Umbilical hernia

Definition
A hernia is a protrusion of an organ through the usually muscular wall that normally surrounds or contains it. An umbilical hernia occurs when part of the intestines or fatty tissue near the navel (also called the umbilicus or belly button) break through the muscular wall of the abdomen. Umbilical hernias are most common in infants, but they may also occur in adults.

Causes/associated factors
Generally, umbilical hernias are most common in infants with low birth weights, females and African Americans.
In infants, umbilical hernias are related to a congenital weakness in the muscles surrounding the navel. This results in an area of soft tissue that protrudes around the navel and can be seen when the infant cries, coughs or strains. Umbilical hernias may be smaller than 1 centimeter and as large as 5 centimeters -- larger umbilical hernias in children are rare.

In adults, umbilical hernias may develop when the outward abdominal pressure becomes stronger than the muscles of the abdominal wall -- often because of obesity, multiple pregnancies, large abdominal tumors or large amounts of accumulated abdominal fluid. Plus, the umbilical area is a natural weak spot, making it a common place for hernias to develop. Once they appear in adults, hernias tend to gradually increase in size and cause abdominal pain.


Signs/symptoms
With an umbilical hernia, the soft tissue around the navel protrudes when you're at rest or when you cry, cough or strain. You may notice sharp or dull pain in the umbilical area. A dragging or aching sensation is more common with large umbilical hernias.

Diagnosis
Diagnosis is typically based on symptoms and a physical exam. More commonly for adults, tests such as blood work, abdominal ultrasounds (using sound waves to create images of internal body parts) or X-rays may be done to screen for certain complications.

Treatment
For most children, umbilical hernias close on their own without treatment by age 1. However, the doctor may recommend surgery if the child develops complications, the hernia gets bigger after age 1 or 2, doesn't disappear by age 5 or 6, or becomes painful.
For most adults, surgery is recommended to avoid possible complications. For those in good health, surgery is typically successful and recurrences are rare.


Complications
If the herniated material twists and its blood supply is blocked, the hernia may become strangulated. This emergency situation causes severe pain, fever, vomiting and tissue death. Shock is also a possibility. Because strangulation is life-threatening, immediate surgery is necessary. Although rare in children, strangulated umbilical hernias are common in adults. Other potential complications of umbilical hernias may include obstruction or perforation of the intestines and infection of the abdominal cavity.
After surgery, the risk of complications increases if you have a large hernia or some type of abdominal disease. The risk also increases with age and poor overall health.


Pregnancy-specific information
Multiple pregnancies may increase the chance of developing an umbilical hernia due to the repeated pressure on your abdominal muscles.

Senior-specific information
Older adults are more likely to have certain conditions that contribute to umbilical hernias, such as obesity, poor abdominal muscle tone and abdominal tumors. If you suspect a hernia, consult your doctor.

Prevention
To prevent an umbilical hernia, maintain good abdominal muscle tone through regular exercise and use proper body mechanics when lifting heavy objects. It's also helpful to maintain a healthy weight.