Brief Answer:
Please look for non reducible hernia with signs of pain and inflammation

Detailed Answer:
Hi XXXX,
Thanks for writing in to us.

I have read through your query in detail.
Please find my observations below.

1. An umbilical hernia appears when the muscular inner layers of the abdominal wall in the umbilical wall gives away and the bowel or fat is seen protruding under the skin as a soft to firm swelling on coughing or when stressing during stool.

2. Initially the hernia might be small and will not cause any discomfort and the hernia is self reducible. However as time progresses, the hernia might get larger and then the herniating fat and bowel get stretched at times of increased pressure and might not reduce completely. This is the reason probably you are having pain during bowel movements. At this time the hernia is partially reducible.

3. Ultrasound scan shows the neck or narrowest portion of the hernia and the herniating contents.

4. Any umbilical hernia, if not treated, progresses from the reducible to partially reducible and finally to the non reducible state and this needs to be looked for as it can cause problems to your health.

5. The following features are to be watched for concerning a non reducible hernia which might also show signs of strangulation and is a medical emergency

(i) The visible bulge or swelling persists and is not reducible even on attempts made to do so
(ii) Pain and pressure at the site of hernia
(iii) Any suspicious signs of inflammation at the hernia location like change in color of skin, increased temperature over the skin and tenderness.

The above features indicate an emergency and should you have any of these signs then you must rush to emergency room.

6. Umbilical hernia surgery is a surgery by which the muscle layers are approximated towards each other and the defect is closed. Many patients also get a mesh placed in the hernia site that prevents hernia recurrence.

7. Since your hernia is not causing any significant problems on ultrasound, it appears to be partially or completely reducible. Please discuss with your surgeon on planning a surgical repair to treat your discomfort and pain during bowel movements. An early repair is always better than waiting for the condition to progress.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
Please consult a surgeon who can discuss and plan a surgery if required

Detailed Answer:
Hi Diane Maupin,
Thanks for writing back with an update.

1. I completely agree with your views that you need to consult a general surgeon who might have operated on many umbilical hernias in the past.

2. Umbilical hernia repair is usually done by any one of the 3 techniques as below
a. using primary suture
b. Mayo repair
c. flat mesh-based repair (usually for hernias more than 4 cm)

3. If it is not an emergency situation then you can discuss and plan an elective surgery with your surgeon to address your pain and discomfort during bowel movements. Please note that symptoms due to an umbilical hernia should not be neglected and consulting the surgeon is important to avoid any complication or emergency situation.

4. Recurrence rate after mesh repair technique is almost nil and this is also the recommended technique for those with large umbilical hernias.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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