An umbilical hernia is a bulge near the belly button (umbilicus). It occurs when an internal part, like intestine or fatty tissue, pushes through a weak spot in the abdominal wall. Umbilical hernias are a common condition, affecting both newborns and adults.
Umbilical Hernias in Children vs. Adults
Umbilical hernias are common in infants when the umbilical ring, an opening in the abdominal wall, does not fully close after birth. In most cases, these hernias in children are not painful and often resolve on their own. Approximately 90% of umbilical hernias in infants will naturally close by the time a child reaches 4 to 5 years of age.
In contrast, umbilical hernias in adults are less likely to close spontaneously and tend to persist or enlarge over time. Adult hernias often result from increased pressure within the abdomen, which can stem from factors such as obesity, multiple pregnancies, or chronic straining.
When Surgical Intervention is Considered
For children, surgical intervention for an umbilical hernia is considered if the hernia persists beyond 4 to 5 years of age. Surgery may also be recommended for hernias larger than 1.5 to 2 centimeters in diameter, as these are less likely to close on their own. While complications are rare in pediatric cases, surgery might be necessary sooner if the child experiences pain or discomfort, or if there are signs of skin irritation over the hernia.
In adults, surgical repair is recommended for most umbilical hernias, regardless of initial size, as they rarely resolve spontaneously and carry a higher risk of complications. Urgent surgical evaluation is indicated if symptoms suggest incarceration or strangulation. Incarceration occurs when tissue becomes trapped and cannot be pushed back into the abdomen, potentially causing severe pain, nausea, or vomiting. Strangulation, a more serious condition, involves the blood supply to the trapped tissue being cut off, leading to symptoms like increasing sharp abdominal pain, vomiting, and changes in the hernia’s color to red or purple. These symptoms, irrespective of hernia size, are medical emergencies requiring immediate attention.
Non-Surgical Management Approaches
For umbilical hernias in children, a common non-surgical approach is watchful waiting. Doctors monitor the hernia’s size and symptoms, expecting spontaneous closure by the time the child reaches school age. This observation period allows the abdominal muscles to potentially close the opening naturally. Taping or binding the hernia is not recommended, as it is ineffective and may cause skin irritation.
In adults, non-surgical options are limited due to the low likelihood of spontaneous closure and the potential for complications. For very small, asymptomatic hernias, particularly in individuals who may not be suitable candidates for surgery, a period of monitoring may be considered. This approach involves carefully watching for any changes in the hernia’s size or the development of symptoms.
What to Expect if Surgery is Recommended
If surgical repair is recommended, the procedure, known as a herniorrhaphy, is safe and common. The surgery involves pushing the bulging tissue back into the abdomen and then closing or reinforcing the weakened abdominal wall. This reinforcement may be done with stitches alone or by using a surgical mesh, particularly for larger hernias or in adults, to strengthen the area and reduce the risk of recurrence.
Most patients, including children, are able to go home on the same day as the operation. Recovery involves some pain and discomfort for a few days, managed with pain medication. While light activities like walking can be resumed within days, strenuous activities and heavy lifting are restricted for about two to six weeks to allow for proper healing. Full recovery time can vary, with many individuals returning to normal activities within two weeks, though some may take longer depending on the hernia’s size and complexity of the repair.