An umbilical hernia presents as a noticeable bulge near the belly button (umbilicus), where an internal body part, typically fatty tissue or intestine, pushes through a weak spot in the abdominal muscle wall. Whether this condition resolves on its own depends almost entirely on the person’s age, as the underlying causes and structural weaknesses differ significantly between infants and adults. While the vast majority of cases in children close spontaneously without medical intervention, the prognosis is quite different for adults. Understanding the nature of the defect and the risks involved is necessary to know when watchful waiting is appropriate and when professional care is required.
Understanding Umbilical Hernias
An umbilical hernia occurs due to a defect in the anterior abdominal wall around the navel. The abdominal wall muscles have not fully closed, creating an opening, often called the umbilical ring, through which tissue can protrude. The resulting lump is more apparent when there is increased abdominal pressure, such as when a baby is crying or an adult is straining or coughing.
The causes differ by age group. In infants, the hernia develops because the small opening for the umbilical cord fails to seal completely soon after birth. Adult hernias are typically acquired later in life, caused by excessive pressure on an already weakened abdominal wall. Risk factors include multiple pregnancies, obesity, excessive fluid in the abdomen, or persistent coughing.
A physician assesses the hernia’s characteristics during an examination, notably whether it is “reducible.” A reducible hernia is one where the protruding tissue can be gently pushed back into the abdominal cavity. If the tissue becomes trapped and cannot be returned, the hernia is considered “incarcerated,” which carries a higher risk of complications.
Why Infant Hernias Often Resolve Naturally
In newborns and young children, spontaneous closure is the expected outcome, with over 90% of cases resolving without intervention. This natural resolution occurs because the defect is a result of developmental timing, not a permanent structural failure. The abdominal wall muscles, which did not fully join after birth, continue to grow and strengthen, gradually closing the umbilical ring.
The typical timeline for closure is by the age of two, though it can continue until the child is four or five years old. Parents are advised to practice watchful waiting during this period, as most pediatric umbilical hernias are asymptomatic and cause no discomfort. Defects smaller than one centimeter are more likely to close on their own than larger ones.
Early surgical intervention is avoided due to the high likelihood of natural resolution and the increased chance of recurrence with early repair. Delaying surgery allows the muscle wall to mature and thicken, simplifying the procedure if repair is eventually needed. Interventions like taping coins over the hernia are ineffective and should be avoided due to the risk of skin irritation or infection.
When Medical Intervention is Required
While spontaneous resolution is the rule in infants, surgical intervention is almost always necessary for adults and a small percentage of pediatric cases. Adult umbilical hernias rarely resolve on their own because they result from acquired weakness under chronic pressure, not a temporary developmental delay. For adults, surgery is recommended to prevent complications, even if the hernia is not currently painful.
In both adults and children, the most serious reason for urgent intervention is when the hernia becomes incarcerated or strangulated. Incarceration means the tissue is trapped outside the abdominal cavity and cannot be pushed back in, potentially causing pain and bowel obstruction. A strangulated hernia is a medical emergency that occurs when the blood supply to the trapped tissue is cut off.
Signs of strangulation require immediate emergency care, including a sudden increase in pain, fever, vomiting, or the bulge turning red, purple, or dark. For children, surgery is also recommended if the hernia is very large, symptomatic, or persists past the age of five. The surgical repair, or hernioplasty, involves returning the protruding tissue to the abdomen and closing the defect, often using a surgical mesh in adults to reinforce the abdominal wall.