Umbilical (Bellybutton) Hernia

An umbilical hernia forms when fatty tissue or a loop of bowel pushes through a natural weak point in the abdominal wall at the navel, where the umbilical cord passed through before birth. Umbilical hernias in babies often close by themselves, but hernias that appear in adulthood do not, and they tend to enlarge slowly over time.

In adults they are commonly associated with factors that increase pressure inside the abdomen, such as pregnancy, being overweight, persistent coughing, heavy lifting or fluid in the abdomen. The usual symptom is a soft bulge at or beside the bellybutton that is more obvious when standing or straining and may disappear when lying flat. Some people notice aching or discomfort, particularly after activity, and the overlying skin can become thin or irritated as the hernia grows.

Adult umbilical hernias do not heal on their own. Repair is recommended when the hernia is causing pain, discomfort or difficulty with daily activities, when it is enlarging, or when the skin over it is thinning or becoming irritated. Small hernias that cause no symptoms can be monitored, and your surgeon will discuss whether watching or repairing the hernia is the better option for you.

Because the opening in an umbilical hernia is often relatively narrow, there is a risk that fat or bowel can become trapped (incarcerated) or lose its blood supply (strangulated). Planned repair avoids the need for emergency surgery. If you are planning a pregnancy or significant weight loss, your surgeon may recommend adjusting the timing of surgery to reduce the chance of the hernia returning.

Umbilical hernia repair is performed under general anaesthesia and usually takes less than an hour. The hernia contents are returned to the abdomen and the defect in the abdominal wall is closed.

• Open repair - a small curved incision is made at the edge of the bellybutton. Very small hernias may be closed with stitches alone, while most are reinforced with a synthetic mesh to reduce the chance of recurrence
• Laparoscopic (keyhole) repair - small incisions are made away from the navel and the mesh is placed on the inside of the abdominal wall. This is often chosen for larger hernias, hernias that have recurred, or when there are several defects

The bellybutton is preserved in almost all cases, and your surgeon will discuss which approach is most appropriate for your hernia.

Most umbilical hernia repairs are day surgery, with patients going home the same day or after a single night in hospital. Discomfort around the navel is expected for the first week or so and settles with simple pain relief. Bruising and mild swelling are common and resolve over a few weeks.

You can shower the day after surgery and should keep the wound clean and dry. Light activities and walking are encouraged from the first day. Most people return to office work within one to two weeks and to heavier lifting, manual work and sport within four to six weeks, depending on the size of the hernia and the type of repair. Your surgeon will give you specific advice about lifting and exercise, and you will be reviewed in the clinic to check the wound and your recovery.

Occasionally the contents of an umbilical hernia become stuck (incarcerated) or the blood supply is cut off (strangulated). This is an emergency and needs urgent assessment.

Go to your nearest emergency department or call 000 if:

• The hernia becomes suddenly painful, firm or tender and cannot be gently pushed back in
• The skin over the hernia becomes red, purple or discoloured
• You develop vomiting, bloating or severe abdominal pain
• You are unable to pass wind or open your bowels

After surgery, contact the practice or seek medical attention if you notice increasing redness, discharge or pain at the wound, a fever, or a new bulge at the site of the repair.