Postpartum umbilical hernia, diastasis recti, and prolapse actually all have a related root cause. They stem from pressure inside your abdomen and/or pelvis, that is under stress. This pressure can build up due to alignment or postural factors.
Hernia describes where a bit of your body that should be inside (like part of your intestine or bowel) actually pokes out through your abdominal wall. Not like, out through your skin, ‘out’. Out through a layer of internal tissue, so you see a lump, ‘out’.
There are different types of hernia but the one most likely to affect women during or after pregnancy is an umbilical hernia. This means a hernia 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).
How do I know if I have a hernia?
You will see a bulge, or an outie belly button, or a thumb-shaped protrusion. There may be a soft swelling, possibly with a dark tint to the skin in the area. It may feel tender to touch, you may be able to gently push it back in sometimes. You may be more aware of it when you strain (lifting something heavy, or coughing or sneezing).
What causes it?
A hernia, like diastasis recti or prolapse, is caused by excessive intra abdominal pressure. That’s pressure inside your abdomen and pelvis, that is pushing away (outwards).
Some factors which can contribute are: multiple pregnancies or obesity, as well as straining, heavy lifting, or violent or prolonged coughing.
But having more than a couple of babies, or moving heavy furniture around or coughing don’t cause hernia on their own.
Umbilical hernia occurs when your alignment or core function isn’t quite optimal. And this can happen because of postural and load shifts during and after pregnancy. Like a kinked hose-pipe or an over-squeezed balloon, eventually something’s got to give, and the result is the hernia popping out.
Should I get surgery for postpartum umbilical hernia?
Surgery is often not considered necessary for a small umbilical hernia. It is really dependent on whether the hernia is causing you distress or pain, or is getting bigger. ‘Strangulation’ of a hernia can cause more serious problems, however.
Surgery to repair a hernia is relatively common. The surgeon will push the offending protruding part back where it belongs, and then sew up the hole. Laparoscopic surgery or open repair using sutures (without mesh) is known as ‘primary closure’.
Some procedures use a surgical mesh to reinforce the abdominal wall. Surgical mesh is also used in some incontinence and pelvic organ prolapse surgeries, but this has involved significant controversy.
The issue is not too much pressure inside your abdomen – it’s supposed to be there – the issue is that your core muscle system is not able to stabilise the pressure correctly. It’s kinked. Like the hosepipe. So even if you have surgery to close the hole and reverse the hernia, the pressure problem inside can still be there.
Remember too, that surgery is fixing the symptom (the visible hernia) but has not addressed the cause (the pressure, or the core weakness). You should still follow alignment and core strengthening strategies to avoid a recurrence.
Alignment adjustments to relieve hernia symptoms
‘Alignment’ in this context means the way you carry your body every day. The way your body is biomechanically stacked, head on shoulders, on ribs on pelvis. All the way down to your feet and the shoes you wear. How your body is positioned as you stand, sit, or walk determines how effectively your core muscle system can stabilise and hold everything where it’s supposed to be.
There are some very common movement habits which compromise this alignment ‘mismatch’ and prevent the core muscles from functioning correctly to do this.
Untuck your tailbone
Many of us tend to walk and stand with our backside slightly clenched, effectively flattening our bum and pushing our pelvis forward. This position compromises our core’s ability to contain pressure effectively. Try at first just noticing if you do this, and remind yourself as often as you can to unclench and untuck, letting your bum sit high and proud, like bums are supposed to.
Change your shoes
The heel height of your shoes forces your body to compensate for the angle and keep you upright, creating a pelvic thrust and tilt. Your core muscles are simply not in an optimal position to do their job and contain intra abdominal pressure effectively. It doesn’t mean high heels must be abandoned entirely, but give your feet plenty of opportunities to have full contact with the ground and your toes room to wiggle and spread.
Feet face forward!
Do your feet turn outward as you stand or walk? This can have the effect of forcing a flattened bum and a tucked tailbone. Keep checking in on the direction your feet are facing, and try to adjust your alignment to straighten them up and let your glutes work properly.
The added bonus of the above adjustments is that your bum will look better! A flat bum is a friend to no woman… and just a few minor, ongoing adjustments to your alignment can have the effect of switching those glutes back on.
Exercises to avoid if you have umbilical hernia
Some moves will strain and exert further pressure on your abs and pelvic floor and should be avoided if you have an umbilical hernia. Stay away from crunches or sit-ups, and be aware of breath holding or straining when you work out.
Safe exercise for umbilical hernia after pregnancy
MUTU System is the online, medically recommended exercise and recovery program. Daily practice is for only 15-20 minutes with step-by-step instructions. It will help you strengthen your core and pelvic floor, lose weight, and feel confident and great again. MUTU focuses on strengthening and realigning your core and whole body posture to reduce this pressure, as well as relieve back pain and improve core muscle function.
Includes comprehensive modifications, strategies and resources to address umbilical hernia after pregnancy and associated issues.
Further resources & links
Downloadable (free) PDF information leaflets and very helpful diagrams available from the International Urogynecological Association (IUGA) (click ‘Patient Leaflets’)
WebMD on umbilical hernia in adults
Medical papers / more technical:
NCBI / PubMed on umbilical hernia repair