Umbilical hernia after pregnancy, or postpartum hernia, is related to the discussion on diastasis recti. As is Prolapse. Let me explain. And at the bottom of this post there are links to get the right help.
Hernia, diastasis recti and prolapse are all caused by the same problem: Excessive intra-abdominal pressure, meaning too much pressure inside your abdomen and/or pelvis.
This pressure has buit up inside your body and has nowhere to go but outwards and downwards and so eventually something has to give. I have discussed diastasis recti at length on this blog and pelvic organ prolapse is discussed here 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 and 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 and it’s the one I’m going to talk about here.
It will look and feel 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 and pelvis, that is pushing away – out and 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).
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 and 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 and 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, as well as the strength (or lack of strength) of your core muscles: the ones that support your entire abdominal and pelvic region… these are what you need to address to minimise the risk and 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 and 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 and the organs of your chest cavity from all the stomach bits and enables you to breathe), and your pelvic floor. Their job is to contain that entire abdominal and pelvic cavity, and to regulate pressure within it, comfortably and without strain.
HOW DO YOU FIX A HERNIA?
Well, you may need to have surgery, and whether or not this is advisable or the best course of action for your particular circumstance is obviously a matter for you and your doctor.
Doctors won’t always advise surgery to fix a hernia and 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. (Technical terms, obviously). 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.
NON-SURGICAL TECHNIQUES + EXERCISES 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 and strains your hip flexors and 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 and 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 and for a more scientific explanation of the biomecahnics, see the ‘Under Pressure’ links below.
2. Next you need to find, train and then strengthen your core muscles, which include your pelvic floor. You can read more about doing the right ab exercises here and a summary of the key ‘Core’ facts here.
3. You need to stop doing some things: certain exercises that strain and exert pressure on your abs and pelvic floor like sit ups or crunches; and you need to not only learn to do the right ab exercises, but also how to use your core effectively and optimally during every workout or movement. It’s no good carefully doing your breathing exercises and finding your transverse muscle, and then straining your way through a bootcamp session or a breath-holding kettle bell swinging routine without your core active, stable and supporting you.
4. You need to be aware of how your body is positioned and 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 and 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 and you need to re-teach and re-align yourself to work right and 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 and realigning your core and whole body posture to reduce this pressure, as well as relieve back pain, flatten your tummy and tone your pelvic floor You can follow the entire 8 week program online or on DVD.
FURTHER RESOURCES + LINKS
WHEN TO SEEK SPECIALIST PERSONAL HELP – MORE INFORMATION ON CONSULTING WITH A WOMEN’S A HEALTH PHYSIOTHERAPIST
Great information in this article ‘What is Pelvic Health Physiotherapy?’ from Pelvic Guru
… and also from Tracy Sher at the Pelvic Guru, The Ultimate Pelvic Anatomy Resource! Links, articles and videos – this post has EVERYTHING and is kept updated – an amazing resource.
Downloadable (free) PDF information leaflets and very helpful diagrams available from the International Urogynecological Association (IUGA) (click ‘Patient Leaflets’)
‘Under Pressure’ on Katy Bowman’s blog at Aligned and Well
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