UMBILICAL HERNIA

UMBILICAL HERNIA

AETIOPATHOGENESIS

IN AYURVEDA:

• Umbilical hernia may be correlated with Nabhi-gata Vikara or Antra Vriddhi.

• The displacement or weakening of Nabhi marma (vital point at umbilicus) due to Vata prakopa and Mamsa-Snayu-Kshaaya can cause protrusion of intestines.

• Improper formation or weakness of Garbha-nabhi nadi during fetal development is considered a congenital cause.

• Acquired causes include:

  • Ati-bharavahana (carrying heavy weight)

  • Ati-vegavarodha (suppressing natural urges)

  • Atipranaayaama, Atijatharaagni, Atyambu paana etc.

🔸 Reference:
“नाभ्याः प्रवृद्धान्तरमशुचिर्नाभ्यां सप्रपतनः स्यात् ।
मांसस्नाय्वस्थिसन्धिप्रदूषणाज्जायते शूलयुक्तः ॥”
— Sushruta Samhita, Nidana Sthana 6/31

IN MODERN MEDICINE:

• A hernia is defined as protrusion of an organ or tissue through a defect in its surrounding walls.

• Umbilical hernia occurs when abdominal contents protrude through the umbilical ring.

• Congenital:

  • Due to incomplete closure of umbilical ring after birth.

• Acquired:

  • Obesity

  • Pregnancy

  • Ascites

  • Chronic cough

  • Straining during micturition or defecation

  • Postoperative weakness

CLASSIFICATION

AYURVEDIC CLASSIFICATION:

• Not directly classified in Ayurvedic texts but can be interpreted under:

  • Antra Vriddhi

  • Chhiddra Roga

  • Kshataja roga involving Nabhi marma

MODERN CLASSIFICATION:

1. Congenital Umbilical Hernia:

   • Present at birth

   • Common in infants

   • Often closes spontaneously by 2–3 years

2. Acquired Umbilical Hernia:

   • Occurs in adults

   • More common in females due to multiple pregnancies

3. Paraumbilical Hernia:

   • Slightly above or below the umbilicus

   • Contains omentum or bowel

CLINICAL FEATURES

AYURVEDIC DESCRIPTION:

• Swelling at the Nabhi pradesha

• Shoola (pain)

• Gourava (heaviness)

• Anaha, Adhmana (abdominal distension)

• Symptoms aggravated on straining or exertion

MODERN DESCRIPTION:

• Visible bulge at the umbilicus, especially while crying, coughing, or straining

• May reduce on lying down

• Soft, reducible swelling

• Discomfort or pain over the swelling

• Strangulated hernia: irreducible, tender, signs of intestinal obstruction

EXAMINATIONS

INSPECTION:

• Swelling over umbilical region

• Cough impulse present

• Skin changes in case of chronicity

PALPATION:

• Soft and reducible swelling

• Positive cough impulse

• Defect in linea alba felt

PERCUSSION:

• Resonant if bowel present

AUSCULTATION:

• Bowel sounds may be heard over the hernia

INVESTIGATIONS & DIAGNOSIS

MODERN INVESTIGATIONS:

• Ultrasound abdomen – to confirm contents and defect size

• X-ray abdomen (erect) – if intestinal obstruction suspected

• CT scan – for detailed anatomical assessment

• Blood tests – CBC, renal function, if surgery planned

DIAGNOSIS BASED ON:

• Clinical history and examination

• Radiological findings

COMPLICATIONS

• Incarceration – herniated content stuck and non-reducible

• Strangulation – compromised blood supply → necrosis

• Obstruction – intestinal obstruction due to trapped bowel

• Infection – especially if skin is stretched and excoriated

• Recurrence – after incomplete repair

MANAGEMENT

AYURVEDIC MANAGEMENT:

🔸 Initial Management:

• Deepana-Pachana for Ama pachana

• Vatahara chikitsa

• Abhyanga, Swedana over abdomen to relieve pain

• Bandhana – mechanical support using cloth or belt

🔸 Internal Medicines:

• Trikatu + Hingvashtaka Churna – for Vata-Anulomana

• Dashamoola Kwatha – Vatahara

• Eranda Taila – Vata anulomaka

🔸 Basti Chikitsa (Matra/Anuvasana Basti) – to regulate Vata

🔸 Surgical Management (if conservative fails or in large hernia):

• Can be equated with Chedana Karma

• Pre-operative Snehana-Swedana

• Ksharasutra not directly applicable but supportive in wound healing

• Post-operative Vrana Shodhana and Ropana Chikitsa

🔸 Reference:
“तत्र च विपुलमांसं स्नेहसिद्धैर्द्रवैरुपतप्तं
छित्वा प्रदूषितमांसं विनिर्हृत्य सम्यगुपचरेत् ॥”
— Sushruta Samhita, Chikitsa Sthana 17/58

MODERN MANAGEMENT:

🔸 Conservative:

• Observation in infants (<2 years), as many cases resolve spontaneously

• Avoid activities increasing intra-abdominal pressure

🔸 Surgical:

• Herniorrhaphy – hernial sac reduced and defect sutured

• Hernioplasty – use of synthetic mesh to reinforce abdominal wall (for large/recurrent hernia)

🔸 Emergency surgery:

• For incarcerated or strangulated hernia