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Q: I have an umbilical hernia which is causing me great concerns and problems. I would appreciate information on my umbilical hernia. Also, my husband has an inguinal hernia.

-- F.T., Angola

A: A hernia is defined as the abnormal protrusion of a portion of an organ or other body structure through some other tissue such as a membrane or muscle.

As you might expect from that definition, there are many types of hernias. Many hernias occur through the walls that line the abdomen and through the muscles that surround the abdomen. As you might guess, they are all called abdominal hernias. An umbilical (or paraumbilical) hernia is a type of abdominal hernia that is near the umbilicus (belly button.)

The abdominal wall consists of three sets of muscles. Each of these groups of muscles is oriented at an angle to the other. This forms a lattice of muscles that support, confine and protect the underlying organs. It requires a splitting of all three layers for a hernia to protrude through, except where the muscles come together in the middle.

Umbilical hernias are considered congenital in infants and children, and acquired in adults. The "acquisition" of your umbilical hernia probably occurred over time as a tear in the muscle wall opened more and more.

The most common cause of abdominal hernias in adults is over-stretching of muscles during physical activity. The risk of this is much greater in someone who is obese.

Although strain is the major factor in abdominal hernias, and heavy lifting produces strain, other factors and conditions can result in strain, including pregnancy and bowel movements.

Another very common cause of umbilical hernias is structural abnormalities of the muscles of the abdomen that occur at birth. They are called congenital because they are present at birth.

Symptoms of uncomplicated abdominal hernias include a dull ache and a bulge, often more pronounced during physical activity requiring straining. Severe complications of abdominal hernias are intestinal obstruction and strangulation of protruding bowels that may require immediate surgery.

Treatment consists of decreasing activities that cause excess straining of the abdominal muscles. Reducing weight is also very important. Building up these muscles through gradually increased exercise under the direction of a health professional may also help.

In an adult, if the hernia protrudes, gently pushing it back may be enough. But if this happens too frequently and the protrusion is increasing, surgery should be seriously considered. With the more recent use of wire mesh in surgical repair, the results are excellent.

The approach to children is different. Studies have found the almost all of these hernias will repair themselves by age 4 and that strapping the child's abdomen to keep the intestine from protruding is not helpful. If not healed after age 4 then surgery should be considered.

Another common abdominal hernia is the inguinal hernia. In an inguinal hernia, a part of the intestine pushes through an opening in the abdominal wall down into the inguinal canal.

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