How is umbilical hernia in adults (para-umbilical)?

Protrudes through linea alba just above umbilicus or occasionally below it, called paraumbilical middle aged or elderly women (1:5) Risk factors: obesity, multiparous women, persistent source of straining (chronic cough, constipation, bladder neck obstuction) Content is greater omentum accompanied w/small intestine or a portion of transverse colon, sac is loculated in most cases and hernia is irreducible. Swelling in umbilical region, small and gradually increases in size Dragging pain due to adherent omentum, firm swelling, dull on percussion, cough impulse when contents arenot adherent but absent when irreducible.