Your navel, or belly button, is where the umbilical cord enters your body to provide you with nourishment when you were a foetus. After birth, the opening closes naturally, creating the navel. An umbilical hernia is a condition where a part of your intestine protrudes through a gap or weak spot in your abdominal muscles at or near the navel. This is a common condition in infants, and the protrusion often recedes within the first 2 years of life. If the condition remains till the 4th or 5th year, surgery may be required to fix it. Umbilical hernia in children is usually painless and causes no physical discomfort.
Umbilical hernia in adults occurs for a number of reasons, the most common of which are being clinically obese, lifting heavy objects or having a chronic and/or persistent cough. In women, multiple pregnancies increase the risk of hernia. The bulge of the hernia may recede when lying down and become more apparent while standing, coughing, going to the toilet or laughing. Some hernias may be small and asymptomatic; however, if the hernia is large, there may be varying degrees of pain and discomfort. If any of the following symptoms exist, the treatment of the condition has probably been delayed already:
Although an umbilical hernia is not considered a critical medical condition, the longer the treatment is delayed, the greater the risk of developing complications (strangulation [compromised blood supply] and incarceration [trapped]).
An umbilical hernia is diagnosed during a physical examination. If the doctor suspects there may be complications, such as bowel obstruction, additional tests, including X-rays, blood tests, and ultrasounds, may be required.
Asymptomatic hernias where the risk of complications, such as strangulation, is less than 1%, non-operative management is considered, which involves monitoring the hernia size and symptoms of pain, redness, or hardening of the hernia.
The standard treatment for an umbilical hernia in adults is through surgery, where the bulge is pushed back into place, and the abdominal wall is strengthened to prevent the condition from occurring again. The decision to operate is based on the presence of symptoms, hernia size, presence of comorbidities, risk of complications and overall risk of surgery. For patients with high surgical risk, watchful waiting may be an acceptable approach. The operation is typically a quick one, and either open or laparoscopic surgery may be used, depending on what the surgeon thinks is best for the patient.
In the case of an open procedure, the surgeon will make an incision at or near the umbilicus, push the herniated tissue back into the abdomen, and close the gap or weak areas of the muscle using sutures. This is useful for small hernias or when the use of mesh is contraindicated. However, the recurrence rates range between 4% and 15%. This is making suture-only repair outdated.
Mesh repair is preferred for hernias more than 1 cm, as the recurrence rates are lower. Mesh reinforcement reduces tension on suture lines and improves long-term durability if the abdominal wall is weak (e.g., due to obesity or previous surgeries).
The most widely used method is intraperitoneal onlay mesh (IPOM). The ports are laterally placed. The hernia sac is reduced after careful dissection. This is followed by inspection of the hernial sac contents, measurement of the hernial defect, insertion of the mesh, and its fixation with sutures. This type of umbilical repair is suitable for patients with obesity, recurrent hernias, intra-abdominal pathologies or abdominal wall defects. Limitations of laparoscopy include a steep learning curve, high cost, long operative time and risk in patients with comorbidities, such as cardiopulmonary disease.
In IPOM Plus, the fascial defect is closed with sutures, with intraperitoneal mesh placement on the top. This method improves abdominal wall function, and the recurrence rate is reduced compared to IPOM alone.
In both open and laparoscopic procedures, recovery time is minimal, and patients often return home on the same day as surgery. Follow-up visits are required to monitor the progress of recovery.
IPOM requires mesh placement inside the peritoneal cavity, which can cause mesh-related complications, adhesions, or chronic pain. In eTEP, the peritoneal cavity is untouched, and the mesh is placed in the retromuscular space (between the abdominal layers, avoiding intraperitoneal mesh contact). In eTEP, the mesh is not in contact with the bowel, reducing infection and adhesion risks. Studies have reported fewer complications, shorter hospital stay, and reduced recurrences.
In transabdominal preperitoneal repair (TAPP), the preperitoneal space is accessed via the abdominal cavity. The hernia sac is released, and the defect is closed with sutures. A mesh is placed in the preperitoneal space over the defect, preventing direct contact between the mesh and the bowel. The peritoneal flap is closed to cover the mesh.
Robot-assisted variants of IPOM, eTEP, and TAPP are also being adopted. Robot-assisted repair ensures better visualization of the surgical site and improved range of motion, allowing fine, accurate movements for better mesh placement and improved closure of the defect. The limitations are the high cost and longer operative time. Robot-assisted surgery is useful in large and recurrent hernias or cases that require complex dissection and closure; the technical advantage of robotic instruments comes in handy in such cases.
In this method, instead of using a full flat sheet of mesh, narrow strips of polypropylene mesh (~2 cm wide) are inserted through the abdominal wall and tied like sutures. The strip acts like a wide suture, distributing tension and avoiding the use of a large, foreign mesh patch, which reduces foreign body volume and mesh-related complications. Patients have reported no pain, cannot feel the knot, and have an improved quality of life during follow-up.
This technique is suitable for hernias less than 3 cm in size and minimal abdominal wall weakness. While it has not been universally adopted due to the need for more long-term studies, it has shown promising results as a combination of traditional suturing and full-mesh placement. However, this method may not be suitable for individuals with obesity or hernias larger than 3 cm.
There have been several improvements in the mesh materials that have reduced the risk of complications and enhanced durability. Duramesh is a suturable mesh originally designed for incisional hernia repair. However, it has recently been used for a recurrent umbilical hernia case, wherein it reduces the risk of tissue injury by spreading the tension across a large area.
T-line hernia mesh has been used for large and complex umbilical hernias in patients with recurrent hernia, obesity, or large defects. T-line mesh can be placed either on the muscle or under the rectus muscle. No short-term complications or recurrence have been observed.
Biosynthetic or absorbable mesh, such as Phasix ST Umbilical Hernia Patch, has been approved by the FDA for umbilical hernia repair. It uses a polymer called poly-4-hydroxybutyrate (P4HB) in combination with a hydrogel barrier that is fully absorbable, reducing the prolonged presence of a foreign body and mesh-related complications or rejection, thereby proving to be a useful alternative to permanent synthetic meshes.
Umbilical hernias occur when intra-abdominal contents, such as omentum, preperitoneal fat, or a bowel segment, push through a weakness in the abdominal wall at the umbilical ring.
Surgery is the ultimate treatment for an umbilical hernia. Studies show mesh repair has significantly fewer recurrences than traditional suture repair. Another technique is mesh-strip repair, which blends the simplicity of suture repair with the strength and durability of mesh reinforcement.
Biocompatible mesh materials are also being designed to integrate better with the body, reduce inflammation, and infection risk. A lot of focus is being given to mesh placement, with preperitoneal position being preferred over onlay, as the risk of complications and recurrence is drastically reduced. Long-term follow-up and high-quality research are required to confirm the usefulness of the mesh-strip method and specialized mesh materials.
What is an umbilical hernia?
An umbilical hernia occurs when part of the intestine or abdominal tissue pushes through a weak spot in the abdominal wall near the belly button, creating a visible bulge.
Is an umbilical hernia dangerous?
Most umbilical hernias are not immediately dangerous. However, if the bulge becomes painful, hard, red, or cannot be pushed back, it may indicate strangulation or incarceration and needs urgent medical attention.
Do umbilical hernias go away on their own?
In infants, many umbilical hernias close naturally by age 2 to 4 years. In adults, they do not resolve on their own and usually require surgical repair if symptomatic.
What causes an umbilical hernia in adults?
Common causes include obesity, heavy lifting, chronic cough, constipation, pregnancy, abdominal surgery, and anything that increases pressure inside the abdomen.
What are the symptoms of an umbilical hernia?
Symptoms include a soft bulge near the navel, swelling that increases when standing or coughing, mild pain or discomfort, and in severe cases, nausea or vomiting.
How is an umbilical hernia diagnosed?
Doctors usually diagnose it through a physical examination. Imaging tests like ultrasound or CT scan may be used if complications are suspected.
When is surgery required for an umbilical hernia?
Surgery is recommended if the hernia is painful, enlarging, larger than 1 cm, recurrent, or at risk of strangulation. Mesh repair is often preferred to reduce recurrence.
What is the best surgical treatment for umbilical hernia?
Mesh-based repair, either open or laparoscopic, is considered the most effective treatment. Minimally invasive techniques like eTEP, TAPP, or robotic repair may be used in suitable cases.
How long does recovery take after umbilical hernia surgery?
Most patients return home the same day. Light activities can resume within 1 to 2 weeks, while heavy lifting should be avoided for about 4 to 6 weeks.
Can an umbilical hernia come back after surgery?
Yes, recurrence is possible, especially with suture-only repair. Mesh reinforcement significantly lowers the risk of recurrence.
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