Umbilical Hernia (Belly Button Hernia)

What causes an umbilical hernia

In babies

Before birth, the umbilical cord passes through an opening in the abdominal muscles. This normally closes soon after birth. If it closes incompletely, fat or bowel can push through, creating a bulge that becomes more noticeable when the baby cries, coughs or strains.

Umbilical hernias are more common in:

• premature and low-birth-weight babies
• Black infants
• babies with Down syndrome, congenital hypothyroidism and some other conditions

Crying does not cause the hernia, and the hernia rarely causes pain in babies.

In adults

Adult umbilical hernias usually develop over time from increased pressure inside the belly:

• obesity
• pregnancy, especially multiple pregnancies
• heavy lifting or straining
• chronic cough
• constipation
• fluid in the abdomen (ascites), such as from liver cirrhosis
• previous abdominal surgery near the belly button, including laparoscopic port sites (these become incisional hernias)

Symptoms

• a soft bulge at or near the belly button
• the bulge gets bigger when coughing, straining, standing or crying, and smaller when lying down
• mild aching or discomfort, especially in adults
• in adults, the hernia may slowly enlarge over time

Signs of a trapped hernia

• incarcerated hernia: the bulge is stuck and cannot be pushed back
• strangulated hernia: the trapped tissue loses its blood supply and can cause bowel obstruction, causing severe pain, redness or dark discoloration, vomiting and fever; this needs emergency surgery

Strangulation is rare in children and more common in adults, especially with small defects.

Umbilical hernia vs diastasis recti

Diastasis recti is a widening of the gap between the two vertical abdominal muscles, common after pregnancy. It causes a ridge down the middle of the belly when straining but no true hole. The two can occur together.

Diagnosis

Diagnosis is usually by examination, which also checks for other hernias in the groin or abdominal wall: the doctor feels the bulge and the size of the opening, often while you cough or stand. Ultrasound or CT can help in larger people, when the diagnosis is unclear, or to plan surgery.

Treatment

Babies and children

• watchful waiting: most close by age 4 to 5
• surgery is usually recommended if the hernia is still present by age 4 to 5, the opening is large (over about 1.5 to 2 cm), it is getting bigger, or it becomes trapped
• taping coins or binding the belly does not help and can irritate the skin

Adults

• surgical repair is usually recommended for symptomatic hernias and many asymptomatic ones, because adult hernias do not close and can become trapped
• very small, painless hernias in people with high surgical risk may be watched
• repair methods: stitches alone for very small defects; mesh is recommended for most defects of 1 cm or larger to reduce recurrence
• open or laparoscopic/robotic surgery depending on hernia size, body weight and other factors
• in people with cirrhosis and ascites, repair is planned carefully with control of fluid

Before surgery

• lose weight if possible
• stop smoking, which improves healing and lowers recurrence
• control blood sugar if you have diabetes
• treat chronic cough and constipation

Recovery

Most people go home the same day. Light activity resumes within days, and heavy lifting is usually avoided for 4 to 6 weeks, depending on the repair.

Frequently asked questions

Is an umbilical hernia in a baby dangerous?

Usually not. Most umbilical hernias in babies are painless and close on their own by age 4 to 5. Complications are rare. See a doctor urgently if the bulge becomes hard, tender or discolored or your baby is vomiting.

Can an umbilical hernia go away on its own in adults?

No. Adult umbilical hernias do not close by themselves and often get bigger over time. Repair is commonly recommended, especially if the hernia causes symptoms or is at risk of becoming trapped.

What are the symptoms of a strangulated umbilical hernia?

Signs include sudden severe pain at the hernia, a firm bulge that cannot be pushed back, red, purple or dark skin over it, nausea, vomiting and fever. This is a surgical emergency.

What happens if an umbilical hernia is not treated?

Small hernias may stay unchanged for years, but many grow and become more uncomfortable. There is a risk of incarceration or strangulation, which requires emergency surgery with higher risk than planned repair.

How long is recovery after umbilical hernia surgery?

Most people return home the same day and resume light activities within a few days. Avoid heavy lifting and strenuous exercise for about 4 to 6 weeks, or as your surgeon advises.