An umbilical hernia develops when internal tissue pushes through a weak spot in the abdominal wall near the navel, creating a visible bulge. While they are common in adults, they can occur after conditions that increase pressure inside the abdomen, such as multiple pregnancies or significant weight gain. Most adult umbilical hernias are not emergencies, but understanding the signs of a complication is important for timely medical intervention.
Understanding the Typical Umbilical Hernia in Adults
An adult umbilical hernia often presents as a soft swelling or lump directly at or near the belly button. This bulge is typically reducible, meaning it can be gently pushed back into the abdomen or disappear when the person lies down. The bulge may become more obvious when abdominal pressure increases, such as during coughing, sneezing, or straining.
The primary cause of these hernias in adults is a weakening of the abdominal muscles combined with chronically elevated intra-abdominal pressure. Risk factors contributing to this pressure include obesity, which places constant strain on the abdominal wall, and a history of multiple pregnancies. Other contributing factors are conditions that cause chronic straining, such as persistent coughing, or the accumulation of excess fluid in the abdominal cavity, known as ascites.
For many people, the hernia remains asymptomatic or causes only mild, occasional discomfort or a dull ache, particularly when moving or lifting heavy objects. This mild discomfort is generally not a cause for immediate concern, but it does indicate the presence of a structural defect that will not resolve on its own in adults. The majority of umbilical hernias in adults are managed electively, meaning a planned repair to prevent future issues, rather than requiring an urgent response.
Immediate Warning Signs of Complication
The time to worry about an umbilical hernia is when it develops signs of acute incarceration or strangulation, which are medical emergencies. Incarceration occurs when the tissue that has pushed through the opening becomes trapped and cannot be pushed back in, often leading to a small bowel obstruction. This trapping can progress to strangulation, where the blood supply to the trapped tissue is cut off, causing tissue death, or necrosis.
A sudden onset of severe, rapidly escalating pain at the hernia site is the most concerning symptom and should prompt immediate medical attention. Unlike the mild, intermittent ache of a typical hernia, this pain is unrelenting and often accompanied by a distinct change in the hernia’s physical appearance. The bulge will become firm, hard, and exquisitely tender to the touch, and the inability to manually reduce the bulge is a defining sign of incarceration.
Skin discoloration over the bulge indicates potential strangulation. The skin may turn a red, purple, or dark color due to the lack of blood flow, signifying tissue death. Any of these local signs, especially when combined with systemic symptoms, require emergency care to prevent severe complications like infection or peritonitis.
Systemic symptoms strongly suggest that the trapped tissue is causing a blockage or is becoming necrotic. These include persistent nausea, forceful or repeated vomiting, or an inability to pass gas or have a bowel movement. The presence of a fever alongside these symptoms indicates a serious infection, signaling an immediate need for emergency surgical evaluation.
Management and Treatment Options
Once an umbilical hernia is diagnosed, the approach to management depends on its symptoms and size. For small, asymptomatic hernias that remain reducible, a strategy of watchful waiting is a reasonable option. This approach involves regular monitoring for any change in size or the development of pain, which may indicate a higher risk of future complications.
Surgical repair, known as herniorrhaphy, is generally recommended for adults to prevent the risks of incarceration and strangulation, even if the hernia is currently asymptomatic. Surgery is indicated for any hernia that is symptomatic, large, or has shown signs of becoming incarcerated or strangulated. The goal of the procedure is to return the protruding tissue to the abdominal cavity and close the defect in the abdominal wall.
Surgeons typically perform the repair using one of two main approaches: open or laparoscopic surgery. The open technique involves a single incision near the navel, while the laparoscopic method uses several smaller incisions through which instruments and a camera are inserted. In most adult repairs, a synthetic mesh is used to strengthen the weakened abdominal wall, as this technique provides a stronger reinforcement and significantly lowers the rate of the hernia recurring.