An umbilical hernia is a soft bulge near the navel, caused by abdominal contents pushing through the umbilical ring—the opening where the umbilical cord passed through during development. When this closure is incomplete after birth, fat or a loop of intestine can protrude, often becoming more noticeable when a person coughs or strains. Whether an umbilical hernia resolves on its own depends almost entirely on age: natural resolution is common in infants, but far less likely in adults without medical intervention.
The Mechanism of Natural Resolution in Infants
The vast majority of umbilical hernias in newborns and young children resolve spontaneously through natural muscle strengthening and growth, making “watchful waiting” the common approach. As the child grows, the rectus muscles move inward and the fascial layers fuse, effectively closing the defect in the abdominal wall. This closure usually happens within the first two years of life, and more than 90% of pediatric umbilical hernias close without intervention by the time a child reaches five years of age. The hernia often appears larger when the infant is crying or active, but it shrinks or disappears when they are relaxed, a sign that the hernia is “reducible” and not trapped. Small hernias, especially those less than 1.5 centimeters in diameter, are the most likely to close on their own.
Attempts to manually close the hernia, such as taping a coin or other object over the bulge, are not effective and are discouraged by medical professionals. This practice can irritate the skin or cause infection, as the natural healing process is driven by internal muscular development, not external pressure. Parents are advised to simply monitor the hernia’s size and appearance during this period.
Indicators That Require Medical Intervention
While most pediatric umbilical hernias resolve on their own, certain signs indicate the need for prompt medical attention. The primary danger is “incarceration,” where the protruding tissue becomes trapped and cannot be pushed back into the abdomen. This complication, though rare in children, carries a risk of “strangulation,” where the blood supply to the trapped tissue is cut off, requiring emergency surgery. Warning signs include sudden, sharp, or worsening pain at the hernia site. The bulge may become firm, tender, or change color, often appearing red, purple, or dark.
These symptoms, especially when accompanied by vomiting, fever, or an inability to pass gas or have a bowel movement, require immediate evaluation by an emergency department. For hernias that are not an emergency, elective surgery is considered if the hernia has not closed by the age of four or five. Surgery may also be recommended if the opening is particularly large (exceeding 1.5 to 2 centimeters in diameter) or if the child experiences discomfort. The surgical repair involves pushing the tissue back into the abdomen and closing the defect with sutures.
Umbilical Hernias in Adulthood
Umbilical hernias in adults are acquired conditions resulting from increased pressure within the abdominal cavity, often due to obesity, multiple pregnancies, or chronic coughing. Unlike the developing muscle tissue in infants, mature muscle tissue is unable to spontaneously close the opening once a defect has formed. For this reason, an adult umbilical hernia will rarely resolve on its own and tends to worsen over time. Surgery is the standard treatment due to the higher risk of incarceration and strangulation compared to pediatric cases. Although a small, painless hernia might be monitored, surgical repair is generally recommended to prevent future complications, involving closing the defect, often with a surgical mesh to reinforce the abdominal wall.