Umbilical Hernia

An umbilical hernia occurs when a part of the intestine or other abdominal contents pushes through a weak spot in the abdominal wall near the navel (umbilicus). In infants, this is often a congenital condition, meaning it's present from birth, due to the umbilical ring not closing completely after the umbilical cord is removed. In adults, umbilical hernias are acquired, developing due to increased pressure inside the abdomen combined with a weakening of the abdominal wall at the navel. While most umbilical hernias in infants close on their own by age 4-5, adult hernias do not resolve spontaneously and may require treatment, especially if they cause symptoms or complications.

Symptoms

A soft swelling or bulge near the navel (umbilicus).
The bulge may become more noticeable when coughing, crying, laughing, or straining.
The bulge may disappear or reduce when lying down or relaxed.
Most hernias are asymptomatic or cause only mild discomfort.
A dull ache or pressure sensation at the hernia site, especially after prolonged standing or physical activity.
Sudden, sharp, or severe pain at the hernia site (emergency symptom).
The hernia becomes tender, swollen, and firm (emergency symptom).
The bulge can no longer be pushed back into the abdomen (irreducible, emergency symptom).
Discoloration of the skin over the hernia (red, purple, or dark, emergency symptom).
Nausea and vomiting (emergency symptom).
Fever (emergency symptom).
Abdominal distension and inability to pass gas or have a bowel movement (signs of bowel obstruction, emergency symptom).

Causes & Risk Factors

Congenital: Incomplete closure of the umbilical ring, the muscular opening through which the umbilical cord passes during fetal development, allowing abdominal contents to protrude.
Acquired: A combination of weakness in the abdominal wall at the umbilicus and sustained or repeated increase in intra-abdominal pressure, forcing tissue to bulge through a gap in the muscle and fascia.
For infants: Prematurity, low birth weight, African-American ancestry, certain congenital conditions (e.g., Beckwith-Wiedemann syndrome, Down syndrome).
For adults: Obesity (BMI > 30), multiple pregnancies (multiparity), ascites (fluid in the abdomen), previous abdominal surgery, chronic conditions causing increased intra-abdominal pressure (e.g., chronic cough, chronic constipation, benign prostatic hyperplasia), heavy lifting, female sex.
Modifiable risk factors: Obesity/overweight, lifting heavy weights, chronic cough, chronic constipation.
Non-modifiable risk factors: Age, sex (female > male for acquired hernias), race/ethnicity (for congenital hernias), genetic predisposition to connective tissue weakness, history of multiple pregnancies, congenital weakness of the umbilical ring.

Diagnosis

Patient report of a bulge at the umbilicus, including onset, duration, pain, reducibility, and exacerbating factors.
Inquiry about emergency symptoms like severe pain, vomiting, or constipation.
Physical examination of the umbilicus in both lying down and standing positions.
Palpation to determine the size of the fascial defect, assess for tenderness, and test if the hernia can be pushed back in (reducibility).
Provocative maneuvers, such as asking the patient to cough or strain, to make the hernia more apparent.
Ultrasound imaging may be used if the diagnosis is uncertain, if there is significant obesity, or if complications are suspected, to confirm the hernia and identify its contents.
CT Scan imaging may be used for detailed anatomical information, complex cases, surgical planning, or evaluating for bowel obstruction.

Treatment Options

Watchful waiting for infants: Most congenital umbilical hernias close spontaneously by age 4-5 years.
Watchful waiting for adults: An option for small (<1-2 cm), asymptomatic, and easily reducible hernias, with counseling on emergency symptoms.
Surgical repair for children: Indicated if the hernia persists after age 4-5, is very large, becomes symptomatic, or incarcerates (becomes trapped).
Surgical repair for adults: Indicated for symptomatic hernias (pain, discomfort), incarceration/strangulation, large defect size, or patient preference.
Open Hernia Repair: An incision is made over the hernia, the protruding tissue is returned to the abdomen, and the fascial defect is closed. Mesh is typically used for defects larger than 1-2 cm to reduce recurrence.
Laparoscopic Hernia Repair: Small incisions are made away from the hernia, and the repair is performed using a camera and specialized instruments. Mesh is placed from inside the abdomen.
Emergency surgery: Required for incarcerated or strangulated hernias to restore blood flow and repair the defect, potentially involving bowel resection if tissue is non-viable.

Frequently Asked Questions

Will my baby's umbilical hernia go away on its own?

Yes, for infants, the prognosis is excellent. Approximately 90% of congenital umbilical hernias close spontaneously by age 4-5 years.

At what age should my child have surgery if the hernia hasn't closed?

Surgery is typically indicated if the hernia persists after age 4-5 years, is very large, becomes symptomatic, or becomes trapped (incarcerates).

Is an umbilical hernia in an adult dangerous?

Acquired umbilical hernias in adults do not resolve on their own and tend to remain stable or gradually enlarge. While the risk of complications like incarceration (trapped tissue) or strangulation (loss of blood supply) for asymptomatic hernias is low, these are serious medical emergencies that require immediate attention.

Do all adult umbilical hernias need to be repaired?

No, not all adult umbilical hernias require immediate repair. Small (<1-2 cm), asymptomatic, and easily reducible hernias can sometimes be managed with watchful waiting. However, surgical repair is generally recommended for symptomatic hernias, large defects, or if complications like incarceration or strangulation occur.

What are the signs that my hernia is an emergency?

Emergency symptoms, which suggest trapped or strangulated tissue, include sudden, sharp, or severe pain at the hernia site; the hernia becoming tender, swollen, and firm; the bulge no longer being able to be pushed back in; discoloration of the skin over the hernia (red, purple, or dark); nausea and vomiting; fever; or abdominal distension with inability to pass gas or have a bowel movement.

Can I live with an umbilical hernia without surgery?

For adults, living with an umbilical hernia without surgery is an option if it is small, asymptomatic, and easily reducible. However, the hernia will not resolve on its own and may gradually enlarge. You would need to be aware of and monitor for emergency symptoms.

Will my hernia get bigger over time?

Acquired umbilical hernias in adults tend to remain stable or gradually enlarge over time. They do not resolve on their own.

Can exercise make my hernia worse?

Activities that significantly increase intra-abdominal pressure, such as heavy lifting or straining, can potentially make an umbilical hernia more prominent or contribute to its enlargement. It is advisable to use proper lifting techniques and manage conditions like chronic cough or constipation.

What types of exercise are safe with an umbilical hernia?

The dossier does not specify safe types of exercise. However, it generally recommends avoiding heavy lifting and straining. It is best to discuss specific exercise routines with your healthcare provider.

How does pregnancy affect an umbilical hernia?

The risk of incarceration and strangulation of an umbilical hernia increases during pregnancy due to rising intra-abdominal pressure. Most umbilical hernias in pregnant women are managed conservatively, with elective repair typically planned for after delivery. Emergency surgery is performed if strangulation occurs, which carries risks for both mother and fetus.

Is it safe to get pregnant if I have an umbilical hernia?

The dossier indicates that the risk of complications like incarceration and strangulation increases during pregnancy. While most hernias are managed conservatively during pregnancy, it is important to discuss your specific situation with your doctor to understand the risks and management plan.

What is the difference between open and laparoscopic hernia surgery?

Open repair involves a single incision made directly over the hernia, through which the repair is performed. Laparoscopic repair uses several small incisions away from the hernia, with a camera and specialized instruments to perform the repair from inside the abdomen.

Which type of surgery is better for me?

The choice between open and laparoscopic repair depends on factors such as the surgeon's expertise, your individual health, and the characteristics of your hernia. Your surgeon will discuss the best option for your specific situation.

Will I need a mesh for my repair?

International guidelines strongly recommend the use of mesh for elective repair of umbilical hernias in adults, especially for defects larger than 1-2 cm, to reduce the risk of the hernia returning. Suture-only repair is associated with higher recurrence rates.

What are the risks and benefits of using surgical mesh?

The primary benefit of using surgical mesh is a significantly lower risk of hernia recurrence compared to suture-only repair. Risks, though uncommon, can include infection, migration of the mesh, erosion into adjacent structures, or a foreign body sensation.

What is the recovery time after umbilical hernia surgery?

The dossier does not provide specific timelines for recovery. Recovery time can vary depending on the type of surgery (open vs. laparoscopic) and individual factors. Your surgeon will provide specific post-operative instructions.

When can I return to work and normal activities after surgery?

The dossier advises adherence to post-operative instructions, including activity restrictions. Your surgeon will provide specific guidance on when you can safely return to work and normal activities.

What are the chances of the hernia coming back after repair?

The chance of the hernia returning (recurrence) is significantly lower with mesh repair, typically less than 5%. With suture-only repair, recurrence rates can be as high as 10-30%, especially for larger defects.

Can I prevent an umbilical hernia from developing?

There are no definitive methods to prevent congenital umbilical hernias. For acquired hernias in adults, prevention focuses on minimizing intra-abdominal pressure by maintaining a healthy weight, using proper lifting techniques, avoiding straining from constipation, and managing chronic cough.

Does a hernia belt or truss work?

The dossier does not provide information on the effectiveness of hernia belts or trusses. It is best to consult with your healthcare provider regarding such devices.

What causes pain in an umbilical hernia?

Most umbilical hernias are asymptomatic or cause only mild discomfort. Pain can be caused by a dull ache or pressure sensation, especially after prolonged standing or physical activity. Sudden, sharp, or severe pain, tenderness, or firmness can indicate a serious complication like incarceration or strangulation.

Is it normal for the hernia to change size during the day?

Yes, it is common for the bulge to become more prominent when coughing, crying, laughing, or straining, and to disappear or reduce when lying down or relaxed. This change in size is typical for a reducible hernia.