An umbilical hernia is a common medical condition defined by a noticeable bulge or soft swelling near the navel. This occurs when a portion of the abdominal contents, such as fat or intestine, pushes through a weak spot in the surrounding muscle wall. The weakness originates from the umbilical ring, an opening that normally closes shortly after birth. While common in infants, adults can also develop an umbilical hernia due to factors that increase pressure on the abdominal wall.
Diagnosis and Initial Referral Path
The first medical professional a patient consults depends on age. Adults typically start with a Primary Care Physician or Family Doctor, while children are assessed by a Pediatrician during a routine check-up. Diagnosis is confirmed by visually inspecting the bulge, which often becomes more prominent when the patient cries, coughs, or strains the abdominal muscles.
These primary care providers determine if the hernia is reducible, meaning the contents can be gently pushed back into the abdominal cavity. For small, asymptomatic hernias, the physician may recommend watchful waiting. If the hernia is symptomatic, large, or shows signs of complication, the primary care doctor issues a referral to a surgical specialist.
The Primary Specialist for Adult Repair
For adults requiring intervention, the physician who repairs umbilical hernias is a General Surgeon. These specialists are trained in abdominal procedures and assess the complexity of the hernia defect and surrounding tissue quality. The General Surgeon evaluates the size of the opening; defects greater than two or three centimeters typically require surgical reinforcement to prevent recurrence.
Surgical repair in adults, known as herniorrhaphy or hernioplasty, commonly involves placing a synthetic surgical mesh to strengthen the weakened abdominal wall. The procedure may be performed using an open technique with a single incision, or a minimally invasive laparoscopic approach utilizing several small incisions. The goal is to return the protruding tissue to the abdomen and permanently close the muscle defect.
The Primary Specialist for Pediatric Repair
When an infant or child requires surgical correction, the specialist is a Pediatric Surgeon. Their approach differs from adult repair because the vast majority of umbilical hernias in infants close spontaneously, usually by age four or five.
The Pediatric Surgeon advises watchful waiting unless the hernia is exceptionally large, symptomatic, or shows signs of immediate complication. If surgery is necessary, it is typically performed before the child enters school. The repair technique for children is generally a simple suture repair, closing the muscle defect with stitches alone, without synthetic mesh. This suture-only technique is effective because the surrounding muscle tissue is healthy and offers a low risk of recurrence.
When Surgical Intervention Is Necessary
While many umbilical hernias can be monitored, certain signs indicate that surgical intervention is necessary for both adults and children. Elective surgery is indicated if the hernia causes increasing pain, discomfort, or continues to increase in size. Elective repair is also recommended for hernias that persist in children past the age of five.
The most serious reasons for surgery involve complications known as incarceration and strangulation. Incarceration occurs when the protruding tissue becomes trapped and cannot be pushed back into the abdomen. Strangulation is an emergency where the blood supply to the trapped tissue is cut off, causing tissue death.
Warning signs include severe, sudden pain, a hard or tender bulge that may change color, and symptoms such as vomiting or inability to pass gas or stool. Any patient exhibiting these severe symptoms requires immediate consultation with a General or Pediatric Surgeon.