What are the other Names for this Condition? (Also known as/Synonyms)

• Exomphalos
• Exumbilication
• Omphalocele

What is Umbilical Hernia? (Definition/Background Information)

• When a part or whole of an internal organ (or tissues) protrudes through weak areas of the adjoining muscles or connective tissues, the condition is termed as a hernia. Hernia occurs through the weakened area, whenever there is increased pressure or strain on it. They most commonly occur in the abdomen region
• Medically, there are various types of hernia and the most common ones are:
  • Inguinal hernia
  • Incisional hernia
  • Femoral hernia
  • Umbilical hernia
  • Hiatal hernia            
• An Umbilical Hernia is the protrusion (bulging) of abdominal contents (intestine or fatty tissue) through the umbilicus (belly button). It is usually harmless and is most commonly observed in infants
• The condition is seen in approximately 15% of the infants (during the 1st year of life). It may be caused by various factors such as low birth weight and or preterm birth. An Umbilical Hernia is usually visible only when the infant cries (causing an increase in intra-abdominal pressure)
• Among adults, it is most commonly seen in the elderly. Obesity, multiple abdominal surgeries, and multiple pregnancies are factors that contribute to the development of Umbilical Hernias in adults. A prominent bulge may be visible that may cause some discomfort; the condition can also be painless
• In infants, Umbilical Hernias usually disappear by or before they reach 12-18 months of age. However, in adults, a surgical correction is required most of the time. Generally, a surgery yields a very good outcome

Who gets Umbilical Hernia? (Age and Sex Distribution)

• Umbilical Hernias are very common in infants and children, but it can affect adults too, especially adults over the age of 60
• The disorder is seen with equal frequency in both male and female infants
• However, Umbilical Hernias are more frequently observed in female adults than male adults. In adults, it is responsible for 10% of all belly hernias
• Statistically, it has been observed that African-Americans are more prone to Umbilical Hernias, than individuals of any other race
• The condition is seen worldwide

What are the Risk Factors for Umbilical Hernia? (Predisposing Factors)

In infants, some of the risk factors for Umbilical Hernias are:

• Low birth weight
• Premature or preterm babies
• Children born to African American parents seem to have a higher risk
• Babies born with certain genetic disorders, such as Down syndrome, Edwards syndrome, and Patau syndrome

In adults, some of the risk factors for Umbilical Hernias are:

• Muscle weakening with increasing age
• Obesity puts more strain on the abdomen muscle
• Multiple pregnancies
• Individuals, who have undergone multiple abdominal surgeries

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Umbilical Hernia? (Etiology)

• The congenital cause of Umbilical Hernia is due to weaknesses in the abdominal wall, near the region of the umbilicus. The weakness occurs due to a developmental defect of the abdominal wall, while the child is still in the womb. The abdominal contents protrude through this defect. The muscles strengthen with age, and the hernia usually disappears by age 1 to 2 years
• Umbilical Hernia in adults is mostly due to acquired causes than congenital factors. The following factors may cause the condition:
  • Surgery (usually more than one surgery)
  • Chronic increase in intra-abdominal pressure due to factors such as lifting heavy weights, cough that exist for a long period of time, and chronic constipation
  • Obesity
  • Multiple pregnancies
  • Ascites (fluid in the abdomen), which may be caused by chronic alcohol consumption          

What are the Signs and Symptoms of Umbilical Hernia?

The signs and symptoms due to an Umbilical Hernia may include:

• Soft compressible swelling at the navel
• In children, the bulge is more prominently visible when the baby cries, coughs, or strains its stomach muscles. It may disappear, when the child is quiet or lies on its back
• The swelling is usually painless in infants, but it may cause minimal discomfort or feeling of pressure in adults
• Redness or swelling in and around the bulge may signify that the intestine is stuck in the defect (incarceration). It may progress and cause severe pain, nausea, and vomiting, if the blood supply to intestine gets “cut off” (a condition termed as strangulation)

How is Umbilical Hernia Diagnosed?

The following exams and procedures may be used to diagnose a Umbilical Hernia:

• Umbilical Hernia is diagnosed clinically on physical examination of the patient. No other special investigations are generally required
• Evaluation of medical history in case of an adult may be required
• Imaging studies, such as an abdominal ultrasound, may be required to check for complications
• If surgery is planned, then additional tests, such as imaging, blood tests, and urine exam, may be necessary

Note: It is important to differentiate between an Umbilical Hernia and Para-Umbilical Hernia. Para-Umbilical Hernias usually occurs in adults and is present near the umbilicus, but not at the umbilicus.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Umbilical Hernia?

Complications are more common in adults than in infants. The complications of Umbilical Hernia may include:

• Incarceration (intestine gets stuck in the Umbilical Hernia defect):  It presents with severe pain and irreducible swelling (one may not be able to push back the intestine or other contents into the abdomen)
• Incarceration can progress and cause loss of blood supply to the trapped abdominal contents (strangulation), eventually leading to death of bowel (gangrene)
• Gangrene can result in infection into the abdominal cavity (peritonitis) and sepsis (infection of blood)
• Complications of surgery for Umbilical Hernia may include injury to the nerves, bladder, and bowel, and infection. The hernia can also recur, though it is uncommon

How is Umbilical Hernia Treated?

• Typically, Umbilical Hernias in infants disappear on their own; by the time they are 12-18 months old. The physician may recommend a surgery, when:
  • The swelling becomes bigger during 1-2 years
  • The swelling does not disappear by the age of 4
  • If any complication develops such as swollen abdomen, tender to touch, vomiting, and severe pain             
• Incarcerated hernias are those which cause severe umbilical pain, tenderness, and redness. These need to be evaluated by a physician and surgically treated immediately
• In adults, surgery is recommended for all patients to avoid complications. If Umbilical Hernia is very small, “watchful waiting” may be done for some cases
• Following surgery, lifting of heavy objects or climbing for 1 to 2 months should be avoided

Note: Binders or truss (used as a conservative measure) may press upon the bulge and give some relief. They do not correct the defect.

How can Umbilical Hernia be Prevented?

• Currently, there are no methods available to prevent congenital Umbilical Hernias
• In adults, the condition may be prevented by avoiding actions or activities that lead to increase in intra-abdominal pressure such as obesity, chronic cough, and lifting heavy weights

What is the Prognosis of Umbilical Hernia? (Outcomes/Resolutions)

• Umbilical Hernia in children is not a life-threatening condition. Usually, most hernias disappear spontaneously, around the age of 12-18 months, without any treatment
• In adults, Umbilical Hernia is not a dangerous condition, as long as no complications develop. The outcome is generally good when identified and treated earlier with surgery

Additional and Relevant Useful Information for Umbilical Hernia:

• Mothers usually tend to push the belly-button inside, to make the hernia disappear. This should be strictly avoided, as it might lead to many complications
• An umbilical hernia repair (umbilical herniorrhaphy) is a surgical procedure that involves closing or repairing an Umbilical Hernia

The following article link will help you understand a umbilical hernia repair surgical procedure:

http://www.dovemed.com/common-procedures/procedures-surgical/umbilical-hernia-repair/