining the Condition and Location
A paraumbilical hernia is a protrusion of tissue through a defect in the abdominal wall located immediately adjacent to the umbilicus, or navel. This is distinct from an umbilical hernia, which occurs directly through the umbilical scar tissue itself and is more commonly seen in infants. In adults, the defect typically develops in the linea alba, the fibrous structure running down the midline of the abdomen, near the umbilicus.
The hernial sac, lined by peritoneum, pushes through this weak point. The contents of the sac can vary but often include omental fat or loops of the small or large intestine. Because the protrusion occurs next to the belly button, it often distorts the umbilicus into a crescent shape. This condition is sometimes referred to as an acquired umbilical hernia of adults.
Identifying Signs and Risk Factors
The most common sign of a paraumbilical hernia is a visible lump or bulge around the navel. This swelling may become more noticeable when standing, coughing, straining, or engaging in vigorous exercise, as these actions increase pressure within the abdominal cavity. Patients often report discomfort or a dull ache in the umbilical region, sometimes described as a “dragging pain.”
The development of this hernia is linked to factors that repeatedly or consistently increase intra-abdominal pressure. Obesity is a primary risk factor, as excess body weight places constant strain on the abdominal muscles and connective tissues. Women who have had multiple pregnancies are also at a higher risk, as pregnancy stretches and weakens the abdominal wall. Other contributing factors include chronic coughing and activities involving heavy lifting or straining.
Diagnosis and Treatment Pathways
Diagnosing a paraumbilical hernia typically begins with a thorough physical examination by a healthcare provider. The clinician will feel the lump to assess its size, location, and reducibility, which determines if the protruding tissue can be gently pushed back into the abdominal cavity. Imaging tests, such as an ultrasound or a CT scan, may support the diagnosis, especially if the defect is difficult to feel.
For adults, the standard treatment is surgical repair, known as herniorrhaphy, because these hernias rarely resolve on their own and tend to worsen over time. The surgical approach can be performed using open surgery or laparoscopic repair. Open surgery involves a single incision near the navel, through which the surgeon pushes the contents back into the abdomen and closes the defect.
Laparoscopic, or keyhole, surgery is a minimally invasive technique using small incisions, a camera, and specialized instruments. Regardless of the technique, the defect is often reinforced with a surgical mesh, a synthetic patch placed over the weak spot. The mesh provides a scaffold that encourages the growth of strong scar tissue, reinforcing the abdominal wall and reducing the likelihood of recurrence.
Potential Complications
While many paraumbilical hernias cause only minor discomfort, they carry the risk of acute complications requiring immediate medical attention. One complication is incarceration, which occurs when the protruding tissue becomes trapped and cannot be manually pushed back into the abdomen. An incarcerated hernia is often accompanied by severe pain, tenderness, and sometimes changes in the overlying skin.
The most serious complication is strangulation, which happens when the neck of the hernia sac cuts off the blood supply to the trapped tissue, such as a loop of intestine. Without oxygen and nutrients, this tissue quickly dies, leading to necrosis and potentially life-threatening conditions like gangrene or sepsis. Symptoms of strangulation include sudden, excruciating pain, fever, nausea, vomiting, and an inability to pass gas or have a bowel movement.