Umbilical hernia
An umbilical hernia is an outward bulge in the area around the belly button. It occurs when internal organs or the abdominal lining bulges through the muscles near the belly button.
An umbilical hernia is a protrusion of the peritoneum and fluid, omentum, or a portion of abdominal organ(s) through the umbilical ring. The umbilical ring is the fibrous and muscle tissue around the navel (belly-button). Small hernias usually close spontaneously without treatment by age 1 or 2. Umbilical hernias are usually painless and are common in infants.
Causes
In the womb, the umbilical cord is attached to the baby through an opening in the baby's abdomen. After birth, this opening normally closes. When this area doesn't close completely, it leaves a weak spot in the abdomen, which can lead to a hernia. Hernias may be seen after birth or later in life.
Umbilical hernias are common in infants. They occur slightly more often in African Americans. Most umbilical hernias are not related to disease. Some umbilical hernias are linked with rare conditions such as Down syndrome.
Symptoms
A hernia can vary in width from less than 1 centimeter (cm) to more than 5 cm (about 1/2 to 2 inches).
There is a soft swelling over the belly button that often bulges when the baby sits up, cries, or strains. The bulge may be flat when the infant lies on the back and is quiet. Umbilical hernias are usually painless.
Exams and Tests
A hernia is usually found by the health care provider during a physical exam.
Treatment
Most hernias in children heal on their own. Surgery to repair the hernia is needed only in the following cases:
- The hernia does not heal after the child is 3 or 4 years old.
- The intestine or other tissue bulges out and loses its blood supply (becomes strangulated). This is an emergency that needs surgery right away.
So what do you do after your child's had an umbilical hernia repaired? I'm Dr. Alan Greene with some tips for home care after that operation. Well, the first thing to know is that your child will probably go home with a bandage over the surgical site that's best to leave in place until your return visit to the doctor or until your doctor tells you to take it off. And while that bandage is there you want to keep that area pretty dry. That means usually sponge baths, not real bathing, not swimming certainly until it's time for that bandage to come off. Your doctor probably will give some pain medication for your child, especially that first couple days it can be pretty tender afterwards, so it's nice to give that pain medication around the clock when they're awake to kind of stay ahead of the pain instead of waiting until you know that they're uncomfortable. They can pretty well eat what they want once they go home and more or less normal activity. You'll want it kind of quiet for the first 3 or 4 days, but after that they can resume completely normal activity except for rough sports - you probably want to hold off for about a week or so to let that incision really strengthen. When should you call the doctor? It's a good idea to call the doctor if your child develops a new fever sometime afterwards over 101° or so. If their pain is increasing at any point or if they're having trouble urinating would be another reason. If vomiting or nausea develops in the couple of days after surgery. If there's an increase in redness or if it looks to you after the bandage comes off that the wound seems to be coming apart would all be reasons to get back in touch with the doctor. Most children with this operation though have no complications and if there are complications they're pretty easily dealt with. So, enjoy this quiet time with your child and then enjoy getting right back to regular activity sometime in the next week.
Outlook (Prognosis)
Most umbilical hernias get better without treatment by the time the child is 3 to 4 years old. If surgery is needed, it is usually successful.
Possible Complications
Strangulation of the intestines can occur. This complication is rare but serious and needs surgery right away.
When to Contact a Medical Professional
Contact your provider or go to the emergency room if:
- Your baby is very fussy
- Your baby seems to have bad abdominal pain
- The hernia becomes tender, swollen, or discolored
Prevention
There is no known way to prevent an umbilical hernia. Taping or strapping an umbilical hernia will not make it go away.
References
Nathan AT. The umbilicus. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 125.
Sujka JA, Holcomb GW. Umbilical and other abdominal wall hernias. In: Holcomb GW, Murphy JP, St. Peter SD, eds. Holcomb and Ashcraft's Pediatric Surgery. 7th ed. Philadelphia, PA: Elsevier; 2020:chap 49.
Version Info
Last reviewed on: 8/5/2023
Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
