Although umbilical hernias are easily treatable, in rare situations they can become a serious condition.
In this article, we will look at the causes, risk factors, diagnosis, and treatment of umbilical hernias.
Here are some key points about umbilical hernias. More detail and supporting information is in the main article.
- Umbilical hernias are particularly common in premature babies
- They are not normally painful, but if they become sore, a doctor should be consulted
- Umbilical hernias in adults are more common in females than males
- Obesity is a risk factor for umbilical hernias
- Diagnosis of an umbilical hernia can normally be confirmed by a physical examination alone
What is an umbilical hernia?
An umbilical hernia occurs when part of the bowel or fatty tissue pokes through an area near the belly button.
Umbilical hernias are common in young infants, but the exact rate is not known because many cases go unreported and resolve themselves without the need for treatment.
They are particularly common in premature babies; up to 75 percent of babies born under 1.5 kilograms in weight have an umbilical hernia.
While the developing fetus is in the uterus (womb), the umbilical cord passes through an opening in the abdominal wall, which should close soon after a baby is born.
However, sometimes the muscles do not completely seal, leaving a weak spot through which an umbilical hernia can develop.
An umbilical hernia looks like a lump in the navel, which might become more obvious when the baby is laughing, crying, going to the toilet, or coughing. When the child is lying down or relaxed, the lump may shrink. It is not usually painful.
In the majority of cases, an infant's umbilical hernia closes on its own by the age of 12 months. If the hernia is still there by the time the child is 4 years old, a doctor may recommend surgery.
Umbilical hernias might also develop in adults, especially if they are very overweight, lifting heavy objects, or have a persistent cough. Women who have had multiple pregnancies have a higher risk of developing an umbilical hernia.
In adults, hernias are much more common in females. Among infants, the risk is about the same for boys and girls.Symptoms
There may be a soft bulge/swelling near the umbilicus (navel), ranging from 1-5 centimeters in diameter. The bulge is usually more noticeable if the baby cries, laughs, coughs, or strains.
Pain - in children and infants, umbilical hernias are not usually painful. However, adults may feel pain or discomfort if the hernia is large.
When to see a doctor:
- The bulge becomes painful
- The infant/adult vomits (and there is a bulge)
- The bulge swells up more
- The bulge becomes discolored
- You used to be able to reduce the hernia (i.e. push the bulge flat against the abdomen), but now it cannot be reduced without significant pain/tenderness
The major risk factors for umbilical hernias are:
Age - infants, especially those born prematurely, have a higher risk of having an umbilical hernia than older people.
Being obese - obese children and adults have a significantly higher risk of developing an umbilical hernia, compared with individuals of normal weight for their height and age.
Coughing - having a cough for a long period of time increase the risk of hernias because the force of coughing applies pressure to the abdominal wall.
Multiple pregnancies - when the pregnant mother is carrying more than one baby inside her. The risk of an umbilical hernia is higher if the woman has a multiple pregnancy.Causes
Babies - as the fetus develops in the mother's uterus (womb), there is a small opening in the abdominal muscles allowing the umbilical cord to pass through - this connects the mother to the baby.
Around the time of birth, or shortly after, this opening in the abdominal muscles should close. When this does not happen - if the opening does not close completely, fatty tissue or part of the bowel can poke through, causing an umbilical hernia.
Adults - if there is too much pressure on the abdominal wall, fatty tissue or a part of the bowel can poke through a weak part of the abdominal muscle. Individuals at high risk are more likely to have higher-than-normal pressure in areas where fatty tissue or parts of the gut can protrude.diagnosis
A doctor will be able to diagnose an umbilical hernia during a physical examination. He/she may also be able to determine what is protruding - what is caught in the hernia sac.
If the doctor wants to screen for complications, an abdominal ultrasound, X-ray, or blood tests may be ordered.
Babies and children - in the majority of cases, the hernia closes on its own by the age of 12 months. Sometimes, the doctor may be able to push the lump back into the abdomen (it is important that only the doctor does this).
Surgery may be ordered if:
- The hernia grows after the child is 1-2 years old
- The bulge is still there by the age of 4
- If the intestines are within the hernial sac, preventing or reducing the movement of the intestines (called peristalsis)
- If the hernia becomes trapped
Adults - surgery is usually recommended, to prevent potential complications, especially if the hernia grows or starts to hurt.
Umbilical surgery is a quick procedure.
Umbilical hernia surgery is a small, quick operation to push the bulge back into place and to make the abdominal wall stronger.
In most cases, the patient will be able to go home on the same day.
The surgeon makes an incision at the base of the belly button and pushes either the fatty lump or bowel back into the abdomen.
Muscle layers are stitched over the weak area in the abdomen wall, effectively strengthening it.
Dissolvable stitches or a special glue are used to close the wound. Sometimes, the surgeon will place a pressure dressing, which remains there for 4-5 days.
An umbilical hernia operation usually takes about 20-30 minutes.Complications
Umbilical hernia complications are very rare in children. If the protrusion becomes incarcerated (trapped) and cannot be pushed back into the abdominal cavity, the primary concern is that the intestines might lose some of its blood supply and become damaged.
If the blood supply is completely cut off, there is a risk of gangrene and life-threatening infection. Incarceration is rare in adults, but even rarer in children.