Overview

A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall.

Your muscles are usually strong and tight enough to keep your organs and intestines in place, but a hernia can develop if there are any weak spots.

What is an umbilical hernia?

Umbilical hernias are very common in infants and young children, especially in babies born prematurely.

It may get bigger when laughing, coughing, crying or going to the toilet and may shrink when relaxing or lying down.

In many cases, the umbilical hernia goes back in and the muscles reseal before the child's first birthday.

Umbilical hernias can also develop in adults. Without treatment, the hernia will probably get worse over time.

For information on other types of hernia, see:

• inguinal hernia
• femoral hernia
• hiatus hernia

What causes an umbilical hernia?

During pregnancy, the umbilical cord passes through an opening in the baby's abdomen (tummy). This opening should close shortly after birth, but in some cases the muscles don't seal completely.

This leaves a weak spot in the surrounding muscle wall (abdominal wall). An umbilical hernia can develop when fatty tissue or a part of the bowel pokes through into an area near the navel.

In adults, factors that can contribute to developing an umbilical hernia include:

• being overweight or obese
• straining while moving or lifting heavy objects
• having a persistent heavy cough
• having a multiple pregnancy (such as twins or triplets)

When is surgery needed?

If necessary, umbilical hernias can be treated with surgery to push the bulge back into place and strengthen the weakness in the abdominal wall.

This operation may be recommended for your child if the hernia is large or hasn't disappeared by the time they reach four or five years old.

You'll usually be advised to wait for your child to reach this age because the operation isn't essential unless there are complications. The risk of your child developing complications is very low.

However, surgery is recommended for most adults with an umbilical hernia as the hernia is unlikely to get better by itself when you're older and the risk of complications is higher.

Complications that can develop as a result of an umbilical hernia include:

• obstruction – where a section of the bowel becomes stuck outside the abdomen, causing nausea, vomiting and pain
• strangulation – where a section of bowel becomes trapped and its blood supply is cut off; this requires emergency surgery within hours to release the trapped tissue and restore its blood supply so it doesn't die

Surgery will get rid of the hernia and prevent any serious complications, although there's a chance of it returning after the operation.

Repairing an umbilical hernia

An umbilical hernia repair is a relatively simple procedure that normally takes about 20 to 30 minutes to perform. General anaesthetic is usually used so there's no pain while the operation is carried out.

The weak spot in the abdominal wall is usually closed with stitches in children. If the hernia is large or in adults, a special mesh may be used to strengthen the area instead.

You or your child should be able to go home the same day the operation is carried out, but you may feel a bit sore and uncomfortable while you recover.

Strenuous activities will need to be limited for a few weeks after the operation, and a week or two off school or work is often advised. Most people are able to return to all their normal activities within a month of surgery.

Read more about:

• how an umbilical hernia repair is performed
• recovering from an umbilical hernia repair

Are there any risks from surgery?

Complications from an umbilical hernia repair are uncommon, but can include:

• the wound becoming infected and needing antibiotics
• the hernia returning
• feeling sick and having a headache or numbness in the legs a few hours after the operation

The belly button often looks normal after surgery, but there's a chance its appearance may change as a result of the operation.

How is it performed?

Umbilical hernia repair is a fairly quick and simple operation. It takes about 20 to 30 minutes and it's usually possible to go home on the same day.

However, some people stay in hospital overnight if they have other medical problems or if they live alone.

Before the operation

The hospital will send instructions about when to stop eating and drinking before the operation.

At the hospital, you'll meet the nurse, anaesthetist (specialist who puts you or your child to sleep), and surgeon.

In most cases, the operation is carried out under general anaesthetic. This means you're asleep during the procedure and won't experience any pain as it's carried out.

If general anaesthetic is used, it's usually inhaled as a gas or injected into the back of the hand. You can stay with your child until they're asleep and taken into the operating theatre.

Local anaesthetic, where the area being operated on is numbed but you remain awake, is occasionally used instead of general anaesthetic. This is usually only considered in adults with a small hernia who aren't in good enough health to have a general anaesthetic.

During the operation

During umbilical hernia repair, the surgeon makes a small cut of about 2 to 3cm at the base of the belly button and pushes the fatty lump or loop of bowel back into the tummy (abdomen).

The muscle layers at the weak spot in the abdominal wall where the hernia came through are stitched together to strengthen them. For large or adult umbilical hernias, a special mesh patch may be placed in the abdominal wall to strengthen the area instead.

The wound on the surface of the skin is closed with dissolvable stitches or special surgical glue. Sometimes a pressure dressing is applied, which usually stays on for four to five days.

After the operation

Although the operation only takes up to 30 minutes, you'll be away from the ward for around an hour.

If your child has had surgery, you'll be taken to the recovery room as soon as they wake up so you can be with them on their way back to the ward.

Read more about recovering from an umbilical hernia repair below.

Recovery

It's usually possible to go home the same day as having an umbilical hernia repair.

It's normal to feel sore and uncomfortable immediately after surgery. Local anaesthetic, which numbs the area, will be injected before the end of the operation to reduce the pain. Painkillers will also be provided.

Your child may be sleepy or cry a lot and demand extra attention after the operation. This is normal and will pass.

Most adults and children can go home a few hours after surgery, after they've had something to eat and drink.

An overnight stay in hospital for monitoring is usually only recommended for people with other medical problems, or people who are vomiting regularly and can't keep down any food or drink.

At home

There may be bruising and tenderness around the wound during your recovery at home. This is normal and usually settles within about a week. However, the swelling may not go down for several weeks.

The hospital will advise you about taking painkillers to relieve any discomfort. You can give your child painkillers such as paracetamol and ibuprofen. Children under 16 must not be given aspirin.

Loose clothing may also help reduce any discomfort your child has, but they should be able to wear trousers or a skirt as normal.

Make sure you follow the instructions about hygiene, caring for the wound and bathing your nurse gave you before you left hospital.

Straining on the toilet because of constipation can cause pain around the wound. Drinking lots of fluids and eating plenty of vegetables, fruit and high-fibre foods such as brown rice, wholemeal bread and pasta can help reduce the chances of this occurring.

Activities

Your surgical team will be able to give you a good idea of how long it takes to recover from surgery.

If the operation was carried out under a general anaesthetic, your co-ordination and reasoning may be affected for a short time. Adults should therefore avoid drinking alcohol, operating machinery or signing legal documents for at least 48 hours after the procedure.

Normal activities can gradually be resumed over time until they can be carried out without feeling any pain. Most people are able to do light activities after one or two weeks.

Gentle exercise, such as walking, can help the healing process. Heavy lifting and strenuous activities should be avoided for about four to six weeks.

Work and school

You should keep your child off school for about a week to give them time to recover from the anaesthetic and the operation. They should be excused from sports and games for at least two weeks after they return to school.

Adults who have surgery should be able to return to work after a week or two, although you may need more time off if your job involves manual labour.

Driving

It's usually advisable to avoid driving until you're able to perform an emergency stop without feeling any pain or discomfort – you can practise this without starting your car.

It will usually be at least one or two weeks after surgery before you reach this point.

It's normally recommended you contact your car insurance company before starting driving again.