Umbilical Hernia: Symptoms, Types, Causes and Treatment

Umbilical hernias are a common abdominal condition affecting individuals of all ages, from newborns to adults. While they are often harmless and self-resolving, particularly in children, they can sometimes lead to complications and may require surgical intervention. Whether you are a concerned parent, an adult with a new abdominal bulge, or simply interested in learning more, understanding umbilical hernias can help you recognize symptoms, appreciate risk factors, and know when to seek medical care.

Symptoms of Umbilical Hernia

Recognizing the symptoms of an umbilical hernia is the first crucial step toward timely and effective management. While many cases cause little more than a visible bulge, others may present with pain or signs of complications. Understanding these warning signs can make a significant difference in outcomes, especially in young children or individuals at higher risk for complications.

Symptom	Description	Common in	Source(s)
Bulge	Soft swelling at or near the navel	Children, Adults	1, 3, 4
Pain	Localized discomfort or tenderness	Especially in complications	1, 8
Vomiting	Nausea and vomiting, especially if obstructed	Children	1
Constipation	Difficulty passing stools	Children (complicated cases)	1
Irreducibility	Cannot push bulge back in	All ages, urgent	1, 8
Obstruction	Symptoms of bowel blockage	Severe cases	1, 8

Table 1: Key Symptoms of Umbilical Hernia

Common Presentations

Most umbilical hernias are discovered as a soft, painless bulge at or near the belly button, which may become more prominent when the person cries, coughs, or strains. In infants and young children, this bulge is often most noticeable when they are crying or straining and may flatten or disappear when they are calm or lying down 3, 4.

Warning Signs and Complications

While many hernias are harmless, certain symptoms signal complications:

• Pain: Persistent or worsening pain at the site is a red flag, especially if accompanied by tenderness 1, 8.
• Irreducibility: If the bulge cannot be gently pushed back in, it may mean the hernia contents are trapped (incarcerated), which can cut off blood supply and damage the tissue.
• Vomiting and Constipation: In children, vomiting and constipation may indicate bowel obstruction due to a complicated hernia 1.
• Obstruction: Signs such as abdominal swelling, inability to pass stool or gas, and severe pain require immediate medical attention 1, 8.

Special Cases

Rarely, umbilical hernias may contain unusual organs, such as the appendix, which can lead to unique presentations like appendicitis within the hernia sac—a very rare but documented scenario 8.

Types of Umbilical Hernia

Umbilical hernias are not all the same. They can vary in size, complexity, and associated conditions. Knowing the types helps in understanding the risks and best management approaches.

Type	Key Features	Typical Age/Population	Source(s)
Simple	Bulge, reducible, no complications	Infants, adults	3, 4, 12
Complicated	Irreducible, painful, obstruction risk	Young children/adults	1, 8
Hernia of Cord	Bowel herniation into umbilical cord	Newborns	2
Exomphalos/Omphalocele	Large defect, organs outside abdomen	Newborns (severe)	4
Gastroschisis	Bowel protrudes beside umbilicus	Newborns (severe)	4

Table 2: Types of Umbilical Hernias

Simple Umbilical Hernia

The most frequent type, especially in infants and adults, is the classic “simple” umbilical hernia. It usually presents as a soft, reducible bulge at the umbilicus. These often resolve spontaneously in children by the age of 3-5 years as the abdominal muscles strengthen 3, 4.

Complicated Umbilical Hernia

Complicated hernias are defined by symptoms such as pain, irreducibility, and sometimes signs of bowel obstruction. These are more urgent and can occur at any age, although children under 3 years are particularly at risk for complications like incarceration or strangulation, which require prompt surgical intervention 1, 8.

Hernia of the Umbilical Cord

A distinct entity seen in newborns, this type involves a small bowel herniation into the proximal part of the umbilical cord. It generally has a good prognosis after surgical correction, but may be associated with other malformations 2.

Severe Congenital Defects

• Exomphalos (Omphalocele): Organs herniate into a sac outside the abdomen; often associated with other congenital anomalies 4.
• Gastroschisis: Bowel protrudes beside, not through, the umbilicus and lacks a covering sac; typically a surgical emergency 4.

Causes of Umbilical Hernia

Understanding why umbilical hernias develop can help with prevention, early recognition, and management. Causes range from developmental issues in infancy to acquired factors in adulthood.

Cause	Mechanism/Explanation	Commonly Affected	Source(s)
Congenital	Failure of umbilical ring closure	Infants, children	3, 4
Genetics	Family history, molecular factors	Pigs, potentially humans	5, 6, 7
Increased Pressure	Obesity, pregnancy, ascites	Adults	8, 12
Delayed Healing	Poor tissue repair after birth	Infants	4
Other Risk Factors	Female gender, ethnicity (Africans higher risk)	Variable	3, 8

Table 3: Main Causes and Risk Factors

Congenital Causes

In children, umbilical hernias are most often caused by incomplete closure of the umbilical ring after birth. The umbilical ring is a natural opening in the abdominal wall that allows passage of the umbilical cord vessels. After birth, this opening should close as the muscles and connective tissues fuse together. Failure or delay in this process leads to hernia formation 3, 4.

Genetic and Molecular Factors

Research in animals, particularly pigs, has identified several genes and genetic regions associated with umbilical hernia development. These findings suggest a potential genetic predisposition in humans as well, although further research is needed. Genes involved in extracellular matrix remodeling, collagen production, and cell adhesion seem particularly important 5, 6, 7.

Increased Intra-abdominal Pressure

Adults can develop umbilical hernias due to any condition that increases pressure inside the abdomen. Common factors include:

• Obesity
• Pregnancy
• Chronic cough
• Ascites (fluid accumulation)
• Heavy lifting 8, 12

These factors can weaken the abdominal wall, allowing tissue or bowel to protrude through the umbilical area.

Other Risk Factors

• Female gender: Women are at higher risk, especially during and after pregnancy 8.
• Ethnicity: Higher incidence in African populations, though the reasons remain unclear 3.
• Delayed healing or tissue weakness: In infants, factors that slow healing after the umbilical cord falls off can contribute 4.

Treatment of Umbilical Hernia

The approach to treating umbilical hernias depends on age, symptoms, hernia size, and risk of complications. While many pediatric hernias resolve naturally, adults and complicated cases often require surgery.

Treatment Type	Indication/Use	Key Considerations	Source(s)
Observation	Uncomplicated, small pediatric hernias	Most close by age 5	3, 4
Surgical Repair	Persistent, symptomatic, or complicated hernias	Open, laparoscopic, robotic options	1, 8, 10, 12
Suture Repair	Very small defects (<1 cm)	Higher recurrence risk	9, 11, 13
Mesh Repair	Most adult hernias, larger defects	Lower recurrence, guideline-recommended	9, 10, 11, 12, 13
Emergency Surgery	Incarceration, strangulation	Prompt intervention needed	1, 8

Table 4: Treatment Approaches for Umbilical Hernia

Observation and Conservative Management

• Children: Most umbilical hernias in infants and young children resolve without intervention. Observation is advised if the hernia is small, painless, and can be pushed back in, as spontaneous closure is common by age 3-5 3, 4.
• Adults: Observation may be considered for very small, asymptomatic hernias in select patients, but the risk of complications is higher than in children.

Surgical Repair

Surgery is indicated for:

• Persistent hernias beyond early childhood
• Symptomatic or painful hernias
• Enlarging hernias
• Complicated hernias (incarceration, strangulation, obstruction) 1, 8, 10, 12

Suture Repair

Traditionally used for small hernias (<1 cm), suture repair involves stitching the defect closed. However, multiple studies and meta-analyses show a significantly higher risk of recurrence compared to mesh repair, especially in adults 9, 11, 13.

Mesh Repair

Mesh repair involves placing a synthetic mesh to reinforce the abdominal wall. Current guidelines recommend mesh repair for most adult umbilical hernias and for pediatric hernias that fail to close by themselves. Mesh repair reduces the risk of recurrence, even in small hernias (1-4 cm), and is generally safe and effective 9, 10, 11, 12, 13.

• Techniques: Open, laparoscopic, or robotic approaches are available. The choice depends on hernia size, patient factors, and surgeon experience 12.

Emergency Surgery

If the hernia becomes incarcerated (trapped) or strangulated (blood supply cut off), emergency surgery is required to prevent tissue death and severe complications. Symptoms like severe pain, irreducibility, vomiting, and signs of obstruction warrant immediate attention 1, 8.

Complications and Outcomes

• Recurrence: Less likely with mesh repair than suture repair 9, 11, 13.
• Infection, seroma, hematoma: Low rates, similar between techniques 9, 11.
• Chronic pain: Some patients may experience ongoing discomfort, particularly after recurrence 12.
• Guidelines: International hernia societies recommend mesh for most adult cases, with suture reserved for select, very small defects 10, 13.

Conclusion

Umbilical hernias are common across all age groups and can range from benign, self-resolving lumps in infants to potentially dangerous conditions in adults. Recognizing symptoms, understanding the different types and causes, and being aware of modern treatment guidelines can help ensure the best outcomes.

Key Points:

• Most umbilical hernias in children resolve without treatment; persistent or complicated cases require surgery.
• Symptoms can range from a painless bulge to pain, vomiting, and signs of bowel obstruction—immediate attention is needed for complications.
• Types include simple, complicated, hernia of the cord, and severe congenital defects like exomphalos and gastroschisis.
• Causes include congenital factors, genetics, increased abdominal pressure, and certain risk groups such as females and those of African descent.
• Surgical repair—preferably with mesh—offers the lowest recurrence rates for most adult hernias; suture repair is reserved for very small defects.
• Mesh repair is safe, effective, and guideline-recommended for hernias larger than 1 cm.
• Emergency surgery is needed for strangulated or obstructed hernias to prevent life-threatening complications.

By understanding these essentials, patients and caregivers can make informed decisions and seek timely care for the best possible outcomes.