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Umbilical hernia
By Mayo Clinic staffOriginal Article: http://www.mayoclinic.com/health/umbilical-hernia/DS00655
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Definition
An umbilical hernia occurs when part of the intestine protrudes through an opening in the abdominal muscles. Umbilical hernias are most common in infants, but they can affect adults as well. In an infant, an umbilical hernia may be especially evident when the infant cries, causing the baby's bellybutton protrude. This is a classic sign of an umbilical hernia.
Most umbilical hernias close on their own by age 1, though some take longer to heal. To prevent complications, umbilical hernias that don't disappear by age 4 or those that appear during adulthood may need surgical repair.
Umbilical hernia is a common and typically harmless condition.
Symptoms
An umbilical hernia creates a soft swelling or bulge near the navel (umbilicus). The bulge may range from less than 1/2 inch to about 2 inches (about 1 to 5 centimeters) in diameter.
If your baby has an umbilical hernia, you may notice the bulge only when he or she cries, coughs or strains. The bulge may disappear when your baby is calm or lies on his or her back.
Umbilical hernias in children are usually painless. Umbilical hernias that appear during adulthood may cause abdominal discomfort.
When to see a doctor
If you suspect that your baby has an umbilical hernia, talk with your child's pediatrician. Seek emergency care if your baby has an umbilical hernia and:
- Your baby appears to be in pain
- Your baby begins to vomit
- The bulge becomes tender, swollen or discolored
Similar guidelines apply to adults. Talk with your doctor if you have a bulge near your navel. Seek emergency care if the bulge becomes painful or tender. Prompt diagnosis and treatment can help prevent complications.
Causes
During pregnancy, the umbilical cord passes through a small opening in the baby's abdominal muscles. The opening normally closes just before birth. If the muscles don't join together completely in the midline of the abdomen, this weakness in the abdominal wall may cause an umbilical hernia at birth or later in life.
In adults, too much abdominal pressure can cause an umbilical hernia. Possible causes in adults include:
- Obesity
- Heavy lifting
- A long history of coughing
- Multiple pregnancies
- Fluid in the abdominal cavity (ascites)
Risk factors
Umbilical hernias are most common in infants — especially premature babies and those with low birth weights. Black infants appear to have a slightly increased risk of umbilical hernias. The condition affects boys and girls equally.
For adults, being overweight or having multiple pregnancies may increase the risk of developing an umbilical hernia.
Complications
For children, complications of an umbilical hernia are rare. Complications can occur when the protruding abdominal tissue becomes trapped (incarcerated) and can no longer be pushed back into the abdominal cavity. This reduces the blood supply to the section of trapped intestine and can lead to umbilical pain and tissue damage. If the trapped portion of intestine is completely cut off from the blood supply (strangulated hernia), tissue death (gangrene) may occur. Infection may spread throughout the abdominal cavity, causing a life-threatening situation.
Adults with umbilical hernia are somewhat more likely to experience incarceration or obstruction of the intestines. Emergency surgery is typically required to treat these complications.
Preparing for your appointment
If you or your child has signs or symptoms common to an umbilical hernia, make an appointment with your family doctor or your child's pediatrician.
Here's some information to help you prepare for your appointment and what to expect from your doctor.
What you can do
- List any signs or symptoms you or your child has had, and for how long.
- Bring in a photo of the hernia if signs of the problem aren't always evident.
- Write down key medical information, including any other health problems and the names of any medications you or your child is taking.
- Write down questions you want to be sure to ask your doctor.
Below are some basic questions to ask your doctor about umbilical hernia. If any additional questions occur to you during your visit, don't hesitate to ask.
- Do I or my child have an umbilical hernia?
- How large is the defect?
- Are any diagnostic tests needed?
- What treatment approach do you recommend, if any?
- Is surgery an option in this case?
- Might surgery become an option if the hernia doesn't get better?
- How often should I or my child be seen for follow-up exams?
- Is there any risk of complications from this hernia?
- What emergency signs and symptoms should I watch for at home?
- How soon do you expect signs and symptoms to improve?
- Do I or my child need to follow any activity restrictions?
- Should a specialist be consulted?
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask:
- What signs and symptoms have you noticed?
- When did you first notice these signs and symptoms?
- Have these signs and symptoms gotten worse over time?
- Are you or your baby in pain?
- Have you or your baby vomited?
- If you are the one affected, do your hobbies or your work involve heavy lifting or straining, or have you recently gained a significant amount of weight?
- Have you or your child recently been treated for any other medical conditions?
- What medications are you or your child currently taking, including prescription and over-the-counter drugs as well as vitamins and supplements?
- What else concerns you?
Tests and diagnosis
An umbilical hernia is diagnosed during a physical exam. Sometimes blood tests or imaging studies — such as an abdominal ultrasound or X-ray — are used to screen for complications.
Treatments and drugs
Most umbilical hernias close on their own by age 1. Your doctor may even be able to push the bulge back into the abdomen during a physical exam. Don't try this or anything like it on your own, however. Although some people claim a hernia can be fixed by taping a coin down over the bulge, this "fix" doesn't help and germs may accumulate under the tape, causing infection.
For children, surgery is typically reserved for large or painful umbilical hernias or those that:
- Get bigger after age 1 or 2
- Don't disappear by age 4
- Become trapped or block the intestines
For adults, surgery is typically recommended to avoid possible complications — especially if the umbilical hernia gets bigger or becomes painful.
During surgery, a small incision is made at the base of the bellybutton. The herniated tissue is returned to the abdominal cavity, and the opening in the abdominal wall is stitched closed. Most people are able to go home within a few hours after surgery and resume typical activities within two to four weeks. Recurrences are unlikely.
- Abdominal wall hernias. The Merck Manuals: Home Edition for Patients and Caregivers. http://www.merck.com/mmhe/sec09/ch132/ch132c.html. Accessed Jan. 26, 2010.
- Stoll BJ. The umbilicus. In: Kliegman RM, et al. Nelson Textbook of Pediatrics. 18th ed. Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/179974528-5/943858714/1608/337.html#4-u1.0-B978-1-4160-2450-7..50107-9--cesec10_2769. Accessed Jan. 26, 2010.
- Brooks DC. Abdominal wall hernias. http://www.uptodate.com/home/index.html. Accessed Jan. 26, 2010.
- Hoecker JL (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 4, 2010.
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