An umbilical hernia is a bulge near your belly button caused by tissue or intestine pushing through a weak spot in your abdominal wall muscles. It’s one of the most common types of hernia, affecting both newborns and adults. In babies, it usually closes on its own. In adults, it typically requires surgery if it causes symptoms or grows larger.
How an Umbilical Hernia Forms
Before you’re born, the umbilical cord passes through a small opening in your abdominal muscles. After birth, that opening normally closes as the muscles knit together. Sometimes, though, the gap doesn’t seal completely or the surrounding muscle stays weaker than it should be. Fat or a loop of intestine can push through that weak point, creating a soft bulge at or near the belly button.
In newborns, the hernia is present from birth because the muscle opening never fully closed. In adults, the same weak spot can reopen later in life when pressure inside the abdomen increases enough to force tissue through.
Common Causes and Risk Factors
Anything that raises pressure inside your abdomen over time can trigger an umbilical hernia or make an existing weak spot give way. The most common contributors in adults include:
- Pregnancy: A growing uterus stretches and pressurizes the abdominal wall, especially near the belly button.
- Excess body weight: Carrying extra abdominal fat puts constant outward pressure on the muscle layer.
- Fluid buildup in the abdomen: Conditions that cause fluid retention in the abdominal cavity increase internal pressure.
- Repeated heavy lifting or straining: Chronic coughing, constipation, or physically demanding work can gradually widen the opening.
- Previous abdominal surgery: Prior incisions near the belly button can weaken the fascia.
Having naturally weak abdominal muscles or a family history of hernias also raises your risk. Pregnancy-related umbilical hernias are especially common in people who had a small, unnoticed hernia before becoming pregnant.
What It Looks and Feels Like
The hallmark sign is a soft, squishy bulge on or right next to your belly button. For some people, the bulge is visible all the time. For others, it only appears when they cough, strain, or lift something heavy. In babies, the classic presentation is a belly button that pops outward when the infant cries and flattens when they’re calm.
Many umbilical hernias cause no pain at all, especially small ones. Larger hernias in adults can produce a dull ache or sense of pressure around the belly button, particularly after standing for long periods or during physical activity. The discomfort often eases when you lie down, because gravity helps the tissue slide back through the opening.
How It’s Diagnosed
A physical exam is usually all it takes. Your doctor will look at and feel the area around your belly button, and may ask you to cough, bear down, or tighten your abdominal muscles so the bulge becomes more obvious. In most cases, no imaging is needed. If the hernia is hard to feel or the doctor wants to check the size of the opening, an ultrasound or CT scan can provide a clearer picture.
Umbilical Hernias in Children
Umbilical hernias are extremely common in newborns and usually not a cause for alarm. The vast majority close on their own as the abdominal muscles strengthen during early childhood. Research published in the New England Journal of Medicine found that 90% of small hernias (1 cm or less) and 80% of larger ones closed spontaneously within five years. Most closed by age 3, and those still open at that point often sealed by age 5.
Surgery is generally considered for children only if the hernia is still open after age 4 or 5, if it’s larger than about 2 cm, or if it becomes painful or trapped. The old folk remedy of taping a coin over the bulge doesn’t help and can irritate the skin.
When Adults Need Surgery
Unlike in children, adult umbilical hernias don’t close on their own. They tend to slowly enlarge over time. Surgery is recommended when the hernia causes pain, grows noticeably bigger, or poses a risk of complications. Hernias wider than about 3 cm in adults are considered large and more likely to need repair.
Small, painless hernias in adults can sometimes be monitored with a “watchful waiting” approach, but most surgeons recommend repair sooner rather than later because the risk of complications increases as the hernia grows.
What Surgery Involves
There are two main approaches to umbilical hernia repair. In open surgery, the surgeon makes an incision near the belly button, pushes the protruding tissue back into the abdomen, and closes the muscle opening. In laparoscopic surgery, the surgeon works through several tiny incisions using a camera and small instruments. Laparoscopic repair tends to cause less postoperative pain and fewer fluid collections at the surgical site.
One important decision during surgery is whether to close the muscle gap with stitches alone or to reinforce it with a small piece of surgical mesh. A large randomized trial published in The Lancet compared the two approaches for hernias between 1 and 4 cm. After two and a half years, the recurrence rate with mesh was 4%, compared to 12% with stitches alone. Mesh reinforcement has become the standard for most adult repairs, especially for larger hernias.
Recovery After Repair
Expect soreness and swelling around your belly button for the first few days. Energy levels are typically lower than normal during the first week. Most people with desk jobs return to work within one to two weeks. If your job involves heavy lifting or strenuous physical activity, plan for four to six weeks off.
During recovery, avoid anything that makes you strain. That includes lifting heavy grocery bags, picking up children, vacuuming, jogging, weight training, and carrying heavy backpacks. Your surgeon will let you know when it’s safe to gradually resume these activities, usually at a follow-up appointment a few weeks after the procedure.
Complications to Watch For
Most umbilical hernias are harmless, but two complications can turn one into an emergency. The first is incarceration, where the tissue pushing through the opening gets stuck and can’t be pushed back in. Blood still flows to the trapped tissue at this stage, but the hernia becomes firm, tender, and doesn’t flatten when you lie down.
The second, more dangerous complication is strangulation. This happens when the trapped tissue is squeezed tightly enough to cut off its blood supply. Without oxygen, the intestine or tissue inside the hernia can begin to die in as little as four hours. Warning signs include sudden, severe abdominal pain that keeps getting worse, nausea and vomiting, and skin color changes around the bulge (redness progressing to a darker discoloration). Strangulation is a surgical emergency that requires immediate treatment.