An umbilical hernia is a common concern during pregnancy, appearing as a soft bulge near the belly button, or umbilicus. This condition develops when a portion of the intestine, fat, or other abdominal tissue pushes through a weak spot in the abdominal wall near the navel. While the appearance of a bulge can be alarming, most umbilical hernias that develop or become apparent during pregnancy are harmless and require only monitoring. They are a direct result of the immense physical changes the body undergoes when carrying a child, increasing the pressure inside the abdomen. A healthcare provider should always evaluate a new bulge or discomfort to ensure proper diagnosis and monitoring throughout the pregnancy.
Understanding Umbilical Hernias and Pregnancy
An umbilical hernia occurs at the site of the umbilical ring, which is a natural opening in the abdominal fascia, the strong connective tissue layer surrounding the muscles. While this ring typically closes completely after birth, some individuals retain a small, inherent weak point. Pregnancy significantly stresses this area, either causing a new hernia or exacerbating a pre-existing one that was previously unnoticed.
The primary mechanical driver is the massive increase in intra-abdominal pressure as the uterus grows to accommodate the developing baby. This continuous outward force pushes internal organs and tissues against the abdominal wall’s weakest points, leading to a protrusion at the umbilicus. Hormonal changes, such as the increase in relaxin, also play a role by softening and stretching the connective tissues, making the fascia more pliable and susceptible to separation.
Furthermore, many pregnant individuals experience diastasis recti, a separation of the large vertical abdominal muscles, which further weakens the midline structure of the abdomen. This weakening, combined with the pressure from the expanding uterus, creates the conditions necessary for an umbilical hernia to form or enlarge. Umbilical hernias are more likely to occur or become symptomatic from the second trimester onward, which is when the uterus expands up to the level of the belly button.
Recognizing the Signs and Potential Complications
The most common sign of an umbilical hernia is a visible, soft swelling or bulge around the belly button, which may become more noticeable when the pregnant individual coughs, sneezes, or strains. This bulge often disappears or can be gently pushed back into the abdomen when lying down, a characteristic known as a reducible hernia. Most hernias during pregnancy are small and cause only mild discomfort, a feeling of pressure, or a dull ache in the navel area.
It is imperative for pregnant individuals to recognize the signs of a non-reducible or complicated hernia, which indicates a medical emergency. A hernia is considered incarcerated if the protruding tissue becomes trapped and cannot be pushed back in, which may lead to a more dangerous condition called strangulation. Signs of strangulation include severe, sudden, and constant pain at the hernia site that does not resolve with rest, along with the bulge becoming hard, firm, and tender to the touch.
Other red flags that warrant immediate medical attention are skin discoloration around the navel (red, purple, or darkened), fever, and symptoms of bowel obstruction, such as persistent nausea, vomiting, or an inability to pass gas or stool. If the blood supply to the trapped tissue is cut off, immediate surgical intervention is required to prevent tissue death and potential life-threatening complications.
Managing the Hernia Through Delivery
In the vast majority of cases, the recommended approach for an umbilical hernia during pregnancy is conservative management, often referred to as “watchful waiting.” This involves regular monitoring by a healthcare provider to track the hernia’s size and symptoms without immediate surgical intervention. Management focuses primarily on alleviating discomfort and preventing the hernia from worsening.
Pregnant individuals can relieve pressure by avoiding activities that increase intra-abdominal strain, such as heavy lifting, excessive straining during bowel movements, or prolonged bouts of coughing. Wearing supportive garments, like an abdominal binder or a maternity support belt, can help hold the hernia in place and reduce the sensation of pulling or pressure. Any use of such external support should be discussed with a doctor to ensure it is appropriate and fitted correctly.
For most small or asymptomatic hernias, a vaginal delivery is safe and remains the recommended approach. The medical team will monitor the hernia closely during labor, but the presence of an umbilical hernia rarely necessitates a planned Cesarean section. In the rare circumstance of a large, symptomatic, or incarcerated hernia, a doctor may recommend specific pushing techniques or, in exceptional cases, a C-section to minimize abdominal strain.
Timing Surgical Repair
Elective surgical repair of an umbilical hernia is almost always deferred until after the delivery of the baby. The main reason for this delay is to allow the abdominal wall and connective tissues to heal, stabilize, and return to their pre-pregnancy state, which minimizes the risk of the hernia recurring. Surgeons typically advise waiting until several months postpartum, often six to twelve months, to allow for hormonal stabilization and the resolution of any remaining diastasis recti.
Performing a repair too early, especially a suture-only repair, increases the likelihood of recurrence due to the ongoing laxity in the abdominal wall. The only exceptions to postponing surgery are cases involving acute incarceration or strangulation, which require emergency surgery regardless of the stage of pregnancy. If emergency surgery is necessary, the second trimester is generally considered the most appropriate time to minimize risks to both the mother and the fetus.