Umbilical hernia !
An umbilical hernia is a bulge at or beside the navel where fat or bowel pushes through the umbilical ring; it is common in babies and adults.
Updated 2026-10-29
Structures involved
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In embryology
- Embryonic folding: head, tail and lateral folds
- Umbilical cord: two arteries, one vein
- Omphalocele and gastroschisis
In the clinical exam
What it is
Protrusion of fat or bowel through a defect at or next to the umbilical ring. In infants it is a congenital failure of the ring to close; in adults it is usually acquired.
Who gets it
Very common in infants, especially premature and low-birth-weight babies. In adults it is linked to raised abdominal pressure (obesity, pregnancy, ascites) and is more common in women and in people with cirrhosis.
Causes
- Infants: incomplete closure of the umbilical ring after the cord falls off
- Adults: weakening of the linea alba around the umbilicus (often called paraumbilical hernia)
- Chronically raised intra-abdominal pressure
Risk factors
- Prematurity and low birth weight
- Obesity
- Pregnancy and multiparity
- Ascites, especially in cirrhosis
- Chronic cough, constipation, heavy lifting; peritoneal dialysis
- Diastasis of the rectus muscles
Pathophysiology
The umbilical ring is a natural weak point where the umbilical vessels passed through the linea alba. If it stays open or stretches, preperitoneal fat, omentum or bowel can push through. A narrow neck in adults can trap the contents, cutting off their blood supply.
Classification
- Congenital (infantile) vs acquired (adult, often paraumbilical)
- Reducible, incarcerated (irreducible) or strangulated
- By defect width (small, medium, large); the European Hernia Society classifies primary ventral hernias this way
Symptoms and signs
- Soft bulge at the umbilicus that grows with crying, coughing or straining
- Infants: usually painless and reducible
- Adults: discomfort or ache, worse with effort
- Thinned or discoloured skin over large hernias in ascites
Diagnosis
- Clinical
- Inspection and palpation of the umbilicus at rest and with coughing or straining; size of the defect, reducibility and tenderness.
- Tests
- Usually none for an uncomplicated hernia. Blood count, lactate and electrolytes if strangulation is suspected; liver tests and coagulation in patients with cirrhosis before surgery.
- Imaging
- Ultrasound if the diagnosis is unclear or the patient is obese. CT if strangulation is suspected or to plan repair of a large or recurrent hernia.
Differential diagnosis
- Diastasis of the rectus muscles
- Epigastric or incisional hernia
- Umbilical granuloma or patent urachus (infants)
- Umbilical metastasis (Sister Mary Joseph nodule)
- Lipoma or abdominal wall abscess
Goal of treatment
In infants, allow time for spontaneous closure and repair only if it persists or complicates. In adults, relieve symptoms and prevent incarceration with a durable, low-recurrence repair.
Treatment
- Follow-up
- Infants: observation, because most close on their own in the first years of life. Strapping or coins over the umbilicus are not helpful and can irritate the skin.
- Surgical
- Children: repair if the hernia persists into school age, is large or incarcerates; timing criteria vary between guidelines.
- Surgical
- Adults: primary suture for very small defects; mesh (open or laparoscopic) is generally favoured for larger ones because it lowers recurrence.
- Acute
- Incarcerated or strangulated hernia: urgent surgery, with bowel resection if the bowel is not viable.
- Medical
- Cirrhosis with ascites: control of the ascites (diuretics, paracentesis or TIPS) before or around repair, which is planned with the liver team.
- Lifestyle
- Weight loss and smoking cessation before elective adult repair lower the risk of complications and recurrence.
Complications
- Incarceration and strangulation of omentum or bowel
- Bowel obstruction
- Skin necrosis and rupture with ascitic leak in cirrhosis
- Recurrence after repair; mesh infection or seroma
Prognosis
Most infant hernias close by early childhood without surgery. Adult hernias do not close and tend to enlarge; elective repair has good results, while emergency repair carries more risk.
Prevention
- Healthy weight
- Control of ascites in liver disease
- Treatment of chronic cough and constipation
Test yourself
Think of the answer, then tap the question to see it.
What is the usual course of an umbilical hernia in an infant?
Most close spontaneously during early childhood, so observation is the usual approach unless it persists, is large or incarcerates.
Why is an umbilical hernia in a patient with cirrhosis and ascites a concern?
Raised pressure from ascites enlarges it and thins the skin, with risk of incarceration, skin necrosis and rupture with ascitic leak.
Which repair is generally favoured for an adult umbilical hernia that is not very small?
Repair with mesh, open or laparoscopic, because it has lower recurrence than suture repair alone.
What umbilical finding can be a sign of advanced intra-abdominal cancer?
A firm periumbilical nodule (Sister Mary Joseph nodule), a metastasis that can mimic a hernia.
Related conditions
Educational information, not medical advice. For any symptom, see a health professional.
Sources: Umbilical Hernia (StatPearls (NCBI Bookshelf), 2024).
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