An umbilical hernia occurs when part of the bowel or fatty tissue pushes through a weak spot in the abdominal wall, near the navel.

There are different types of hernia. An umbilical hernia happens when there is a defect in the anterior abdominal wall, which underlies the umbilicus, or navel.

These hernias are very common in newborns and infants, but they can affect adults, too. Although umbilical hernias are easily treatable, on rare occasions, they can become a serious condition.

This article looks at the causes, risk factors, diagnosis, and treatment of umbilical hernias.

Umbilical hernias are the second most common form of hernia in adults. They occur within 3 centimeters (cm) of a person’s navel — either above or below it.

In infants and toddlers

Umbilical hernias are common in infants. They are present in approximately 10–30% of white children at birth, while various studies have shown a prevalence of 23–85% in African American children at birth. Doctors do not yet know the cause of this variance.

This type of hernia is particularly common in infants born preterm. Up to 84% of newborns with a birth weight of between 1 and 1.5 kilograms (kg) have an umbilical hernia.

While the developing fetus is in the womb, the umbilical cord passes through an opening in the abdominal wall. This should close soon after birth. However, the muscles do not always seal completely, leaving a weak spot through which an umbilical hernia can push.

In most cases, umbilical hernias in infants close without intervention by the age of 2 years.

In adults

Only 1 in 10 adults with umbilical hernias carry the condition from childhood, with about 90% of adults acquiring them as a result of issues with the abdominal muscles in later life. Increased pressure on the abdominal muscles, such as during pregnancy or when heavy lifting, raises the risk of acquired umbilical hernias.

Below are images of different umbilical hernias.

An umbilical hernia looks like a lump in the navel. It might become more obvious when the infant is laughing, crying, going to the toilet, or coughing. When the child is lying down or relaxed, the lump may shrink or go away completely.

The symptoms of an umbilical hernia will vary among cases. Regardless of the size of the hernia, if the abdominal wall constricts around it, this can cut off circulation to the protrusion, causing pain. The pain can range from mild to severe.

A person should visit a doctor if the bulge:

  • becomes painful
  • occurs alongside vomiting
  • swells up and becomes discolored
  • does not decrease when lying down or under light pressure

The major risk factors for umbilical hernias are:

  • Age: Infants, especially those born preterm, have a higher risk of an umbilical hernia than adults.
  • Obesity: Children and adults with obesity face a significantly higher risk of developing an umbilical hernia compared with individuals whose body mass index (BMI) falls within the healthy weight range.
  • Coughing: Having a cough for an extended period can increase the risk of hernias because the force of coughing applies pressure to the abdominal wall.
  • Pregnancies: The risk of umbilical hernia is higher among pregnant people. Multiple pregnancies carry a higher risk of hernia.

The causes of umbilical hernia are different among age groups.

Causes in infants

As the fetus develops in the womb, a small opening forms in the abdominal muscles. This opening allows the umbilical cord to pass through.

Around the time of birth, or shortly after, the opening should close. If this does not happen completely, fatty tissue or part of the bowel can poke through, causing an umbilical hernia.

Causes in adults

If there is too much pressure on the abdominal wall, some fatty tissue or a part of the bowel can poke through a weak section of the abdominal muscle.

Individuals at high risk are more likely to experience higher-than-normal pressure in areas where fatty tissue or parts of the gut can protrude.

A doctor will diagnose an umbilical hernia during a physical examination. They may also be able to determine the type of hernia. For example, if it involves the bowel, there may be a risk of obstruction.

If the doctor wants to screen for complications, they may request an abdominal ultrasound, an X-ray, or blood tests.

In infants, most umbilical hernias will resolve within 2 years, and treatment will not be necessary. However, a doctor may recommend surgery if:

  • the hernia is more than 1.5 cm across in children over the age of 2 years
  • the intestines are within the hernial sac, preventing or reducing intestinal movement
  • the hernia causes pain
  • skin discoloration occurs at the hernia site

If a hernia ruptures, emergency surgery is a necessity. However, hernia ruptures are extremely rare.

Hernias are less likely to resolve on their own in adults than in children. As a result, they are more prone to complications, and a person has a higher chance of needing surgery.

Surgery

Umbilical hernia surgery is a small operation that typically takes about 20–30 minutes. In most cases, the person receiving surgery will be able to go home on the same day.

Surgery involves making an incision at the base of the bellybutton and pushing the protruding tissue back into the abdomen. Surgeons may perform either open or laparoscopic surgery.

In many cases, the surgeon will then stitch the muscles of the abdominal wall together to close the hole. In some instances, they may use special meshes to reinforce the area and prevent a recurrence.

These meshes may be synthetic or come from animal tissue. Animal-based structures are absorbable in the body, whereas synthetic meshes are permanent implants. Some procedures use tacks to keep mesh structures in place. However, research has associated tacking with an increase in postoperative pain.

Preparing for surgery

Doctors will advise people to refrain from eating or drinking before surgery. It may also be necessary for people to stop taking anticoagulant medications to reduce the risk of bleeding.

Most surgeons will carry out umbilical hernia surgery with the individual under general anesthesia. An anesthesiologist will guide the person through this procedure before surgery.

Postsurgery care

Following discharge from the hospital, a person may feel pain and discomfort at the surgery site. Taking pain relievers, wearing loose clothing, and avoiding strenuous activities can help reduce this discomfort.

A person may also experience swelling around the site for several weeks.

The surgeon will sometimes apply a pressure dressing to the hernia. It is important to keep this clean and dry to avoid infection.

Wearing hernia support garments may help people recover from surgery and increase activity levels.

If the protrusion becomes trapped, and it is not possible to push it back into the abdominal cavity, the intestines might lose blood supply, causing damage.

If the hernia cuts off the blood supply to the protrusion, there is a risk of gangrene and life threatening infections. Incarceration is rare in adults and even less common in children.

Umbilical hernias occur when part of the bowel or some fatty tissue protrudes from a hole in the abdominal muscles. For doctors to classify a protrusion as an umbilical hernia, it must occur within 3 cm of the naval.

This type of hernia is common in infants and typically resolves independently. The majority of umbilical hernias in adults result from extra pressure on the abdominal wall. This extra pressure may come from carrying multiple pregnancies or straining intensely.

There is a higher risk of complication in adult umbilical hernias, and these almost always require surgery to correct. Hernia surgery typically takes about 20–30 minutes, and the person will be under general anesthetia for the duration of the procedure.

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