An umbilical hernia looks like a soft bulge on or near your belly button, ranging from marble-sized to golf ball-sized or larger. The bulge may be skin-colored and round, and it often becomes more noticeable when you cough, strain, or bear down. In some people the bulge is visible all the time, while in others it only appears when pressure builds in the abdomen.
How the Bulge Appears in Babies
In newborns and infants, an umbilical hernia typically shows up as a rounded swelling right at the belly button. It may be barely noticeable when your baby is calm and lying down, then push outward noticeably when the baby cries, coughs, or strains during a bowel movement. Sitting upright also makes it stick out further. When the baby relaxes, you can often gently press the bulge back in, and it flattens out on its own.
Most infant umbilical hernias close without treatment. Small hernias (1 centimeter or less) close on their own about 90% of the time within five years, and even larger ones resolve in roughly 80% of cases. Pediatric surgeons generally recommend repair only if the hernia persists past age 3 to 5, or if the opening is larger than about 2 centimeters (roughly ¾ of an inch).
How It Looks in Adults
In adults, the bulge sits at or just above the belly button and is soft to the touch. It can range from a subtle outward puffiness to a clearly protruding lump several centimeters across. Many adults first notice it during activities that increase abdominal pressure: lifting something heavy, coughing, sneezing, or straining during a bowel movement. Some people can push the bulge back in when they lie flat, while for others it stays visible at rest.
Pain is more common in adult umbilical hernias than in infant ones. You may feel a dull ache or pressure at the site, especially during physical activity. The discomfort tends to worsen throughout the day or after prolonged standing.
How to Tell It Apart From Muscle Separation
A condition called diastasis recti can also cause a bulge in the midsection and is easy to confuse with a hernia. The key differences come down to location, shape, and pain. Diastasis recti is a stretching of the connective tissue between the abdominal muscles, not a hole in the muscle wall. It typically creates an oval-shaped ridge that runs vertically between the breastbone and belly button, most visible when you sit up from a lying position. It usually does not hurt.
An umbilical hernia, by contrast, is a distinct, localized bulge right at the belly button where tissue or fat pushes through an actual opening in the abdominal wall. Hernias often cause pain at the bulge site, especially with straining. If you can isolate the lump to a single spot near the navel rather than a long ridge running up your abdomen, a hernia is the more likely explanation.
What Doctors Check During an Exam
Diagnosing an umbilical hernia is usually straightforward. Your doctor will look at and feel the area around your belly button, then ask you to bear down or strain (a technique called the Valsalva maneuver). This increases pressure inside your abdomen, which pushes the hernia contents outward through the opening and makes the bulge larger and easier to see. In most cases, no imaging is needed. Ultrasound or a CT scan may be used if the diagnosis is unclear or the doctor needs to see how large the opening in the muscle wall is before planning a repair.
Warning Signs That Need Emergency Care
Most umbilical hernias are harmless and cause only cosmetic concern or mild discomfort. The situation becomes serious if the hernia gets trapped in the abdominal wall, a condition called incarceration. When that happens, the bulge becomes firm and you can no longer push it back in. It may also become tender or painful in a way that feels different from the usual mild ache.
If blood flow to the trapped tissue gets cut off (strangulation), the skin over the bulge changes color. It may turn red or darker than your normal skin tone, then progress to a purplish hue. The bulge will feel hard rather than soft, and the pain intensifies. Nausea and vomiting can accompany these changes. A hernia that turns red, purple, or dark and feels firm is a medical emergency requiring immediate treatment to prevent tissue death.