Umbilical Hernia

What is an umbilical hernia?

An umbilical hernia is an unusual bulge you can often see or feel over your belly button (umbilicus). It develops when part of your small intestine, together with fat or fluid, forms a sac. The sac pushes through an opening or weakness in your abdominal wall muscle.

While they may look or feel alarming, umbilical hernias are usually not serious. But it’s important to contact a healthcare provider so they can take a look. Umbilical hernias are most common in newborns, babies and young children. But adults can get them, too.

Umbilical hernias are three times more common in people with a vagina than in people with a penis.

What are the symptoms of an umbilical hernia?

Umbilical hernia symptoms are similar in adults and children. The most common sign is a visible bulge on or near your belly button that’s soft to the touch. For some people, the bulge is always visible. In other cases, you can only see the bulge when there’s pressure on your abdomen. For example, you may not notice the bulge until you lift something heavy. In newborns and babies, sometimes the bulge doesn’t appear until they’re crying.

They’re usually painless in children. Adults with umbilical hernias are more likely to experience discomfort, dull pain or pressure.

Symptoms that should alert you of a problem with your hernia requiring emergency care include:

• Sharp, sudden or worsening pain in your abdomen
• Bulge that’s red, darkened, purple and firm
• Blood in your poop
• Nausea and vomiting

What causes an umbilical hernia?

Causes are different in children and adults.

Umbilical hernia causes in children

Umbilical hernias in children happen when the holes in their abdominal walls that allow the umbilical cord to pass through (the umbilical ring) don’t fully close.

During pregnancy, the umbilical ring allows the umbilical cord to pass from the birthing parent to the fetus. After birth, the ring in the abdominal wall starts to close. It’s usually completely closed by age 5. In the meantime, hernias can form through that opening.

Umbilical hernia causes in adults

In adults, umbilical hernias happen when pressure in your abdomen causes weaknesses in your abdominal wall muscles. Parts of your small intestine and related tissue can bulge through the weakened muscle.

Several factors can increase your risk, including:

• Sex. People with vaginas are more likely to have umbilical hernias.
• Obesity. Umbilical hernias are more common in adults with obesity.
• Multiple births. People who’ve given birth multiple times have a higher risk of umbilical hernias.
• Fluid buildup in your abdomen (ascites). People with cirrhosis of the liver are at a greater risk of developing umbilical hernias due to developing ascites.
• Previous abdominal surgeries. Procedures on your abdomen that weaken the muscle wall can increase your risk for a hernia.

What are the complications of an umbilical hernia?

Possible complications are that the hernia becomes:

• Incarcerated: This is when your small intestine gets stuck in the hernia, causing problems like a small bowel obstruction (a blockage in your intestine).
• Strangulated: This is when the blood supply to your intestines is cut off, causing the tissue to die. It’s a medical emergency that requires quick action.

Umbilical hernias are usually not dangerous in babies. In adults, there’s a higher risk of complications. It’s important for you and your provider to monitor your hernia and time treatment to prevent the hernia from progressing.

How is an umbilical hernia diagnosed?

A physical exam is usually enough to diagnose an umbilical hernia. Your healthcare provider may ask you to squeeze or contract your abdominal muscles so it’s easier for them to see and feel the bulge.

To check for complications (like incarceration or a bowel obstruction), they may use imaging to see inside your abdomen. Common imaging procedures include an abdominal ultrasound and a CT scan.

Does an umbilical hernia need treatment?

It depends on how severe it is. Children may not need treatment because the hernia eventually goes away. More than 90% of children with umbilical hernias heal by the time they’re 5 years old. In the meantime, your provider may be able to use their hands to push the hernia back into place. A reducible umbilical hernia is one that your provider can treat by pressing the herniated tissue back into place.

You should never attempt to put your child’s hernia back into place. Although you may be trying to help your child, you may injure them instead.

Surgical treatment for umbilical hernias

If your child does need treatment, surgery can help. Your child is more likely to need surgery if their hernia is:

• Incarcerated or strangulated
• Larger than 2 centimeters (around ¾ of an inch)
• Still present by the time they’re 5 years old
• Painful

Most adults eventually need surgery. Umbilical hernias in adults are more likely to worsen and cause complications.

During the procedure to treat umbilical hernia, a surgeon makes incisions (cuts) that allow them to access the hernia and push the tissue back into place. Then, they strengthen the abdominal wall muscle to hold the tissue in place. Sometimes, they use a material called surgical mesh to strengthen the tissue barrier.

How can I lower my risk of an umbilical cord hernia?

There’s nothing you can do to prevent your child from having an umbilical cord hernia. Prevention isn’t always possible in adults, either.

As an adult, you can reduce your risk of a hernia by avoiding activities that create pressure inside your abdomen (like repeated heavy lifting). Also, trying to maintain a weight that’s healthy for you can reduce your risk of developing a hernia.

What can I expect if I have an umbilical hernia?

Umbilical hernias usually have a positive outcome. Most childhood hernias heal naturally over time. Surgery to treat umbilical hernias is also very effective, and the risk of the hernia coming back is low.

Will an umbilical hernia come back?

It’s possible for an umbilical hernia to return after surgery, but it’s uncommon. Ask your healthcare provider what you can do to reduce your risk of a hernia coming back.

When should I seek care?

See a healthcare provider if you notice a bulge at your belly button. Once your healthcare provider diagnoses your hernia, they can advise you on when it may need surgery and when you can monitor it. If you or your child has a hernia, they can help you identify symptoms that should prompt you to seek care, including:

• Pain (signs of pain in an infant may include irritability, crying or refusing to eat)
• A bulge that’s getting bigger
• Nausea & vomiting
• Constipation
• Bloody stool
• A bulge that feels firm, is darkening or changing color

What questions should I ask my healthcare provider?

Questions to ask include:

• How serious is my hernia?
• Does my hernia need treatment?
• How often will I need appointments to monitor my hernia?
• Should I adjust my activity levels or lifestyle to prevent complications?
• What lifestyle changes should I make to reduce the risk of my hernia worsening or returning?