Umbilical Hernia: The Complete Guide

What is an umbilical hernia?

An umbilical hernia is the protrusion of fat or bowel through the umbilical ring, a natural weak point where the umbilical cord passed before birth. With epigastric hernia it belongs to the "primary midline hernias". A hernia just beside the navel is called paraumbilical and is more common in adults. See the complete hernia guide.

In babies and children

• Common, especially in premature and low-birth-weight babies.
• A soft bulge that grows when the baby cries.
• Closes spontaneously in most cases by age 4–5.
• Taping a coin over it is a myth and may irritate the skin.
• Surgery if it persists beyond 4–5 years, is large (>1.5–2 cm) or becomes incarcerated.

See hernia in children.

In adults

Usually acquired, does not close and gradually enlarges. Risk factors: obesity, pregnancy (especially multiple), diastasis recti, ascites in liver cirrhosis, chronic cough, constipation and previous laparoscopic ports at the navel.

Symptoms

• A bulge at or near the navel that grows with coughing and standing.
• Pain or pulling, especially with activity.
• Outward-pointing navel.
• In advanced cases, thinning or ulceration of the overlying skin.

Emergency signs: severe pain, a hard bulge that will not reduce, skin discolouration or vomiting — go to the emergency department. See hernia complications.

Diagnosis

Clinical examination, with ultrasound to measure the defect and CT for multiple defects, wide diastasis or complex planning. The width of any diastasis influences the choice of repair.

Treatment in adults

When to operate?

Repair is recommended for symptomatic umbilical hernias. Very small asymptomatic hernias may be observed, but planned repair is far safer than emergency repair.

Mesh or suture?

According to the EHS/AHS 2020 guidelines:

• Mesh is recommended for adult umbilical hernia repair because it clearly reduces recurrence compared with sutures, even for small defects (≥1 cm).
• Simple suture may be considered for very small defects (<1 cm).
• A preperitoneal or retromuscular mesh position is preferred over intraperitoneal placement where possible.

Open or laparoscopic?

• Open repair suits small and medium single hernias.
• Laparoscopy (e.g. eTEP or IPOM) helps with larger or multiple hernias, coexisting diastasis and obesity.
• With significant diastasis, the hernia and muscle separation can be repaired together, sometimes combined with abdominoplasty.

Special situations

• Pregnancy: repair is usually postponed until after delivery (often 6–12 months) unless painful or incarcerated.
• Cirrhosis with ascites: ascites must be controlled first, with joint hepatology care.

Recovery

Most patients go home the same or next day, walk immediately and return to desk work within days. A short period with an abdominal binder may be advised. See recovery after hernia surgery and hernia mesh.