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JAMA Patient Page
June 6, 2017

Umbilical Hernia

JAMA. 2017;317(21):2248. doi:10.1001/jama.2017.3982

A hernia is a defect in the muscles and connective tissue of the abdomen.

Sometimes fat or bowel can push through this defect, causing pain and a noticeable bulge. An umbilical hernia is a defect of the abdominal wall near the belly button (umbilicus). This is caused by the muscles not closing around the hole left by the umbilical cord and is usually present at birth.

Adults usually notice a bulge at their belly button that is caused by increases in abdominal pressure. Chronic cough, obesity, accumulation of fluid in the belly due to liver disease (cirrhosis), and frequent pregnancies can cause umbilical hernias. Most people who have umbilical hernias have no problems related to the hernia apart from the noticeable bulge, if present.

What to Do If You Have an Umbilical Hernia

If you notice a hernia (or bulge), it is best to see your doctor to determine the appropriate course of action. In children, umbilical hernias usually close by themselves as the child ages. If the hernia is noticed in children older than 5 years, then it is usually repaired surgically. For adults, very small umbilical hernias that do not cause symptoms are often watched, but adult umbilical hernias that become painful or increase in size are often surgically repaired. The surgery can be a minimally invasive repair or open repair.

Mesh for Hernia Repair

Mesh is a material that provides additional support to the weakened abdominal wall during hernia repair. It can be made of plastic or animal tissue. Your doctor may use mesh when repairing the hernia to reduce the chance of the hernia returning. Although this may be beneficial, meshes can become infected or cause pain and fluid can collect on top of them. For this reason, mesh is used only when necessary. For children, hernias are often repaired without mesh by pulling the muscle edges together to close the weak area. For adults, use of mesh is generally based on the size of the defect; smaller defects can be repaired by just closing the weakness in the muscles and larger defects are repaired with plastic mesh. The chance of umbilical hernias returning tends to be lower with mesh placement.

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Article Information

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Sources: Porrero JL, Cano-Valderrama O, Marcos A, et al. Umbilical hernia repair: analysis after 934 procedures. Am Surg. 2015;81(9):899-903.

Berger RL, Li LT, Hicks SC, Liang MK. Suture vs preperitoneal polyprolene mesh for elective umbilical hernia repair. J Surg Res. 2014;192(2):426-431.

Topic: Hernia

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