From the Guidelines
Umbilical hernias are often associated with diastasis recti, and their management should consider the interplay between these two conditions to prevent recurrence and improve outcomes. The relationship between umbilical hernia and diastasis recti is complex, with increased abdominal pressure from conditions like ascites contributing to the development of hernias, as noted in patients with cirrhosis 1.
Key Considerations
- Increased abdominal pressure can lead to rapidly enlarging hernias, and optimal fluid control, nutrition, and conservative management may minimize or prevent hernia development and progression 1.
- The presence of diastasis recti can increase intra-abdominal pressure and reduce structural support around the umbilicus, contributing to hernia formation.
- Surgical repair addressing both the umbilical hernia and diastasis recti simultaneously is often recommended for symptomatic or enlarging hernias, typically through an abdominoplasty-type procedure with rectus muscle plication and hernia repair.
Management Approach
- For small umbilical hernias, primary suture repair may be sufficient, while larger hernias generally require mesh reinforcement.
- Post-operative care includes wearing an abdominal binder, avoiding heavy lifting, and gradually returning to normal activities, with physical therapy focusing on core strengthening recommended starting 6-8 weeks after surgery.
- Conservative measures like physical therapy alone may help with mild diastasis but typically won't resolve an established umbilical hernia.
Outcome Prioritization
- The management of umbilical hernias associated with diastasis recti should prioritize reducing morbidity, mortality, and improving quality of life, considering the potential complications of hernia incarceration, pressure necrosis, rupture, evisceration, and peritonitis 1.
- The approach to management should be individualized, considering factors such as the size of the hernia, the severity of diastasis recti, and the patient's overall health status.