Umbilical Hernia: Symptoms, Causes & Treatment Guide

What Is an Umbilical Hernia?

An umbilical hernia is a bulge or protrusion near the belly button (navel) that occurs when part of the intestine, fat, or other abdominal tissue pushes through a weakened area in the abdominal wall. The hernia appears as a soft swelling that may become more noticeable when coughing, crying, or straining.

The umbilicus, commonly known as the belly button, marks the point where the umbilical cord was attached during fetal development. During pregnancy, the umbilical cord passes through a natural opening in the baby's abdominal muscles to provide nutrients and oxygen from the mother. After birth, this opening normally closes as the muscles grow together. However, when this closure is incomplete or the area becomes weakened later in life, an umbilical hernia can develop.

Umbilical hernias are among the most common types of abdominal wall hernias. They differ from inguinal hernias (groin hernias), which occur in the lower abdomen near the groin. Understanding the anatomy helps explain why this location is particularly vulnerable: the umbilical ring represents a natural weak point in the abdominal wall where connective tissue rather than muscle forms the barrier.

The condition presents differently in children and adults. In infants, the hernia forms because the abdominal wall muscles haven't fully closed around the umbilical ring. In adults, the hernia typically develops because the tissues have become weakened over time due to increased abdominal pressure from various causes such as obesity, pregnancy, or chronic strain.

Umbilical Hernia vs. Paraumbilical Hernia

While often used interchangeably, there is a technical distinction between these terms. A true umbilical hernia occurs directly through the umbilical ring itself, while a paraumbilical hernia occurs just above or below the umbilicus through a weakness in the linea alba (the band of connective tissue running down the middle of the abdomen). In practice, both are treated similarly and the terms are often combined clinically.

Understanding the Hernia Sac

When an umbilical hernia develops, a "hernia sac" forms beneath the skin. This sac consists of the peritoneum (the membrane lining the abdominal cavity) that has been pushed outward through the weakened area. The sac may contain omentum (fatty tissue), small intestine, or both. The size of the hernia can range from a small, barely noticeable bulge to a protrusion several centimeters in diameter.

What Are the Symptoms of an Umbilical Hernia?

The main symptom of an umbilical hernia is a soft, round bulge near the navel that typically ranges from 1-5 cm in diameter. The bulge often becomes more prominent when standing, coughing, or straining, and may flatten when lying down or when gently pressed. Most umbilical hernias cause little or no discomfort, though some people experience mild tenderness or a pulling sensation.

The presentation of umbilical hernia symptoms varies significantly between children and adults, and also depends on whether the hernia has become complicated. Recognizing these symptoms early allows for appropriate monitoring and timely intervention when needed.

Symptoms in Infants and Children

In babies, an umbilical hernia typically becomes noticeable within the first few weeks after birth, often once the umbilical cord stump has fallen off. Parents usually notice a soft bulge or swelling at or near the belly button that:

• Increases in size when the baby cries, coughs, or strains during bowel movements
• Decreases or flattens when the baby is calm or lying down
• Feels soft and squishy to gentle touch
• Usually causes no pain - babies with uncomplicated umbilical hernias typically feed, sleep, and behave normally
• May range from 1-3 centimeters in diameter, though some can be larger

It's important to understand that a visible bulge that can be gently pushed back into the abdomen (reducible hernia) is not an emergency in children. The hernia may seem to "come and go" throughout the day depending on the child's activity level and crying.

Symptoms in Adults

Adult umbilical hernias may develop gradually over time and can present with a wider range of symptoms than those seen in children. Common symptoms include:

• Visible bulge near the navel that may be larger than in children (often 2-5+ cm)
• Discomfort or dull ache at the hernia site, especially after standing for long periods
• Increased discomfort with physical activity, lifting, or straining
• Feeling of pressure or heaviness in the abdomen
• Cosmetic concerns about the appearance of the bulge
• Some adults experience no symptoms at all and discover the hernia during a routine examination

Adults are more likely than children to experience discomfort from their umbilical hernia, particularly if the hernia is larger or if they engage in activities that increase abdominal pressure. The discomfort typically worsens throughout the day as gravity and activity cause the hernia contents to push outward.

Signs of an Incarcerated or Strangulated Hernia

While most umbilical hernias remain uncomplicated, it's crucial to recognize the warning signs of a hernia that has become incarcerated (trapped) or strangulated (blood supply cut off). These are medical emergencies requiring immediate attention.

What Causes an Umbilical Hernia?

Umbilical hernias develop when the abdominal wall near the navel is weakened or fails to close properly. In infants, this occurs when the opening for the umbilical cord doesn't fully close after birth. In adults, causes include obesity, pregnancy, chronic coughing, heavy lifting, and conditions that increase abdominal pressure such as ascites (fluid accumulation).

Understanding the causes of umbilical hernias helps explain why certain populations are more affected and what steps might help prevent this condition. The underlying mechanism involves a combination of weakness in the abdominal wall and increased pressure pushing contents outward through that weakness.

Causes in Infants

During fetal development, the umbilical cord passes through a ring-shaped opening in the baby's abdominal muscles called the umbilical ring. After birth, once the umbilical cord is cut and the stump falls off (usually within 1-3 weeks), the umbilical ring should gradually close as the surrounding muscles and connective tissue come together and strengthen.

An umbilical hernia in infants develops when this closure is incomplete or delayed. The opening remains, allowing abdominal contents to push through, particularly when the baby cries or strains. Several factors may contribute to this incomplete closure:

• Premature birth: Babies born before 37 weeks have less developed abdominal muscles and are more likely to have an umbilical hernia
• Low birth weight: Babies weighing less than 1,500 grams (3.3 pounds) at birth have higher rates of umbilical hernia
• Genetic factors: There appears to be a hereditary component, with some families having higher rates of the condition
• African ancestry: Studies consistently show higher prevalence rates in babies of African descent

Causes in Adults

While some adults may have had a small, unnoticed umbilical defect since childhood, most adult umbilical hernias develop due to weakening of the abdominal wall combined with increased intra-abdominal pressure. The main risk factors and causes include:

Obesity: Excess body weight, particularly abdominal fat, places continuous pressure on the abdominal wall. This chronic pressure gradually weakens the tissue around the umbilicus, making herniation more likely. Studies show that individuals with a BMI over 30 have significantly higher rates of umbilical hernia.

Pregnancy: Multiple pregnancies or pregnancies with large babies stretch and weaken the abdominal muscles. The growing uterus pushes against the abdominal wall for months, and the hormonal changes of pregnancy can soften connective tissue. Women who have had multiple pregnancies are at increased risk.

Chronic increased abdominal pressure: Various conditions that chronically raise pressure inside the abdomen can contribute to hernia development:

• Chronic coughing (from smoking, COPD, or chronic bronchitis)
• Chronic constipation with straining
• Difficulty urinating (such as from enlarged prostate)
• Frequent heavy lifting, especially with improper technique

Ascites: Accumulation of fluid in the abdominal cavity (ascites), often due to liver disease, can dramatically increase pressure on the umbilical ring. Patients with cirrhosis and ascites have very high rates of umbilical hernia.

Previous surgery: Abdominal surgeries, particularly those involving incisions near the umbilicus, can weaken the area and predispose to hernia formation.

When Should You See a Doctor for an Umbilical Hernia?

You should see a doctor if you notice a new bulge near your navel, if an existing hernia grows larger or becomes painful, or if the hernia cannot be pushed back into the abdomen. Seek emergency care immediately if the hernia becomes hard, severely painful, or if you experience nausea, vomiting, or skin color changes over the hernia.

Knowing when to seek medical evaluation for an umbilical hernia can help ensure appropriate treatment and prevent potentially serious complications. The urgency of seeking care depends on the symptoms present and whether the hernia shows signs of complications.

Routine Medical Evaluation

Schedule a non-urgent appointment with your primary care doctor or pediatrician if:

• You notice a new bulge near the navel in yourself or your child
• An existing hernia appears to be growing larger
• You experience mild discomfort or aching at the hernia site
• Your child's hernia hasn't closed by age 4-5 years
• You're concerned about the appearance or have questions about management
• You're planning a pregnancy and have a known umbilical hernia

During a routine evaluation, the doctor will examine the hernia, assess its size and reducibility, and discuss whether watchful waiting or surgical repair is most appropriate for your situation.

Urgent Medical Care

Seek same-day medical evaluation if you experience:

• A hernia that cannot be gently pushed back into the abdomen but is not causing severe pain
• Increasing tenderness or soreness at the hernia site
• Intermittent sharp pain that comes and goes
• Mild nausea without vomiting

Emergency Medical Care

Go to an emergency room or call emergency services immediately if:

These symptoms may indicate that the hernia has become incarcerated (contents trapped in the hernia sac) or strangulated (blood supply cut off to the trapped tissue). Strangulation is a surgical emergency because the trapped tissue can become gangrenous within hours if blood flow is not restored.

How Is an Umbilical Hernia Diagnosed?

Umbilical hernias are typically diagnosed through physical examination. The doctor will examine your abdomen while you're lying down and standing, and may ask you to cough or strain to make the hernia more visible. Imaging tests such as ultrasound or CT scan are only needed in unclear cases or when complications are suspected.

The diagnosis of an umbilical hernia is usually straightforward and can be made based on the patient's history and a physical examination. Additional tests are rarely necessary but may be helpful in certain situations.

Physical Examination

The diagnostic process begins with a thorough physical examination. The doctor will:

• Inspect the umbilical area with you lying flat and again while standing
• Ask you to cough, strain, or bear down to increase abdominal pressure and make the hernia more prominent
• Gently palpate (feel) the hernia to assess its size, consistency, and whether it can be reduced
• Attempt to reduce the hernia by gently pushing it back into the abdomen while you're relaxed and lying down
• Measure the size of the hernia defect (the opening in the abdominal wall)
• Check for tenderness or signs of complications

The physical examination also helps characterize the hernia as reducible (can be pushed back) or irreducible (cannot be pushed back), which influences treatment decisions.

Imaging Studies

While not routinely needed, imaging tests may be ordered in the following situations:

Ultrasound: This is the most commonly used imaging test when needed. Ultrasound can confirm the diagnosis in unclear cases, measure the size of the hernia defect, and identify the contents of the hernia sac. It is painless, non-invasive, and does not use radiation.

CT Scan: Computed tomography may be recommended when complications are suspected, when there's concern for other conditions, or when planning complex surgical repair. CT provides detailed images of the abdominal wall and hernia contents.

MRI: Magnetic resonance imaging is rarely needed but may be useful for distinguishing umbilical hernia from other conditions such as diastasis recti or certain abdominal wall tumors.

Differential Diagnosis

While most cases are straightforward, the doctor will consider other conditions that can cause a bulge near the navel:

• Diastasis recti: Separation of the rectus abdominis muscles without a true hernia defect
• Epigastric hernia: A hernia above the umbilicus in the midline
• Umbilical granuloma: Excess tissue at the umbilicus in newborns (not a hernia)
• Lipoma: A benign fatty tumor beneath the skin
• Metastatic tumor: Rarely, cancer spreading to the umbilicus (Sister Mary Joseph nodule)

How Is an Umbilical Hernia Treated?

Treatment depends on age, hernia size, and symptoms. Children under 4 typically don't need surgery as most hernias close naturally. Adults with symptomatic hernias or hernias larger than 2 cm usually require surgical repair. The hernia can often be gently pushed back temporarily, but this is not a cure. Trusses and belly bands are not recommended as definitive treatment.

The approach to treating umbilical hernias differs significantly between children and adults, and is influenced by factors including the size of the hernia, the presence of symptoms, and the risk of complications.

Treatment in Children

The cornerstone of umbilical hernia management in young children is watchful waiting. This approach is based on the well-documented natural history of pediatric umbilical hernias: the vast majority (80-90%) close spontaneously as the child grows and the abdominal muscles strengthen.

Observation period: Most pediatric surgeons and pediatricians recommend waiting until at least age 4-5 before considering surgical intervention, provided the hernia:

• Remains reducible (can be pushed back easily)
• Does not cause symptoms
• Has a relatively small defect size (typically less than 1.5-2 cm)

What to avoid: Parents may hear about home remedies such as taping coins over the hernia or using belly bands. These methods are not recommended as they do not speed closure and may cause skin irritation or infection. The hernia will close (or not) based on natural muscle development, not external pressure.

Surgery in children may be recommended if:

• The hernia persists beyond age 4-5 years
• The hernia defect is large (typically greater than 1.5-2 cm)
• The hernia becomes incarcerated
• The hernia causes significant symptoms

Treatment in Adults

Unlike in children, umbilical hernias in adults do not resolve on their own and tend to gradually enlarge over time. Treatment recommendations depend on several factors:

Small, asymptomatic hernias: In adults with very small hernias (less than 1 cm) that cause no symptoms, watchful waiting may be reasonable in some cases, particularly in patients with significant surgical risk factors. However, most guidelines recommend repair even for small hernias due to the progressive nature of the condition and the relatively low risk of surgery.

Symptomatic or larger hernias: Surgical repair is generally recommended for adults who have:

• Hernias causing pain, discomfort, or affecting quality of life
• Hernia defects larger than 1-2 cm
• Hernias that are progressively enlarging
• Cosmetic concerns about the hernia appearance

Manual Reduction

A reducible hernia is one where the bulging contents can be gently pushed back into the abdominal cavity. While this provides temporary relief and confirms that the hernia is not incarcerated, it is not a treatment:

What About Trusses and Support Garments?

Hernia trusses (supportive belts worn to hold the hernia in place) are generally not recommended as definitive treatment for umbilical hernias. While they may provide some symptomatic relief in patients who cannot undergo surgery, they:

• Do not prevent hernia progression
• May cause skin irritation or breakdown
• Can give a false sense of security while the hernia enlarges
• May make eventual surgery more difficult due to scarring

What Happens During Umbilical Hernia Surgery?

Umbilical hernia surgery involves pushing the hernia contents back into the abdomen and repairing the weakened area with stitches alone (for small hernias) or with surgical mesh (for larger hernias or to reduce recurrence risk). Surgery can be performed as open repair through a small incision near the navel, or laparoscopically through tiny incisions using a camera.

Umbilical hernia repair is one of the most commonly performed surgical procedures worldwide. The surgery has evolved significantly over the decades, with excellent outcomes and low complication rates when performed by experienced surgeons.

Types of Surgical Repair

Open Hernia Repair: This traditional approach remains the most common method for umbilical hernia repair. The surgeon makes a curved incision below or around the umbilicus (often hidden within the natural skin folds), identifies the hernia sac, and returns the contents to the abdominal cavity. The weakened area is then repaired by:

• Primary suture repair: For small defects (typically less than 2 cm), the edges of the opening can be sutured together directly
• Mesh repair: For larger defects, synthetic mesh is placed to reinforce the repair and reduce recurrence risk

Laparoscopic Repair: This minimally invasive approach involves making several small incisions (typically 5-10 mm) away from the umbilicus. A camera and specialized instruments are inserted, and the repair is performed from inside the abdominal cavity. Mesh is typically placed over the defect. Laparoscopic repair may offer:

• Faster recovery time
• Less post-operative pain
• Smaller scars
• Better visualization of the entire abdominal wall to identify other defects

The choice between open and laparoscopic repair depends on the hernia size, patient factors, surgeon experience, and patient preference. For most straightforward umbilical hernias, both approaches provide excellent results.

The Role of Mesh

Surgical mesh has become an important component of hernia repair, particularly for larger hernias (greater than 2 cm) and for reducing recurrence rates. The mesh acts as a scaffold that reinforces the weakened tissue and allows the body to incorporate it with new tissue growth.

Types of mesh:

• Synthetic mesh: Most commonly polypropylene or polyester; provides durable, long-term reinforcement
• Biologic mesh: Made from human or animal tissue; may be preferred in contaminated fields or in patients at high risk of infection
• Composite mesh: One side designed to contact bowel safely, the other to integrate with the abdominal wall

Research consistently shows that mesh repair has lower recurrence rates than suture-only repair for hernias larger than 1-2 cm. While mesh-related complications can occur (infection, chronic pain, mesh migration), these are relatively uncommon and modern mesh materials have improved safety profiles.

Anesthesia Options

Umbilical hernia repair can be performed under:

• General anesthesia: Most common, especially for laparoscopic repair
• Regional anesthesia: Such as spinal or epidural, which numbs the lower body
• Local anesthesia with sedation: For small hernias in appropriate patients

What to Expect on Surgery Day

Most umbilical hernia repairs are performed as outpatient (same-day) surgery. Typical expectations include:

• Fasting from midnight before surgery
• Surgery duration of approximately 30-60 minutes
• Recovery room monitoring for 1-2 hours
• Discharge home the same day in most cases
• Prescription for pain medication and post-operative instructions

How Long Does Recovery Take After Umbilical Hernia Surgery?

Most patients return to light activities within 1-2 weeks after umbilical hernia surgery. Full recovery, including return to heavy lifting and strenuous exercise, typically takes 4-6 weeks. Children generally recover faster than adults. Pain is usually well-controlled with over-the-counter medications after the first few days.

Recovery from umbilical hernia repair is generally straightforward, with most patients experiencing steady improvement over the first several weeks. Understanding what to expect during recovery helps ensure optimal healing and outcomes.

First Week After Surgery

The first week is typically the most challenging part of recovery:

• Pain: Mild to moderate discomfort at the incision site is normal. Pain is usually worst on days 1-3 and gradually improves
• Swelling: Some swelling and bruising around the incision is normal and resolves over 1-2 weeks
• Activity: Rest is important, but gentle walking is encouraged to prevent blood clots
• Wound care: Keep the incision clean and dry; follow your surgeon's specific instructions
• Bathing: Showering is usually allowed after 24-48 hours; avoid soaking in baths or swimming until cleared

Weeks 2-4

During this period, most patients experience significant improvement:

• Return to light activities and desk work is possible for most patients
• Driving can usually resume when you can perform an emergency stop without pain (typically 1-2 weeks)
• Continue to avoid heavy lifting (nothing over 10-15 pounds)
• Incision continues to heal; steri-strips or sutures may be removed

Weeks 4-6 and Beyond

Full recovery and return to all activities typically occurs by 6 weeks:

• Gradual return to heavier lifting and exercise, as approved by your surgeon
• Most patients feel completely back to normal by 4-6 weeks
• The incision may remain slightly raised or pink for several months but will continue to fade

Recovery in Children

Children typically bounce back remarkably quickly from hernia surgery:

• Most children are active and playing within a few days
• School can often be resumed within 1 week
• Sports and physical education are usually restricted for 2-4 weeks
• The incision is often placed within the umbilicus and heals nearly invisibly

Can Umbilical Hernias Be Prevented?

While congenital umbilical hernias in infants cannot be prevented, adults can reduce their risk by maintaining a healthy weight, avoiding heavy lifting or using proper technique, treating chronic cough, preventing constipation, and strengthening core muscles. After pregnancy, gradual return to exercise helps protect the abdominal wall.

Prevention strategies for umbilical hernias focus on minimizing the factors that weaken the abdominal wall and reducing excessive pressure on the umbilical area. While not all hernias can be prevented, lifestyle modifications can significantly reduce risk.

Maintain a Healthy Weight

Obesity is one of the strongest risk factors for umbilical hernia in adults. Excess weight places continuous pressure on the abdominal wall and can weaken the tissue around the umbilicus over time. Achieving and maintaining a healthy body weight through balanced nutrition and regular exercise can substantially reduce your hernia risk.

Exercise and Core Strengthening

Strong abdominal muscles provide better support for the umbilical ring. Regular exercise that includes core-strengthening activities can help prevent hernias:

• Planks, modified planks, and other isometric core exercises
• Swimming and water aerobics
• Pilates and yoga (when done properly)
• Progressive resistance training

After pregnancy, it's particularly important to gradually rebuild core strength. Working with a physical therapist or trained instructor can help ensure exercises are performed safely and effectively.

Proper Lifting Technique

Improper lifting places tremendous strain on the abdominal wall. When lifting heavy objects:

• Bend at the knees, not the waist
• Keep the object close to your body
• Engage your core muscles before lifting
• Avoid twisting while carrying heavy loads
• Don't hold your breath; exhale during the exertion phase
• Know your limits and ask for help with very heavy objects

Treat Chronic Cough

Repeated forceful coughing dramatically increases intra-abdominal pressure. If you have a persistent cough:

• Quit smoking if you smoke (smoking causes chronic cough and also impairs tissue healing)
• Seek treatment for conditions causing chronic cough (asthma, COPD, allergies, acid reflux)
• Follow prescribed treatment plans for respiratory conditions

Prevent Constipation

Straining during bowel movements increases abdominal pressure. Maintain regular, easy bowel movements by:

• Eating a high-fiber diet (fruits, vegetables, whole grains)
• Drinking plenty of water
• Exercising regularly
• Not ignoring the urge to have a bowel movement
• Using stool softeners if needed

Preventing Recurrence After Surgery

If you've had umbilical hernia surgery, the same preventive measures apply to reduce the risk of recurrence:

• Follow all post-operative activity restrictions
• Return to exercise gradually
• Maintain a healthy weight
• Use proper lifting technique permanently
• Address any underlying conditions that contributed to the original hernia