A hernia occurs when an organ or fatty tissue pushes through a weak spot in the muscle or connective tissue that normally contains it. A periumbilical hernia, often referred to as an umbilical hernia, is a specific type of abdominal wall defect located in or immediately adjacent to the navel, or belly button. This condition results in a noticeable bulge near the center of the abdomen, presenting a common medical concern for both children and adults.
Anatomy and Mechanism of Formation
The formation of a periumbilical hernia is directly related to the anatomy of the abdominal wall at the site of the umbilicus. This location is a natural point of weakness because it is where the umbilical cord passed through the abdominal wall during fetal development. After birth, the small opening, known as the umbilical ring, is supposed to close completely, but if the layers of the abdominal wall do not fully fuse, a weak spot remains.
A periumbilical hernia forms when contents from inside the abdominal cavity, most commonly a piece of fatty tissue or a loop of the small intestine, protrude through this defect. The resulting sac pushes outward under the skin, creating the characteristic bulge.
The mechanism of formation differs significantly between infants and adults. In infants, the condition is typically considered congenital, meaning it is present at birth because the umbilical ring did not close properly. Adult hernias, however, are acquired and often referred to as paraumbilical, developing when the fascia, the strong connective tissue around the navel, weakens and tears under pressure. This acquired defect is generally located slightly above or below the true umbilical scar.
Common Causes and Who is at Risk
Periumbilical hernias in adults are primarily caused by conditions that lead to chronic or repeated increases in intra-abdominal pressure. The constant force against a naturally weak abdominal wall area eventually causes the tissue to fail. One of the most common factors is obesity, where excess weight significantly strains the abdominal muscles and fascia.
Pregnancy is another major contributor, particularly in women who have had multiple pregnancies, as the physical stretching and pressure on the abdominal wall are substantial. Activities that involve repeated straining, such as heavy lifting or chronic constipation, also place excessive stress on the navel area. Conditions that cause persistent coughing, like Chronic Obstructive Pulmonary Disease (COPD), or the accumulation of fluid in the abdomen, known as ascites, similarly increase the internal pressure that drives the hernia’s formation.
Identifying Symptoms and Diagnosis
The most recognizable symptom of a periumbilical hernia is the appearance of a soft bulge or swelling in the area of the belly button. This swelling is often noticed when abdominal pressure is increased, such as during crying, coughing, or standing upright. Conversely, the bulge may temporarily disappear or become smaller when a person lies down and relaxes the abdominal muscles.
In many cases, an adult hernia may be asymptomatic or cause only mild discomfort, often described as a dull ache or a feeling of pressure at the site. If the protruding tissue becomes trapped, however, the discomfort can escalate rapidly to sharp pain. For infants, the hernia is usually painless, and the bulge is most prominent when the baby is crying.
A doctor typically diagnoses the condition through a physical examination, inspecting and gently feeling the abdomen and the bulge near the navel. The examination assesses whether the hernia is “reducible,” meaning the tissue can be manually pushed back into the abdominal cavity. If the physical exam is inconclusive, especially in cases of obesity or complex symptoms, imaging tests such as an ultrasound, CT scan, or MRI may be used to confirm the diagnosis and determine the contents of the hernia sac.
Treatment Options and Recognizing Urgent Complications
The recommended management for a periumbilical hernia differs based on the patient’s age and the severity of the condition. In infants, the majority of congenital hernias will close spontaneously, often by the age of four or five, so doctors typically adopt a “watch and wait” approach. Surgical repair is generally reserved for children if the hernia is very large, does not close by school age, or if complications occur.
For adults, the hernia defect will not heal on its own, and surgery is usually recommended to prevent future complications and address symptoms. The procedure involves returning the protruding tissue to the abdomen and closing the defect in the abdominal wall. Surgeons may use sutures alone to close the opening, but for larger defects, a synthetic mesh is often employed to reinforce the area and reduce the risk of recurrence.
An urgent complication arises when the tissue becomes trapped, a condition called incarceration. This means the contents are stuck outside the abdominal wall and cannot be pushed back in, causing increasing pain and tenderness. The most serious complication is strangulation, which occurs if the blood supply to the trapped tissue is cut off, leading to tissue death. Signs of strangulation include sudden, severe pain, a fever, rapid heart rate, and a change in the color of the skin over the bulge, which may appear red or dark. Immediate medical attention is required for these symptoms, as strangulation is a life-threatening medical emergency.