Learn about the causes, symptoms and effective treatment of umbilical hernia in children and adults. Find out when surgery is required and how the diagnostic process works.
Table of contents
- What is an umbilical hernia? Definition and mechanism of formation
- Most common symptoms of umbilical hernia in children and adults
- Causes of umbilical hernia – risk factors
- Diagnosis of umbilical hernia – when to see a doctor?
- The most effective methods of treating an umbilical hernia
- Complications and prevention – what to look out for?
What is an umbilical hernia? Definition and mechanism of formation
Umbilical hernia (Latin: hernia umbilicalis) is one of the most common abdominal conditions in both children and adults. It involves the displacement of a fragment of abdominal organs, most often loops of intestines or fatty tissue, through a widened or weakened umbilical ring, a place where the abdominal wall is naturally thinner and lacks a full layer of muscle. In practice, this means that tissues of the peritoneum or organs from the abdominal cavity “push” outward, creating a characteristic protrusion or lump in the umbilical region. The size of the hernia can range from small, soft protrusions felt only when standing or coughing, to more extensive, hard lesions visible to the naked eye at all times. Umbilical hernia most often occurs in infants and young children as a congenital abnormality resulting from inadequate closure of the umbilical ring after the umbilical cord has fallen off, but it also occurs in adults under the influence of excessive intra-abdominal pressure, for example, in the course of pregnancy, obesity, lung disease or chronic cough. The risk of this condition also increases with age, as well as in people who perform heavy physical labor or struggle with chronic constipation and other conditions that increase intra-abdominal pressure.
The mechanism of umbilical hernia formation is closely related to the anatomical structure of the umbilical region, which is a natural point of weakness in the abdominal wall. During the fetal period, blood vessels run through the umbilicus to deliver nutrients from the placenta to the developing body. After birth and cutting off the umbilical cord, these vessels overgrow, and the umbilical ring should close by scarring and strengthening with connective tissue and muscle. In some people, however, this process is incomplete or weakens over time, allowing a hernia to form. In the case of children, we are most often dealing with underdevelopment of tissues in the umbilical region, while in adults, the predominant mechanism is the secondary distension of the rectus abdominus muscles, which is contributed to by a chronic increase in abdominal pressure or deterioration of tissue elasticity due to aging processes. The characteristic element of an umbilical hernia is the hernia sac, which is a protrusion of the abdominal peritoneum, into which fragments of the small intestine, the greater web, less often other abdominal organs can move. In some cases, the contents of the hernia sac can be periodically moved back into the abdominal cavity (known as a draining hernia), but in a situation of entrapment or complications, serious health problems such as intestinal obstruction, tissue necrosis or infection can occur. An umbilical hernia is much less likely to cause pain, but because of the risk of complications and the progressive enlargement of the lesion, it is an indication for regular medical follow-up and, in most cases in adults, for surgical treatment. Understanding the process of formation and structure of this hernia is crucial for proper diagnosis and selection of the most effective method of treatment – both in children, in whom spontaneous regression of the lesion is often possible, and in adults, for whom surgery remains the surest solution to prevent complications.
Most common symptoms of umbilical hernia in children and adults
Umbilical hernia manifests itself somewhat differently depending on the age of the patient, but its primary symptom, in both children and adults, is a protrusion or soft, small “lump” visible and/or palpable in the umbilical region. Often the lesion is aggravated when coughing, crying, laughing, passing stools or during exercise, and may be less noticeable at rest, especially when the person is lying on his or her back. In children, especially newborns and infants, the protrusion is usually clearly visible when the abdominal covering is tightened, such as when crying. Importantly, in the youngest, an umbilical hernia rarely causes pain or other discomfort, and its presence often does not interfere with the child’s daily functioning. In most children, the lesion is painless and soft, and usually can be easily drained into the abdominal cavity, meaning that the protrusion fragment retracts with gentle pressure. Many times parents only notice an intermittent “wick” in the belly button, which may subside spontaneously as the child grows and his abdominal muscles develop. However, if the child develops symptoms such as discomfort, anxiety, difficulty feeding, vomiting or redness and tenderness in the umbilical area, immediate medical consultation is necessary, as these may indicate a complication of the hernia, such as bowel entrapment.
In adults, the clinical picture of an umbilical hernia is often more complex and symptoms may be more severe – in addition to a palpable, usually soft, elastic lesion in the umbilical region, patients may complain of a feeling of distension, pulling or aching, especially during exertion, coughing, sneezing or prolonged standing. Some also experience intermittent discomfort or pain of a dull nature, localizing to the abdominal fascia or radiating to the umbilical region. These symptoms tend to increase during the day and subside when lying down. In cases of a large hernia, a significant tumor of up to several centimeters can be observed, which may enlarge or change shape in certain positions of the body. Some umbilical hernias in adults can lead to a complication in the form of entrapment, or wedging of the contents of the hernia sac (usually fragments of intestine). This manifests itself as a sudden increase in pain, hardness and inability to drain the hernia into the abdominal cavity. This may be accompanied by swelling, redness, nausea, vomiting, constipation and general symptoms of gastrointestinal failure. In such a situation, it is an immediate medical emergency, requiring urgent surgical intervention. In addition, in adults, the chronic presence of a hernia not infrequently leads to local soreness, epidermal abrasions and even chronic inflammation of the skin around the umbilicus. It is also worth noting that some small umbilical hernias in adults may be sparsely or even asymptomatic for a long time, which delays reporting to a specialist and increases the risk of complications. Regardless of age group, it is important to carefully observe the lesion for sudden enlargement, hardening, changes in skin color, pain or concomitant general symptoms, which should always prompt prompt contact with a doctor for diagnosis and implementation of appropriate management.
Causes of umbilical hernia – risk factors
Umbilical hernia is a condition for the formation of which a number of different risk factors are responsible, having to do with both individual genetic predisposition, as well as lifestyle, health status and the circumstances surrounding the development of the body. In the case of newborns and infants, the most important factor in the formation of hernia is the inadequate closure of the umbilical ring after birth. During pregnancy, the umbilical cord passes through a tiny opening in the fetal abdominal wall, which physiologically should knit together immediately after birth. When this process is disrupted – most often in premature babies, babies with low birth weight, genetic disorders or defects in the development of connective tissue – there remains a predisposing site for organ displacement in the periumbilical space. Also, excessive crying, chronic coughing or intense intestinal peristalsis exacerbate the local pressure, which increases the risk of the protrusion becoming visible. It is worth noting that children born prematurely or burdened with respiratory or neuromuscular diseases are at special risk. In adults, on the other hand, structural weakness of the periumbilical tissue is primarily the result of muscle fiber laxity and abdominal muscle distension that progresses with age. Chronic elevation of intra-abdominal pressure, which can result from obesity – especially abdominal obesity, chronic constipation, tumor growth in the abdominal cavity or organ shifts due to enlargement of the liver, spleen or uterus during pregnancy, is also an important factor. Particularly vulnerable are women with consecutive pregnancies, whose abdominal shells undergo repeated stretching and whose tissue regeneration process is often inadequate. Physical labor requiring frequent heavy lifting or intense exercise leads over time to a gradual weakening of the rectus abdominis muscles and their fascia, which significantly increases the likelihood of developing an umbilical hernia. Chronic conditions such as chronic cough (e.g., in the course of COPD, asthma, cystic fibrosis), prostatic hypertrophy in men causing difficulty urinating and tightening of the abdominal compression, as well as any disorder leading to chronic coughing, laughing or sneezing, also have a not insignificant impact.
An important aspect that is sometimes overlooked are genetic factors and congenital disorders of connective tissue development – a familial propensity for hernias can result from both abnormal collagen structure and the presence of syndromes that reduce the resistance of abdominal walls to stretching and tearing. Such syndromes include Ehlers-Danlos syndrome, Marfan syndrome or other rare collagenopathy pathologies. In addition, conditions after abdominal surgery are not insignificant – scars and ungrown incision sites weaken muscles and fascia, providing a potential starting point for a future umbilical hernia. Treatment of chronic surgical wounds or the presence of drains and catheters in the abdominal cavity further impairs tissue regeneration properties. Patients with chronic metabolic diseases (e.g., diabetes), liver disease (especially cirrhosis and ascites), as well as the elderly, in whom aging processes are correlated with a decrease in the repair capacity of muscles and fascia, are also particularly vulnerable. It is also worth noting the influence of environmental and lifestyle factors – the formation of an umbilical hernia is affected by a diet poor in nutrients that strengthen tissues, lack of regular physical activity, prolonged sedentary behavior and exposure to chronic stress, which disrupts the regenerative and hormonal mechanisms of the body. Ultimately, the formation of an umbilical hernia is usually the result of a complex interplay of the above factors, and risk assessment should be carried out individually, taking into account both family medical history and the patient’s current body condition. This comprehensive view of risk factors allows not only faster diagnosis, but also the implementation of effective preventive measures in high-risk groups.
Diagnosis of umbilical hernia – when to see a doctor?
The diagnosis of an umbilical hernia is based mainly on medical history and physical examination, but knowing the relevant symptoms that require medical consultation is equally important. Most often, the first sign of an abnormality is a protrusion in the umbilical region, which may be accompanied by a feeling of distension, discomfort or pain, especially during physical exertion, coughing or laughing. Particularly in children, caregivers should pay attention to the enlargement of the lesion during crying and its appearance at rest – if the hernia disappears when relaxed, this is usually not an immediate cause for concern, but regular observation is key. Disturbing symptoms in the youngest are an increase in the bulge, the appearance of pain, difficulty feeding, vomiting, and redness or hardness in the umbilical area. In adults, on the other hand, it is important to pay attention not only to a palpable thickening, but also to a chronic pulling sensation, pain and symptoms of gastrointestinal disorders such as diarrhea, nausea, flatulence or difficulty in defecation. Particularly alarming is the sudden enlargement of the hernia, its redness, hardness, severe pain that makes it impossible to drain the protrusion, and general symptoms such as fever or disturbance of consciousness – these may indicate a hernia entrapment or ischemia of a section of the intestine, which is an indication for urgent surgical intervention. Consultation with a specialist is also necessary if the lesion does not spontaneously disappear in a child by 2-3 years of age, grows, or any additional symptoms indicating a health risk appear.
The diagnostic process begins with a visit to a family doctor, or a pediatrician in the case of children, who takes a detailed history and performs a palpation examination of the abdominal tissues. In most cases, an umbilical hernia is easily diagnosed during a physical examination – the doctor asks the patient to cough, tense the abdominal muscles or assume a standing position to assess the nature and drainability of the lesion. In the differential diagnosis, it is extremely important to exclude other conditions such as cysts, subcutaneous tumors or enlarged lymph nodes. In case of ambiguity or doubt about the nature of the lesion, the doctor may order additional imaging studies – the most common is ultrasonography (ultrasound) of the abdomen, which allows to assess the contents of the hernia sac, the presence of possible complications and the condition of the adjacent tissues. In adults, especially those with large or irremovable hernias, computed tomography (CT) or magnetic resonance imaging (MRI) is sometimes used, which allows detailed imaging of the hernia contents and assessment of the risk of incarceration. If complications such as bowel obstruction are suspected, additional laboratory tests (e.g., CBC, CRP) can be helpful in assessing the general condition and inflammatory process. Diagnosis ends with a diagnosis and an individualized treatment plan, taking into account the patient’s age, the size of the hernia, the degree of discomfort and the presence of risk factors or concomitant diseases. Regular checks and monitoring of symptoms are essential in both children and adults – they allow rapid detection of changes in the nature of the hernia and prevent the development of dangerous complications.
The most effective methods of treating an umbilical hernia
Treatment of an umbilical hernia depends on the patient’s age, health status and the severity of the condition. Choosing the optimal therapeutic method often requires individual evaluation and close cooperation with the surgeon. In infants and young children, most umbilical hernias tend to close spontaneously in the first years of life, especially if the hernia does not reach a large size and there are no alarming symptoms such as pain, redness or feeding difficulties. In such situations, so-called observation and regular pediatric check-ups are recommended – the doctor assesses the size and elasticity of the hernia, and checks for signs of entrapment or obstruction of the digestive tract. Parents are instructed not to use any homemade methods on their own, such as tourniquets or sticking patches, as these can increase the risk of complications and skin damage. Surgical intervention in children is usually considered only when the hernia does not withdraw spontaneously by the age of 4-5 years, becomes enlarged, there are symptoms of discomfort or there is a risk of incarceration. The procedure involves opening the hernia sac, assessing the condition of the organs inside, and then suturing the muscle and fascial defect and strengthening the abdominal wall. The surgical technique in this age group is usually minimally invasive, and return to full activity is rapid. The risk of complications after surgery in children is minimal, and recurrences are rare, especially with proper recovery and adherence to medical advice.
In adults, treatment of an umbilical hernia is almost always based on surgery, since spontaneous fusion of the defect in the abdominal wall is virtually impossible in adulthood. The key indication for surgery is the enlargement of the hernia, worsening pain symptoms, discomfort with daily activities, risk of bowel entrapment or the presence of comorbidities that increase intra-abdominal pressure. Classical surgery (open surgery) or laparoscopic surgery are most commonly used, and the choice of surgical method depends on the size of the hernia, the condition of the abdominal wall, the patient’s overall health and expectations for recovery. During the operation, the surgeon repositions the contents of the hernia sac into the abdominal cavity, and then reinforces the defect in the abdominal wall. The standard nowadays is the use of synthetic mesh – implants that allow permanent strengthening of the abdominal wall and significantly reduce the risk of recurrence. Surgery can be performed on an elective basis or urgently if there are symptoms of acute entrapment or bowel obstruction. Laparoscopic technique is considered more modern, is associated with less post-operative discomfort, faster recovery and less risk of infection and complications, but is not feasible in every case. Sometimes, for very small hernias, non-mesh procedures are used – involving only suturing of the patient’s own tissues, but the risk of recurrence is somewhat higher here. The recovery process after umbilical hernia surgery requires several days of rest, a gradual return to physical activity, and adherence to recommendations to avoid heavy lifting or sudden abdominal movements. In addition, in those with an increased risk of recurrence (e.g., obesity, chronic cough, metabolic diseases), causal treatment and lifestyle modification – weight reduction, physical activity matched to ability, and attention to a healthy diet – are key. Alternative, non-operative treatments, such as belts or hernia corsets, may provide temporary relief from symptoms, but do not treat the cause and can only be used temporarily – for example, when there are contraindications to surgery or the patient is being prepared for surgery. It is important that any treatment, whether conservative or surgical, be carried out under a doctor’s supervision and supplemented with regular check-ups to monitor any complications or recurrence of the hernia.
Complications and prevention – what to look out for?
Umbilical hernia complications can pose a serious threat to both children and adults, so early recognition of alarming symptoms and proper case management are important. Among the most serious complications is hernia entrapment, which involves the closure of a fragment of intestine or other organ inside the hernia sac, leading to impaired blood supply, tissue necrosis, and eventually even intestinal perforation and peritonitis. Symptoms of incarceration are mainly sudden, severe abdominal pain, redness and hardness in the umbilical region, inability to drain the hernia, and gastrointestinal dysfunction (nausea, vomiting, gas and stool retention). This type of situation requires immediate surgical intervention, so ignoring the swelling, pain or change in appearance of the hernia can lead to serious health consequences. In adults, the risk of complications such as chronic pain, postoperative adhesions, wound infection or hernia recurrence increases significantly, especially with the presence of risk factors such as obesity, diabetes or chronic conditions that weaken immunity. Also in children, hernia incarceration, although far less common, requires urgent medical evaluation, especially when the hernia becomes hard, painful, and redness appears around it. Other complications that can occur are skin infections around the umbilicus, bowel obstruction and, rarely, hematoma or abscess around the lesion. It is important for all patients – regardless of age – to be aware of the symptoms that accompany complications, such as increasing pain, fever, redness or discharge from the hernia area, and to consult a doctor immediately if they occur.
Prevention of umbilical hernia includes not only preventive measures aimed at healthy individuals, but also appropriate management of patients after surgery or diagnosed with a mild hernia. Among effective preventive measures, the maintenance of a normal body weight plays a key role, since obesity significantly increases the risk of hernia formation and recurrence due to the continuous increase in abdominal pressure. It is advisable to maintain a balanced diet rich in fiber, which helps avoid chronic constipation and excessive straining during bowel movements – a factor that promotes the formation of hernias. Taking care of adequate physical activity, especially exercises that strengthen abdominal muscles and stabilize posture, can significantly reduce the risk of weakening abdominal coverings, but sudden movements and weight lifting without proper technique should be avoided, and post-operative patients with fresh post-operative wounds should strictly follow their doctor’s advice to limit exercise for several weeks. Prevention also applies to pregnant women, in whom care should be taken to gain weight evenly and to avoid too much physical activity. In children, especially premature and low-birth-weight babies, it becomes important to properly manage the newborn’s navel and avoid excessive crying or coughing by monitoring the toddler’s overall health. After hernia surgery, regular follow-up visits, proper wound hygiene and early recognition of signs of infection or complications are essential. Patient education regarding lifting rules, types of exercise and applicable restrictions should begin at the hernia diagnosis stage to minimize the risk of complications and recurrence. Similarly, it is important to avoid factors that negatively affect the healing process, such as smoking and excessive alcohol consumption. As a result, early response to abnormal symptoms and proper prevention, both primary and secondary, significantly reduce the risk of complications and ensure a faster return to full function.
Summary
Umbilical hernia is a condition that can affect both children and adults. Prompt identification of symptoms and knowledge of risk factors allow implementation of appropriate treatment. In the case of adults, surgery is most often required; in children, spontaneous disappearance of the hernia is possible. Proper diagnosis and prevention minimize the risk of complications, such as hernia incarceration. Remember not to delay medical consultation in case of severe symptoms, severe pain or gas or bowel disturbances.
