The umbilical cord connects a mother and her fetus while in the womb. Babies’ umbilical cords pass through a small opening between their abdominal wall muscles. In most cases, the hole closes soon after birth. An umbilical hernia occurs when the abdominal wall layers don’t join completely, and the intestine or other tissues from inside the abdominal cavity bulge through the weak spot around the belly button. About 20 percent of babies are born with an umbilical hernia.
Umbilical hernias are generally painless and don’t cause any discomfort. About 90 percent of umbilical hernias will eventually close on their own, according to Johns Hopkins Medicine. If an umbilical hernia doesn’t close by the time a child is 4 years old, it will require treatment.
An umbilical hernia occurs when the opening in the abdominal muscle that allows the umbilical cord to pass through fails to close completely. Umbilical hernias are most common in babies, but they can also occur in adults.
African-American babies, premature babies, and babies born at a low birth weight are at an even higher risk of developing an umbilical hernia. There is no difference in occurrence between boys and girls, according to Cincinnati Children’s Hospital Center.
An umbilical hernia in adults usually occurs when too much pressure is put on a weak section of the abdominal muscles. Potential causes include:
- being overweight
- frequent pregnancies
- multiple gestation pregnancies (having twins, triplets, etc.)
- excess fluid in the abdominal cavity
- abdominal surgery
- having a persistent, heavy cough
Umbilical hernias can usually be seen when your baby is crying, laughing, or straining to use the bathroom. The telltale symptom is a swelling or bulge near the umbilical area. This symptom may not be present when your baby is relaxed. Most umbilical hernias are painless in children.
Adults can get umbilical hernias as well. The main symptom is the same — a swelling or bulge near the navel area. However, umbilical hernias can cause discomfort and be very painful in adults. Surgical treatment usually is required.
The following symptoms may indicate a more serious situation that requires medical treatment:
- the baby is in obvious pain
- the baby suddenly starts vomiting
- the bulge (in both children and adults) is very tender, swollen, or discolored
A doctor will perform a physical exam to determine if an infant or adult has an umbilical hernia. The doctor will see if the hernia can be pushed back into the abdominal cavity (reducible) or if it is trapped in its place (incarcerated). An incarcerated hernia is a potentially serious complication because the trapped part of the herniated contents may become deprived of a blood supply (strangulated). This can cause permanent tissue damage.
Your doctor may take an X-ray or perform an ultrasound on the abdominal area to ensure that there are no complications. They may also order blood tests to look for infection or ischemia, especially if the intestine is incarcerated or strangulated.
Complications from umbilical hernias rarely occur in children. However, additional complications can occur in both children and adults if the umbilical cord is incarcerated.
Intestines that can’t be pushed back through the abdominal wall sometimes don’t get adequate blood supply. This can cause pain and even kill the tissue, which could result in a dangerous infection or even death.
Abdominal hernias involving a strangulated intestine require emergency surgery. Contact your doctor or go to the emergency room immediately if the intestine becomes obstructed or strangulated.
Symptoms of a strangulated umbilical hernia include:
- severe abdominal pain and tenderness
- nausea and vomiting
- a bulging lump in the abdomen
- redness or other discoloration
In young children, umbilical hernias often heal without treatment. In adults, surgery is usually suggested to make sure that no complications develop. Before choosing surgery, doctors will normally wait until the hernia:
- becomes painful
- is bigger than one-half inch in diameter
- doesn’t shrink within one or two years
- doesn’t go away by the time a child is 3 or 4 years old
- becomes trapped or blocks the intestines
You will need to fast before the surgery, according to the surgeon’s instructions. But you likely can continue to drink clear liquids until up to three hours before surgery.
The surgery will last about an hour. The surgeon will make an incision near the belly button at the site of the bulge. Then they’ll push the intestinal tissue back through the abdominal wall. In children, they’ll close the opening with stitches. In adults, they’ll often strengthen the abdominal wall with mesh before closing with stitches.
Recovering from surgery
Usually, the surgery is a same-day procedure. Activities for the next week or so should be limited, and you shouldn’t return to school or work during this time. Sponge baths are suggested until three days have passed.
The surgical tape over the incision should fall off on its own. If it doesn’t, wait to have it removed at the follow-up appointment.
Complications are rare, but can occur. Contact your doctor if you notice the following symptoms:
- infection at the wound site
- recurrence of the hernia
- numbness in the legs
The majority of cases in babies will resolve on their own by age 3 or 4. If you think your baby may have an umbilical hernia, speak with your pediatrician. Seek emergency care if your baby seems to be in pain or the bulge becomes very swollen or discolored. Adults with a bulge on their abdomen should also see a doctor.
Hernia repair surgery is a fairly simple and common procedure. While all surgeries have risks, most children are able to return home from an umbilical hernia surgery within a few hours. Mount Sinai Hospital recommends waiting three weeks after surgery to engage in heavy physical activity. It’s unlikely that the hernia will reoccur once it’s properly reduced and closed.