What is an umbilical hernia?

An umbilical hernia is an abnormal bulge, or protrusion, that can be seen or felt over the belly button (the umbilicus). An umbilical hernia develops when a portion of the intestine, along with fat or fluid, bulges through the muscle of the abdominal wall (see illustration).

Umbilical hernias in children result from an opening in the abdominal wall that is present at birth. The bulge in the umbilicus may be present all the time or may only be noticed when the child is crying, coughing, or straining during a bowel movement. It may disappear when the child is quiet.

How common is umbilical hernia?

Umbilical hernias occur in 1 of every 6 children, and affect boys and girls equally. Umbilical hernias are more common among African-American children than Caucasian children. In addition, low birth weight and premature infants are more likely to have umbilical hernias.

What causes an umbilical hernia?

During a baby's development in the womb, the abdominal organs are formed on the outside of the baby's body and return to the abdominal cavity around the 10th week of gestation. If the muscles of the abdominal wall fail to close around the abdominal organs, an umbilical hernia may form.

Sometimes, the intestines can get trapped in this muscular defect and cause umbilical pain and tenderness. This is called an incarcerated hernia and needs to be evaluated by a medical professional to prevent damage to the intestines. With an incarcerated hernia, the child usually has severe pain and the bulge may be red and firm.

When should an umbilical hernia be repaired?

More than 90% of umbilical hernias heal on their own by the time the child is 3 to 4 years old. Therefore, your surgeon will probably recommend waiting until your child is 3 or 4 before advising surgical repair. However, if the umbilical hernia is incarcerated or the defect is greater than 2 cm (about ¾ inch) in diameter, it is less likely to heal spontaneously and may need to be surgically repaired.

What should I know before my child’s surgery?

Umbilical surgery takes about an hour and is usually performed as an outpatient procedure (which means the patient can go home the same day of the procedure).

Strict guidelines are enforced regarding the child's diet the morning of the surgery. These will help reduce the risk of vomiting and aspiration (inhaling fluids) while your child is under anesthesia. Your surgeon’s specific guidelines will be closely reviewed with you before your child’s surgery.

What happens during the surgery?

  • An anesthesiologist (a doctor who specializes in sedation and pain relief) gives your child general anesthesia, which relaxes your child's muscles and induces sleep. Your child will not feel pain during the surgery.
  • A small incision, or cut (from 1 to 3 cm, approximately 1/3 inch to 1 ¼ inch), is made at the base of the belly button.
  • The hernia "sac" containing the bulging intestine is identified.
  • The surgeon pushes the intestine back into its proper place behind the muscle wall.
  • The hernia sac is removed.
  • The muscle wall is reinforced with multiple layers of stitches to prevent another hernia.
  • The skin around the belly button is sewn down to the underlying muscle.

Most children will be able to go home a few hours after surgery. However, premature infants and children with certain medical conditions may need to spend one night in the hospital for observation.

How I care for my child after surgery?

Usually, your child will feel fine again the evening after surgery or by the next morning. You may be given a prescription for pain medication. Most parents find that only a few doses are all the child needs for pain control. After that, over-the-counter pain relievers are usually enough to keep the child comfortable.

As soon as your child is able, he or she can resume normal eating habits.

Your child's activities will be temporarily restricted to prevent damage to the operative site. Your child should not ride a bike, play on a jungle gym, wrestle, or participate in organized sports until the surgeon re-evaluates your child at the follow-up visit.

You may give your child a sponge bath the first few days after surgery. Your surgeon will advise you when it is safe for a tub bath.

When do I call my child's care provider?

You may notice some minor swelling or discoloration around the incision. This is normal. However, call your health care provider if your child is unable to urinate, or has a fever, excessive swelling, redness, bleeding, or increasing pain.

A follow-up appointment will be scheduled from 21 to 28 days after your child's surgery. Your health care provider will assess your child's wound site and his or her recovery.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 3/23/2017…#6241