What is an umbilical hernia?
An umbilical hernia occurs when bowel, fat, or fluid protrudes through a weak point or defect in the abdominal-wall muscles around the navel, creating a bulge near the belly button. The umbilical ring around the cord normally closes gradually around the time of birth. If it does not close completely, the abdominal wall at that point is relatively weak. This makes umbilical hernia one of the more common types of hernia in infants and young children, though it can also occur in adults.
Umbilical hernias in infants and young children
After a newborn's umbilical cord falls off, many parents notice a soft bulge near the navel. It is often more obvious when the baby cries, coughs, or strains during a bowel movement, and may shrink when the baby lies down and relaxes. Umbilical hernias are usually painless, and in most cases a doctor can easily push the bulge back in.
What to watch for: A substantial proportion of umbilical hernias in infants and young children close naturally before the age of one or two as the abdominal-wall muscles develop, so surgery is not always necessary. Rather than deciding on their own, parents should bring the child back for regular follow-up so a doctor can assess the size of the opening and its progress toward closing.
When to be more alert: If a baby begins to vomit and the hernia bulge shows inflammatory signs such as redness, swelling, or darkening, it may be an incarcerated umbilical hernia, meaning that bowel has become trapped. Seek medical attention immediately.
Umbilical hernias in adults
Umbilical hernias in adults are easier to overlook and are commonly associated with the following factors:
- Pregnancy and the postpartum period: During pregnancy, the abdominal wall is stretched; after delivery, it may not yet have fully regained its tension
- Excess body weight: Persistently elevated abdominal pressure gradually stretches apart the abdominal-wall tissue around the umbilical ring
- Cirrhosis with ascites: Pressure inside the abdomen rises substantially. This is an important cause of umbilical hernia in adults, and the ascites and the underlying liver condition also need to be addressed
- Chronic coughing or long-term straining from constipation: Factors that raise abdominal pressure, similar to those involved in hernias elsewhere
Unlike umbilical hernias in infants and young children, abdominal-wall defects in adults generally do not heal on their own, and surgical repair is recommended in most cases. If cirrhosis and ascites are also present, assessing the timing of surgery and the risks of anesthesia is more complex and requires joint discussion between surgery and the relevant medical specialty, such as hepatology or gastroenterology.
Symptoms
- A soft bulge at the navel, more noticeable when standing or straining and possibly smaller when lying down
- A sense of fullness, pressure, or pulling discomfort in some people, which may worsen after prolonged standing or sitting
- A larger umbilical hernia may affect the appearance of the navel
Diagnosis
Most cases can be identified through a physical examination: observing and feeling the size and shape of the bulge, and checking whether it can be pushed back in. If another intra-abdominal condition is suspected, such as cirrhosis with ascites, an ultrasound or other imaging study may be arranged to assist the assessment.
Treatment
- Infants and young children: Most are observed over time, with the need for surgery assessed according to the size of the opening and the child's age. Surgery may be recommended if the hernia persists, grows, or is accompanied by another problem such as incarceration
- Adults: The abdominal-wall defect generally does not heal on its own, so surgical repair is recommended in most cases. The surgical approach and timing are decided after a doctor's assessment of the hernia's size, the condition of the abdominal wall, and whether ascites is present
Key takeaways
- Umbilical hernias do not occur only in infants; adults, especially people in the postpartum period, those with obesity, and those with ascites, can also develop them
- A substantial proportion of umbilical hernias in infants and young children close naturally before the age of one or two, but regular follow-up is still recommended
- Umbilical hernias in adults generally do not heal on their own, and surgical treatment is recommended in most cases
- Vomiting together with redness, swelling, or darkening is a warning sign of an incarcerated umbilical hernia in an infant or young child and requires immediate medical attention
