Understanding Umbilical Hernias – Recognizing Physical Changes Associated with a Hernia

The abdominal wall consists of connective tissue, abdominal muscles, and abdominal skin. It is not uniformly developed throughout and has weak spots. One of these weak spots is the navel. The abdominal wall is constantly subjected to enormous pressure—it supports our internal abdominal organs. This pressure increases significantly when we cough, sneeze, or lift something. Pregnancy also puts strain on the abdominal wall. An umbilical hernia forms when the connective tissue around the navel cannot withstand the pressure.

A gap forms in the abdominal wall—known as the hernial orifice—through which the peritoneum protrudes outward. Doctors refer to this bulge as the hernial sac. Sometimes, parts of the intestine also protrude into the hernial sac. In rare cases, the hernia constricts the intestinal loops—cutting off their blood supply. An incarcerated umbilical hernia is a medical emergency, especially if sections of the intestine have prolapsed. There is a risk that parts of the intestine could die. It therefore requires immediate surgery.

Statistically speaking, babies are by far the most common group affected by umbilical hernias—about one in ten in this country suffers from one. Premature babies with a birth weight under 1,500 grams are particularly at risk—two-thirds of them are born with a congenital umbilical hernia. Among adults, women are at higher risk than men—they are about four times more likely to develop an umbilical hernia. Women between the ages of 50 and 60 are particularly at risk.

Specialists in the field of hernia surgery emphasize that the umbilical region is a natural weak spot and that umbilical hernias occur much more frequently in adults than many people assume. While an umbilical hernia in children often resolves spontaneously, in adults it causes increasing discomfort as it grows larger or tissue becomes trapped.

This is precisely why it is important to know that an umbilical hernia often starts out harmless but can grow larger without treatment. Umbilical hernias in adults should therefore always be evaluated by a doctor in order to plan the appropriate treatment in a timely manner and avoid complications

How does an umbilical hernia develop?

The navel is a natural weak spot in the abdominal wall. During pregnancy, the umbilical cord attaches here, supplying the embryo with all the essentials for life. After birth, the opening through which the umbilical cord passed slowly closes—forming the navel. However, the navel always remains a weak spot, as it consists only of thin layers of muscle and connective tissue.

The navel also interrupts a stabilizing connective tissue seam that connects the tendon layers of the abdominal muscles. The so-called linea alba bypasses the navel area. Expectant mothers will be familiar with this “white line”—during pregnancy, this vertical seam is clearly visible. If the tissue around the navel cannot withstand increased pressure in the abdominal cavity, a hernial orifice forms. The peritoneum then pushes through the resulting opening and forms a bulging sac of skin. If the hernial sac is large enough, loops of intestine can also squeeze into it.

The causes of an umbilical hernia in babies are different. If the umbilical hernia is congenital, the causes can be traced back to embryonic development in the womb. After the 32nd day of pregnancy, a natural umbilical hernia develops in the embryo. At this stage of development, the loops of intestine grow faster than the abdominal cavity—parts of the intestine divert into the umbilical cord due to lack of space. Normally, this umbilical hernia resolves on its own by the ninth week of pregnancy. Sometimes this is not the case, and the baby is born with an umbilical hernia. Occasionally, an umbilical hernia also develops in the first few weeks of life, before the tissue around the navel has completely closed. The still-weak umbilical tissue cannot always withstand the pressure caused by coughing, crying, or straining.

The following risk factors increase the likelihood of an umbilical hernia:

• lifting heavy loads
• significant obesity
• pregnancy
• genetic connective tissue weakness
• certain medical conditions (such as ascites, chronic lung disease, or diabetes)

An umbilical hernia can usually be diagnosed through a physical examination, as the gap in the abdominal wall near the navel is often palpable. In children and adults, palpable bulges and typical symptoms such as a feeling of pressure or pulling are considered the first signs. As the hernia progresses, adults may also experience a noticeable feeling of tightness.

Important to know: Treatment for an umbilical hernia depends on its size and the symptoms present. As long as there are no complications, a hernia often causes only mild discomfort, but pain can occur at any time—especially during physical exertion. Warning signs include sudden severe pain, hardening, or discoloration, as these may indicate an incarcerated hernia.

In such cases, umbilical hernia surgery is necessary to relieve pressure on the prolapsed structures and prevent further damage. If loops of the intestine become trapped, severe pain can develop within a short time, which is why prompt medical attention is crucial. Timely treatment ensures that the abdominal wall is securely closed and further complications are avoided.

What symptoms does an umbilical hernia cause?

In infants, an umbilical hernia manifests as a soft bulge at the navel that a doctor can push back into the abdomen. The size of the bulge varies depending on the size of the opening—it can range from the size of a cherry to the size of a tennis ball. Smaller umbilical hernias are only visible when the baby cries or strains. Normally, an umbilical hernia does not cause any discomfort for the patient.

Pain sometimes occurs only when there is increased pressure on the abdominal cavity (such as when lifting or coughing). The situation is different if loops of intestine become trapped in the umbilical hernia. In this case, severe pain sets in very quickly. Babies cry persistently, and the navel turns dark. In the case of an incarcerated umbilical hernia, immediate action is required—surgery must be performed right away. Even though an umbilical hernia in babies is usually harmless and causes no symptoms, it is essential to have it evaluated by a pediatrician or surgeon—typically a visceral surgeon or hernia surgeon.

When a hernia becomes incarcerated, those affected complain of severe pain, nausea, and vomiting @ staras /AdobeStock

How is an umbilical hernia treated?

In babies, an umbilical hernia rarely requires treatment. In 90 percent of all cases, the umbilical hernia resolves on its own by the end of the child’s second year of life. If this does not happen, surgery is necessary. However, there is no rush as long as the hernia remains asymptomatic. Surgical treatment usually takes place before the child starts school.

Since an umbilical hernia in adults generally does not resolve on its own, umbilical hernia surgery is the only treatment option. During the procedure, the surgeon removes the hernial sac and closes the hernial orifice by suturing the individual layers of tissue together.

If the hernial orifice is very large, the surgeon also inserts a reinforcing synthetic mesh to prevent the umbilical hernia from recurring. In most cases, umbilical hernia surgery can also be performed using a minimally invasive, keyhole technique. However, since only a single small incision directly at the navel is required for the procedure, minimally invasive techniques have not gained widespread acceptance in this area.

Depending on the individual findings, specialists select the appropriate surgical procedure, particularly in cases of larger umbilical hernias. In many cases, the herniated structures can be gently returned to the abdominal cavity, and treatment is performed via a small, direct incision at the navel.

Minimally invasive techniques may be considered for selected patients, especially when the causes and risk factors indicate an increased risk of recurrence. Modern procedures help effectively prevent umbilical hernias and achieve a stable abdominal wall.