Umbilical hernia

What is a hernia?

A hernia occurs when an internal part of the body pushes through a gap in the muscle or tissue that usually contains it.

Hernias are extremely common — it’s estimated that around 100,000 people in the UK have surgery to repair a hernia every year.

Hernias can develop in various areas of the body, including the abdomen. If a hernia appears near your belly button, this is known as an umbilical hernia. It occurs when the intestine protrudes through the umbilical opening in the abdomen.

An umbilical hernia is more common in infants, but they can affect adults too.

Symptoms of an umbilical hernia

The symptoms of an umbilical hernia are the same in both adults and children.

The most obvious is the appearance of a soft bulge or swelling near the belly button. For some patients, the bulge may only be visible when they cry, cough or strain, or if they sit in certain positions. This is especially true of babies, as the bulge is usually most visible when they are crying.

In rare cases, a hernia can become strangulated. This is where the part of the intestine that is protruding through the abdominal wall becomes trapped and blood flow can no longer reach it. This is a medical emergency and causes the following symptoms:

• abdominal pain
• constipation
• fever
• vomiting
• the hernia bulge appears red, purple or generally discoloured

If you or your child experience any of these symptoms, you must speak to an emergency doctor right away as immediate surgery may be needed to treat the umbilical hernia.

What causes an umbilical hernia?

An umbilical hernia is caused when fatty tissue or a part of your intestine pokes through a weakness or space in your abdominal muscles near where your belly button is. It will normally appear as an unusual bulge in your stomach, just above your belly button.

In babies, umbilical hernias most often occur as a result of the time it takes for the stomach muscles to seal after the umbilical cord falls off. This leaves a weak spot in the surrounding muscle wall, which can lead to a hernia developing.

In adults, umbilical hernias can develop as a result of being overweight/obese, or straining when lifting or moving heavy objects, as a result of constipation or vomiting, or other events that cause a rise in the amount of pressure inside the abdomen. Women who have experienced separation of the stomach muscles during pregnancy (a condition known as diastasis recti) can also be at greater risk of developing an abdominal hernia.

In most cases, an umbilical hernia is harmless and can be treated fairly easily. Around 90% of children’s umbilical hernias will close within the first five years of their life without any treatment at all. However, umbilical hernias that occur in adults will need to be repaired.

Can an umbilical hernia be avoided?

There’s no way that children can avoid an umbilical hernia. However, the same can’t be said for adults. This is because umbilical hernias in adults are normally caused by high levels of pressure inside the abdomen from things like carrying excess weight or having an underlying health condition.

As an adult, you could potentially avoid an umbilical hernia (or prevent an umbilical hernia from returning) by:

• maintaining a healthy weight
• doing regular, gentle exercise to keep your stomach muscles strong
• eating a healthy, balanced diet (which can help prevent an umbilical hernia caused by constipation)
• taking care when you lift anything heavy
• doing exercise to keep your stomach muscles strong during pregnancy

You can also help children to develop good, healthy habits that could prevent them from developing an umbilical hernia in the future.

Diagnosing an umbilical hernia

In most cases, an umbilical hernia can be diagnosed by a simple physical examination.

Your doctor will ask you to sit and/or lay down with your shirt off, so that they can see your abdomen. They may also use their hands to feel the area to make sure that the protruding bulge can be pushed back in. The same physical examination is carried out for children.

In some cases, the doctor may recommend an ultrasound or CT scan to confirm the diagnosis. Neither of these tests are invasive or painful.

Umbilical hernia treatment

An umbilical hernia in an infant or child may not be treated unless it starts to cause problems, such as pain and discomfort, or it is a significant size (usually more than 2cm in diameter).

However, if it doesn’t close by the time they are around five years old, they may then be referred for umbilical hernia repair surgery.

Surgery is usually recommended for adults to get rid of the hernia and prevent complications.

Umbilical hernia repair surgery

Hernia repair surgery is a fairly simple and straightforward surgery that is performed under general anaesthetic. It can be done laparoscopically (minimally-invasive surgery) or as open surgery, depending on the individual circumstances of the patient.

Surgery involves making a small incision near the belly button, which provides an access point for the surgeon to push the part of the intestine protruding through the abdominal wall back into position. A section of mesh is often used to strengthen the abdominal wall before the incision is closed using stitches.

You or your child may be allowed to go home the same day or the following day.

If you are having hernia repair surgery, it is important to remember that the effects of general anaesthetic can last for up to 24 hours, so if you do go home you should arrange for someone to drive you and stay with you until they have passed.

Recovery following umbilical hernia treatment

Most adults and children recover from umbilical hernia repair surgery very quickly, particularly if they’ve had laparoscopic surgery.

You or your child may experience some discomfort for a week or two after surgery, and will be given pain medications to help keep this under control. Always take any medication, or give your child medication, exactly as prescribed by your doctor.

Adults and children should be able to get up and move around within hours of surgery, an moving around regularly is recommended to boost circulation, which will help with healing and reduce the risk of blood clots. Drink plenty of water and follow a healthy, balanced diet as soon as you feel ready to start eating again.

Your surgical team will show you how to take care of the wound. Again, make sure to follow the instructions provided to you as this will reduce the risk of experiencing complications.

Adults can go back to work within a week of their surgery, although this will depend on your job and your personal rate of recovery. However, you shouldn’t do any heavy lifting and avoid strenuous exercise for six weeks. You should also avoid driving until you feel confident that you can perform an emergency stop.

If your child has had hernia repair surgery, you may be advised to keep them off school for a week while they recover.

Risks and complications after umbilical hernia repair

There are risks associated with all surgeries, including hernia repair. Complications are rare, but they can occur so it’s important to be aware of them. They include:

• infection at the site of the wound
• seroma (a collection of fluid) under the wound
• poor healing
• the hernia returning

If you feel very unwell following your surgery, and have symptoms such as severe abdominal pain, a high temperature, vomiting or discharge coming from your wound, contact your care team right away.