Hernias

Umbilical Hernias

Hernias are caused by excessive pressure inside your abdomen and/or pelvis. While inguinal hernias are fairly common in men, umbilical hernias are the most common during pregnancy and postpartum. This is when part of your abdominal contents (fatty tissue and/or intestine) protrude through your navel/belly button. This can sometimes occur in conjunction with a diastasis recti (DR). Hernias can often be tender and painful when you experience increases in your intra-abdominal pressure (IAP). Common daily examples of increased IAP include pooping, coughing, sneezing, heavy lifting of weights, lifting an infant carrier or toddler

Surgery vs Conservative Management of Umbilical Hernias

The presence of a hernia means the connective tissue separating your abdominal organs from the rest of the world has been injured. There is no way to completely restore the injured tissue to its original state, however, there are many steps you can take to effectively manage this issue. The most important step to managing a hernia is to control the pressure you are putting on your abdominal wall. If you see a bulging at the site of your hernia it is accompanied by pain because there is pressure on something that can feel pain. Simply put, our insides are generally happier when they stay “inside”…

Hernias can often be managed conservatively with intelligently programmed core strengthening, fixing body alignment and controlling your pressure (IAP). Physical therapy to correct these things is recommended even if you ultimately end up having surgery. This surgery can have a high failure rate if you go back to the same dysfunctional habits that created the hernia in the first place.

Surgery is usually recommended when hernia is causing pain, not allowing you to do certain activities, and if there are any signs that the tissue affected is getting “strangulated” (deprived of blood) or infected (think redness, warmth, swelling). A hernia repair entails returning all of your anatomy to its rightful place and then repairing the abdominal wall. Sometimes a surgical mesh to accomplish the repair. The scar can be an issue itself, particularly if the umbilical hernia repair takes place with a larger abdominal wall repair/”tummy tuck”. There can be very good reasons to have surgery, however, it seems there are ways to avoid it especially if the defect is small enough.

Causes of Umbilical Hernias

There are factors, some of them genetic, that may pre-dispose a person to having a hernia. We would argue that since ultimately this is an issue of “pressure mismanagement”, that there are many things at are also within your control.

Risk Factors

• carrying multiple babies (twins, triplets…)

• number of pregnancies especially if closely spaced

• genetic predisposition

• obesity

• connective tissue disorders

Lack of Core Support

Think of your core as a muscular balloon with a top, bottom, and sides). If any part of the “core” is squeezing too hard, it creates imbalance. Imbalance is what can create many kind s of issues

• Front: Abdominals (transverse abdominals, how your obliques work together)

  • “pressure” issue: abdominal hernia, diastasis recti

• Back: Multifidi (back muscles that helps stabilize the spine)

  • “pressure” issue: disc herniations

• Top: Diaphragm (your main muscle of breathing)

  • “pressure” issues: respiratory dysfunction, poor airway clearance

• Bottom: Pelvic floor (support from below/your “undercarriage”)

  • “pressure” issues: pelvic organ prolapse, urinary and gas/fecal incontinence

Body Alignment — Stack your Sh*t

Correct alignment of your core helps those muscles to “come alive” and function properly. If somebody carries their rib cage behind their pelvis or “flares” (sticks out” their lower ribs chronically, this puts excessive strain on the “front” of the canister. As discussed, excessive strain on the front of your body is often what creates a hernia in the first place and prevents you from getting it under control.

Try the following:

Position your feet about 12 to 18” away from the wall. Lean back, placing your mid-back on the wall. Lower the bottom of your rib cage to decrease the space between your mid-back and wall as needed (get your bra-strap on the wall!) Roll your shoulders back to touch the wall without losing your spine position. Straighten your neck so that it is very long in the back and nod your chin (as if making a double chin). If any of this causes extreme discomfort or pain, relax to a point where it is not bothering you. The cue to “drop your ribs” is what is often most helpful to restoring good alignment.

Activities to Avoid with an Umbilical Hernia

Until you are strong enough and somebody has instructed you to effectively to control your pressure, you have to decrease exercises that significantly increase strain on the abdominal muscles: planks, sit ups, crunches, heavy lifts

Holding your breath/bearing down while exercising or exerting yourself

flaring ribs with exercise

What to do

Take pressure off from above and below:

mobilization of the abdominal wall and abdominal organs— see women’s health PT that does visceral mobilization, take a peak at the video linked below

strengthen and optimize functioning of your pelvic floor

breathing with rib cage expansion to the sides (lay a hand on either side of your lower rib cage and ribs should get BIG with an inhalation)

Restore full body function with the Guides

Krystle mobilizing her own abdominal wall to help with abdominal separation