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Umbilical Hernias

What is an umbilical hernia?

An umbilical hernia, also known as a belly button hernia,  is a common type of hernia found in children that happens when part of your child’s intestines can protrude out through an opening in the muscles of your abdomen around the child’s belly button (umbilicus). Umbilical hernias may be small or on the larger side, but usually are not a cause of immediate major concerns. 

Umbilical hernias can be found in infants, children, teenagers, or adults. They are most commonly found in infants and will often resolve on their own by the age of 4. Beyond the age of 5, umbilical hernias are less likely to spontaneously resolve and typically will require surgical repair.  

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What are the symptoms of an umbilical hernia?

Umbilical hernias are most commonly seen or become more evident with increased pressure in the belly caused by coughing, crying, or pushing to pass a bowel movement. Gentle pressure or a calm environment may allow the hernia to retreat on its own and appear smaller or not visible at all.

While adults may complain of discomfort with an umbilical hernia, typically in infants and young children these types of hernias are painless. Occasionally they may cause discomfort. Incarceration of an umbilical hernia (when the hernia becomes acutely stuck under the belly button) is rare but is considered problematic.

Symptoms that are concerning for possible incarceration and warrant more urgent evaluation by a medical professional include:

  • Firm swelling at the umbilicus with or without redness 
  • Acute pain or tenderness with the umbilical swelling
  • Vomiting and feeding intolerance 
  • Crying/inconsolability in an infant or young child

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What causes an umbilical hernia?

While the baby is forming during pregnancy, there is an opening of the abdominal wall muscles through which the umbilical cord passes. This space typically closes shortly after the baby is born. In approximately 25% of babies closure of the abdominal muscles fails to take place and an umbilical hernia results. This may be noted at birth or sometimes in childhood. 

Umbilical hernias are most commonly seen in babies that are premature or born with lower birth weight. This condition is found equally in boys and girls with a slight increase in the black community. 

How do we diagnose umbilical hernias?

Typically, umbilical hernias can be seen or felt on a physical exam. Rarely, further imaging, in the form of an ultrasound or CT scan, can be used for definitive diagnosis. Again, most of the time, the diagnosis is confirmed by a physical exam alone.

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What is the treatment for umbilical hernias?

We know that 85% of umbilical hernias will resolve spontaneously by age of 4. Larger umbilical hernias that are greater than 2 cm in diameter are less likely to close spontaneously and are more likely to require surgical correction. In the rare event of umbilical hernia incarceration, surgery is necessary for treatment. 

What are potential complications when treating umbilical hernias?

The risks of umbilical hernia in infants and young children causing problems or causing strangulation are quite rare. There is a less than 5% chance that the protruding bowel would get stuck in the hernia sac (incarceration). There is less than a 1% chance of strangulation of the umbilical hernia (when the blood supply to the loop of bowel that is stuck is cut-off). Should your baby or child present with symptoms suspicious for incarceration, medical attention should be sought emergently. 

Expected outcomes from umbilical hernia treatment.

We expect your baby’s umbilical hernia to resolve by 4 years of age. If your child is 4 or older, and has an umbilical hernia that has not resolved, you should have your child seen in our office. Surgical correction will likely be recommended.

Surgery is performed at Golisano Children’s Hospital and your child should go home that same day. He or she will likely be uncomfortable for a few days with pain relief from over-the-counter pain medications. We will advise you on activity restrictions and specific post-op instructions. Following surgery, there is a less than 3% chance of recurrence. 

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