Umbilical Hernia

The navel is the site where the umbilical cord passed through the abdominal wall before birth. It closes afterward, but it remains a natural point of relative weakness for life.

In adults, sustained increases in abdominal pressure can reopen or enlarge that point. Pregnancy, chronic cough, straining, fluid accumulation in the abdomen, and metabolic change all contribute. Infant umbilical hernias behave differently and usually close on their own, which is why adult advice should not be taken from paediatric experience.

Counterintuitively, a small opening can be more concerning than a large one. A wide defect lets tissue move in and out freely. A narrow one can trap a piece of fat or bowel that cannot slip back, which is how incarceration happens.

That is why size alone does not determine the plan, and why a small persistent lump that has become tender should not be dismissed as trivial.

Examination usually settles the diagnosis. The area is examined lying and standing, with a cough or strain, and the size of the defect and whether contents reduce easily are noted.

Ultrasound or CT is added when the examination is difficult, when the diagnosis is uncertain, when a hernia is recurrent, or when other abdominal wall defects are suspected alongside it. Underlying causes of raised abdominal pressure are asked about, since they affect both timing and durability of any repair.

• Examination standing and lying, with strain
• Assessment of defect size and reducibility
• Ultrasound or CT in unclear or recurrent cases
• Review of contributing causes of raised abdominal pressure

Symptomatic hernias are generally repaired. Asymptomatic small hernias in adults may be watched, with clear instruction about what warrants urgent attention. Because the defect does not close on its own, watching is a deliberate choice rather than a cure.

Repair closes the defect, with the technique chosen according to size and individual circumstances. Timing is sometimes coordinated with other planned abdominal procedures, and where liver disease or fluid accumulation is present, that is addressed as part of the planning rather than separately. Hernia repair of all kinds falls within general surgery here.

Sudden pain, a firm bulge that will not push back in, skin discoloration over it, nausea and vomiting, or an inability to pass gas require emergency evaluation. Otherwise, a bulge that is growing, becoming uncomfortable, or interfering with your activity is a reason to book an outpatient evaluation.

This page is educational information, not medical advice. What is right for you is decided in consultation, after a review of your history, your symptoms, and your testing.