Umbilical Hernia: Causes, Symptoms and Treatment

What Is an Umbilical Hernia?

An umbilical hernia is a type of abdominal hernia in which fatty tissue, part of the intestine, or other abdominal contents protrude through a weak spot or opening in the abdominal muscles near the navel (umbilicus). The resulting bulge is often visible and palpable, especially when coughing, straining, or crying.

Umbilical hernias are among the most common types of hernia and can occur in both newborns and adults.

Causes

The causes of an umbilical hernia differ depending on the age group:

In Infants and Young Children

• Incomplete closure of the abdominal wall after the umbilical cord is cut
• Congenital weakness of the abdominal wall near the navel
• More frequent in premature babies and those with low birth weight

In Adults

• Increased abdominal pressure due to overweight or obesity
• Pregnancy, especially multiple pregnancies
• Heavy physical labor or chronic coughing
• Ascites (fluid accumulation in the abdomen)
• Previous abdominal surgeries

Symptoms

Common signs of an umbilical hernia include:

• A soft, visible bulge in the navel area
• Enlargement of the bulge during physical exertion, coughing, or straining
• Usually painless in children; adults may experience a feeling of pressure or discomfort
• In rare cases, incarceration (strangulation) of the trapped tissue, causing severe pain and nausea -- this is a medical emergency

Diagnosis

An umbilical hernia is typically diagnosed through a physical examination. The characteristic bulge is easily felt by a doctor. If needed, imaging tests may be used:

• Ultrasound (sonography): To assess the size and contents of the hernia
• CT scan: For complex cases or when complications are suspected

Treatment

In Children

In the majority of infants and toddlers, umbilical hernias close on their own by age two to four. Surgery is generally only recommended if the hernia persists beyond the age of four, grows larger, or causes symptoms.

In Adults

In adults, umbilical hernias do not heal without treatment. The standard therapy is surgical repair:

• Open hernia repair: The hernial sac is repositioned through a small incision near the navel, and the defect is closed with sutures or a synthetic mesh.
• Laparoscopic repair (minimally invasive surgery): Small incisions are used, resulting in a shorter recovery time and reduced risk of infection.

For small, asymptomatic hernias with a low risk of incarceration, a watchful waiting approach may sometimes be appropriate -- this should be discussed individually with a treating physician.

Complications

The most serious complication is incarceration: the tissue trapped in the hernia becomes constricted, cutting off blood supply and risking tissue death (necrosis). Symptoms include sudden, severe pain, a hard and non-reducible bulge, as well as nausea and vomiting. This requires immediate medical attention.

Prognosis

The prognosis following surgical repair of an umbilical hernia is generally excellent. Recurrence is possible but uncommon when the correct surgical technique and mesh placement are used. In children, the rate of spontaneous resolution is high.

References

1. Coste AH, Jaafar S, Parmely JD -- Umbilical Hernia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
2. Simons MP et al. -- European Hernia Society Guidelines on the Treatment of Inguinal Hernia in Adult Patients. Hernia, 2009.
3. Jenkins JT, O'Dwyer PJ -- Inguinal hernias. BMJ. 2008;336(7638):269-272.