Umbilical hernia after pregnancy, or postpartum hernia, is something that occasionally pops up (forgive me) when I am asked about diastasis recti. Prolapse sometimes comes into the conversation too (Really. Let’s have coffee sometime. My conversation topics are something to behold).
Because hernia, diastasis recti + prolapse are all caused by the same problem: Excessive intra-abdominal pressure, meaning too much pressure inside your abdomen +/or pelvis.
This high pressure has buit up inside your body + has nowhere to go but outwards + downwards + so eventually something has to give. I have discussed diastasis recti at length on this blog + will look at prolapse in my next related post, but today, let’s talk hernia.
What is a Hernia?
A hernia is when a bit of your body that should be inside (like part of your intestine or bowel) actually pokes out through a weak spot in your abdominal wall. You will see a bulge, or an outie belly button, or a thumb-shaped protrusion. It may feel tender to touch, you may be able to gently push it back in sometimes + you will be more aware of it when you strain (lifting something heavy, or coughing or sneezing).
There are different types of hernia but the one most likely to affect women during or after pregnancy is an umbilical hernia ie located at or near your belly button (umbilicus). An incisional hernia is another type of hernia which can sometimes occur after surgery of the abdomen (such as c-section).
Umbilical hernia is the one most associated with the pregnancy or postpartum period + it’s the one I’m going to talk about here.
It will look like: an outie belly button or protrusion, a soft bulge or a swelling, possibly with a dark tint to the skin in the area.
What Causes a Hernia?
A hernia, along with diastasis recti or prolapse, is caused by excessive intra abdominal pressure. That’s pressure inside your abdomen + pelvis, that is pushing away – out + down. In the case of umbilical hernia, it pushes so hard that part of an organ or other tissue actually pushes right through the abdominal wall at the weakest point (at or near your belly button).
But What Causes the Pressure?
This is the important bit. See I will come onto the ‘What You Can do About It’ in a moment, but unless you change the direction + force of the intra abdominal pressure that caused the problem in the first place, you may be heading for a recurrence of the hernia, or some other pressure related condition.
There are some factors which can make the pressure inside your abdomen high: multiple pregnancies (both in terms of more than one baby + more than one pregnancy!) especially if closely spaced. Obesity can be a contributing factor, as can any straining, such as heavy lifting, or violent or prolonged coughing.
But having more than a couple of babies, or moving heavy furniture around don’t cause hernia on their own. Your body is perfectly capable of doing those things, if your core is working right.
Whole body alignment, meaning the way you carry your body every day, + the strength (or lack of strength) of your core muscles: the ones that support your entire abdominal + pelvic region… this is the part that you can do most of all to minimise the risk + the effects of hernia. These muscles need to be not just ‘strong’, but functioning optimally to keep everything in. They also need to be aligned correctly so that the pressure inside your abdomen is drawing + holding you in, not pushing it all away.
Your core muscles consist of your Transverse Abdominis muscle (your deepest abdominal muscle), the Multifidus muscles of your spine, your diaphragm (separates your lungs + the organs of your chest cavity from all the stomach bits + enables you to breathe), + your pelvic floor. Their job is to contain that entire abdominal + pelvic cavity, + to regulate pressure within it, comfortably + without strain.
How Do You Fix a Hernia?
Well, you may need to have surgery, + whether or not this is advisable or the best course of action for your particular circumstance is obviously a matter for you + your doctor. And since I’m not a doctor* I will simply explain the basics + give you some resources…
Doctors won’t always advise surgery to fix a hernia + sometimes they may suggest you leave it alone. Surgery is likely to be recommended if the hernia is causing pain or distress or is getting bigger.
Surgery to repair hernia is common, whereby your surgeon will effectively push the offending protruding part back where it belongs then sew up the hole. (Like I said, I’m not a doctor…). Some procedures use a surgical mesh to reinforce the abdominal wall. There are many good online medical resources, some of which I’ve listed below.
I know my limits. So, onto the stuff I can help with…
Non-Surgical Techniques + Exercises For Moms To Relieve or Prevent Hernia
1. The first thing you can do to relieve the pressure inside your abdomen is to stand right. You see, if you tuck your backside underneath you, or walk in high heeled shoes all the time which thrusts your pelvis out in front + strains your hip flexors + knees, if you bend your knees all the time when you stand or stick your chest out or your chin up… your body isn’t in a straight line + its not holding itself up properly. What that means for your midsection, is that you’re increasing the pressure within your abdomen. Learn more about how to stand right here + for a more scientific explanation of the biomecahnics, see ‘Under Pressure’ + related posts by Katy Bowman.
2. Next you need to find, train + then strengthen your core muscles, which include your pelvic floor. You can read more about doing the right ab exercises here + a summary of the key ‘Core’ facts here.
3. You need to stop doing some things: certain exercises that strain + exert pressure on your abs + pelvic floor like sit ups or crunches; + you need to not only learn to do the right ab exercises, but also how to use your core effectively + optimally during every workout or movement. It’s no good carefully doing your breathing exercises + finding your transverse muscle, + then straining your way through a bootcamp session or a breath-holding kettle bell swinging routine without your core active, stable + supporting you.
4. You need to be aware of how your body is positioned + working (don’t worry – you won’t always have to think so hard about it) when you pick up your baby or toddler, when you haul a heavy basket of laundry or when you shut the car door with a karate kick whilst holding an infant seat + finding the keys in your pocket… Your core needs to be trained how to work right the whole time. Don’t panic – It will learn, it’s just forgotten + you need to re-teach + re-align yourself to work right + relieve the pressure. “Lift yourself [belly button to spine on an exhale, pelvic floor lifted, with no butt tucking or shoulder tensing] before you lift your baby” is a great mantra to live by.
5. This will help too ;) MuTu Focus: the Essential Foundations of a Flatter Post Baby Tummy focuses exclusively on strengthening + realigning your core + whole body posture to reduce this pressure, as well as relieve back pain, flatten your tummy + tone your pelvic floor You can follow the entire 8 week program online or on DVD.
Please share your own experiences by commenting below!
PS: The disclaimer bit.. I’m not a Doctor + I’m not medically trained. I’m a personal trainer + specialist in pregnancy + postpartum exercise prescription. I know quite a lot about women’s’ middles though + have been gently putting them back together after childbirth (often quite some time after childbirth) for some time now. To all the fabulously clever Women’s Physiotherapists, biomechanics experts + alignment geeks as well as all the *proper doctors* out there, I study your papers + your work + I am forever grateful to you for your research + expertise, but with the utmost love + respect… I don’t write for you.
I write for moms with funny shapes sticking out of their tummy + an undercarriage that feels ‘wrong’. So please don’t get annoyed with me when I don’t use lots of medical words + when I tend to err on the ‘need to know’. Of course if I get something factually wrong, then please correct me.
Information on biomechanics + alignment:
Useful resources on Hernia:
The NHS on hernia
WebMD on umbilical hernia in adults
Health Central on umbilical hernia repair in adults
Medical papers / more technical:
NCBI / PubMed on umbilical hernia repair
If you’re a medical professional or specialist who would like to direct readers to useful resources, then please leave a comment + link below (subject to approval from the blog admin).