Umbilical Hernia

A hernia is present at the site of the umbilicus (commonly called a navel, or belly button) in the newborn; although sometimes quite large, these hernias tend to resolve without any treatment by around the age of 2–3 years. Obstruction and strangulation of the hernia is rare because the underlying defect in the abdominal wall is larger than in an inguinal hernia of the newborn. The size of the base of the herniated tissue is inversely correlated with risk of strangulation (i.e. narrow base is more likely to strangulate).

What Is an Umbilical Hernia?

The umbilical cord connects a mother and her fetus while in the womb. Babies’ umbilical cords pass through a small opening in their stomach muscles. In most cases, the hole closes soon after birth. An umbilical hernia occurs when the stomach muscles don’t join completely and the intestine or other tissues bulge through this weak spot around the belly button (umbilicus).

Umbilical hernias are generally painless and don’t cause any discomfort. About 90 percent of umbilical hernias will eventually close on their own, according to Johns Hopkins Medicine. If an umbilical hernia doesn’t close by the time a child is 4 years old, it will need treatment.

What Causes Umbilical Hernias?

An umbilical hernia occurs when the opening in the stomach muscle that allows the umbilical cord to pass through fails to close completely. Umbilical hernias are most common in babies, according to the Mayo Clinic, but they can also occur in adults.

African-American babies, premature babies, or babies born at a low birth weight are at an even higher risk of developing an umbilical hernia. There is no noted difference in occurrence between boys and girls, according to Cincinnati Children’s Hospital Center.

An umbilical hernia in adults usually occurs when too much pressure is put on a weak section of the stomach muscles, due to factors including:

  • being overweight
  • frequent pregnancies
  • multiple gestation pregnancies (having twins, triplets, etc.)
  • fluid in the abdominal cavity
  • stomach surgery
  • having a persistent, heavy cough

What Are the Symptoms of an Umbilical Hernia?

Umbilical hernias can usually be seen when your baby is crying, laughing, or straining to use the bathroom. The telltale symptom is a swelling or bulge near the umbilical area — a symptom that isn’t present when your baby is relaxed.

Adults can get umbilical hernias as well. The symptoms are the same — a swelling or bulge near the navel area that can be very painful. Treatment usually is required.

The following symptoms may indicate a more serious situation that requires medical treatment:

  • the baby is in obvious pain
  • the baby is vomiting
  • the bulge (in both children and adults) is tender, swollen, or discolored

How Doctors Diagnose Umbilical Hernias?

A doctor will perform a physical exam to determine if an infant or adult has an umbilical hernia. The doctor will see if the hernia can be pushed back into the abdominal cavity (reducible). They’ll also examine the baby or adult to determine if the umbilical cord is trapped, or incarcerated. This is a serious complication because the trapped part of the intestine may be deprived of a blood supply.

Your doctor may take an X-ray or perform an ultrasound on the stomach area to ensure that there are no complications. They may order blood tests to look for infections, especially if the intestine is blocked or incarcerated.

Are There Any Complications Associated with Umbilical Hernias?

Complications from umbilical hernias rarely occur in children. However, additional complications can occur in both children and adults if the umbilical cord is incarcerated.

Intestines that can’t be pushed back through the stomach wall sometimes don’t get adequate blood supply. This can cause pain and even kill the tissue (known as gangrene), which could result in a dangerous infection. In addition, if an obstruction of the intestines occurs, emergency surgery might be required.

Contact your doctor or go to the emergency room immediately if the intestine becomes obstructed or strangulated.

Symptoms of a trapped or strangulated umbilical hernia include:

  • fever
  • constipation
  • severe abdominal pain
  • tenderness in the abdomen
  • vomiting
  • a bulging or round abdomen
  • redness or discoloration

Can Umbilical Hernias Be Repaired?

Surgery is usually suggested to make sure that no complications develop in adults. Umbilical hernias in children often fix themselves. Before choosing surgery, doctors will normally wait until the hernia:

  • becomes painful
  • is bigger than one-half inch in diameter
  • doesn’t shrink after one year
  • doesn’t go away by the time your child is 3 or 4 years old
  • becomes trapped or blocks the intestines

Before Surgery

Preparation for this surgery is minimal. You can continue to drink clear liquids up to three hours before surgery.

During Surgery

The surgery will last about an hour. The doctor will make an incision at the belly button where the bulge is. Then they’ll push the intestinal tissue back through the stomach wall. In children, the opening is closed with stitches. Doctors will often strengthen the stomach wall in adults with mesh.

Recovering from Surgery

Usually, the surgery is a same-day procedure. Activities for the next week or so should be limited, and you shouldn’t return to school or work during this time. Sponge baths are suggested until three days have passed.

The surgical tape over the incision should fall off on its own. If it doesn’t, wait to have it removed at the follow-up appointment.

Surgical Risks

Complications are rare, but can occur. Contact your doctor if you notice the following symptoms:

  • infection at the wound site
  • recurrence of the hernia
  • headache
  • numbness in the legs
  • nausea

What Is the Long-Term Outlook for Umbilical Hernias?

The majority of cases in babies will resolve on their own by age 3 or 4. If you think your baby may have an umbilical hernia, speak with your pediatrician. Seek emergency care if your baby seems to be in pain or the bulge becomes very swollen or discolored. Adults with a bulge on their stomach should also see a doctor.

Hernia surgery is a fairly simple and common procedure. While all surgeries have risks, most children are able to return home from an umbilical hernia surgery within a few hours. Mount Sinai Hospital recommends waiting three weeks after surgery to engage in heavy physical activity. It’s unlikely that the hernia will reoccur once it’s closed.