Umbilical hernia

Overview

Symptoms

An umbilical hernia creates a soft swelling or bulge near the navel. In babies who have an umbilical hernia, the bulge may be visible only when they cry, cough or strain.

Umbilical hernias in children are usually painless. Umbilical hernias that appear during adulthood may cause abdominal discomfort.

When to see a doctor

If you suspect that your baby has an umbilical hernia, talk with the baby's doctor. Seek emergency care if your baby has an umbilical hernia and:

• Appears to be in pain
• Begins to vomit
• Has tenderness, swelling or discoloration at the site of the hernia

Similar guidelines apply to adults. Talk with your doctor if you have a bulge near your navel. Seek emergency care if the bulge becomes painful or tender. Prompt diagnosis and treatment can help prevent complications.

Causes

During gestation, the umbilical cord passes through a small opening in the baby's abdominal muscles. The opening normally closes just after birth. If the muscles don't join together completely in the midline of the abdominal wall, an umbilical hernia may appear at birth or later in life.

In adults, too much abdominal pressure contributes to umbilical hernias. Causes of increased pressure in the abdomen include:

• Obesity
• Multiple pregnancies
• Fluid in the abdominal cavity
• Previous abdominal surgery
• Long-term peritoneal dialysis to treat kidney failure

Risk factors

Umbilical hernias are most common in infants — especially premature babies and those with low birth weights. In the United States, black infants appear to have a slightly increased risk of umbilical hernias. The condition affects boys and girls equally.

For adults, being overweight or having multiple pregnancies may increase the risk of developing an umbilical hernia. This type of hernia tends to be more common in women.

Complications

For children, complications of an umbilical hernia are rare. Complications can occur when the protruding abdominal tissue becomes trapped (incarcerated) and can no longer be pushed back into the abdominal cavity. This reduces the blood supply to the section of trapped intestine and can lead to abdominal pain and tissue damage.

If the trapped portion of intestine is completely cut off from the blood supply, it can lead to tissue death. Infection may spread throughout the abdominal cavity, causing a life-threatening situation.

Adults with umbilical hernias are somewhat more likely to experience a blockage of the intestines. Emergency surgery is typically required to treat these complications.

Diagnosis

An umbilical hernia is diagnosed during a physical exam. Sometimes imaging studies — such as an abdominal ultrasound or a CT scan — are used to screen for complications.

Treatment

Most umbilical hernias in babies close on their own by age 1 or 2.Your doctor may even be able to push the bulge back into the abdomen during a physical exam. Don't try this on your own, however.

Although some people claim a hernia can be fixed by taping a coin down over the bulge, don't try this. Placing tape or an object over the bulge doesn't help and germs may accumulate under the tape, causing infection.

For children, surgery is typically reserved for umbilical hernias that:

• Are painful
• Are slightly larger than 1/4 to 3/4 inch (1 to 2 centimeters) in diameter
• Are large and don't decrease in size over the first two years of life
• Don't disappear by age 5
• Become trapped or block the intestine

For adults, surgery is typically recommended to avoid possible complications, especially if the umbilical hernia gets bigger or becomes painful.

During surgery, a small incision is made near the bellybutton. The herniated tissue is returned to the abdominal cavity, and the opening in the abdominal wall is stitched closed. In adults, surgeons often use mesh to help strengthen the abdominal wall.

Preparing for an appointment

If you or your child has signs or symptoms common to an umbilical hernia, make an appointment with your family doctor or your child's pediatrician.

Here's some information to help you prepare for your appointment and know what to expect from your doctor.

What you can do

• List any signs or symptoms you or your child has had, and for how long.
• Bring in a photo of the hernia if signs of the problem aren't always evident.
• Write down key medical information, including any other health problems and the names of any medications you or your child is taking.
• Write down questions you want to be sure to ask your doctor.

Questions to ask your doctor

• Is the swelling near my or my child's bellybutton an umbilical hernia?
• Is the defect large enough to require surgery?
• Are any tests needed to diagnose the swelling?
• What treatment approach do you recommend, if any?
• Might surgery become an option if the hernia doesn't get better?
• How often should I or my child be seen for follow-up exams?
• Is there any risk of complications from this hernia?
• What emergency signs and symptoms should I watch for at home?
• Do you recommend any activity restrictions?
• Should a specialist be consulted?

If any additional questions occur to you during your visit, don't hesitate to ask.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

• When did you first notice the problem?
• Has it gotten worse over time?
• Are you or your child in pain?
• Have you or your child vomited?
• If you are the one affected, do your hobbies or your work involve heavy lifting or straining?
• Have you or your child recently gained a lot of weight?
• Have you or your child recently been treated for another medical condition?
• Do you or your child have a chronic cough?