An umbilical hernia is a type of abdominal wall hernia which may occur in children and adults.
In the newborn, a hernia is usually present at the site of the umbilicus. A small sac usually protrudes through the umbilicus as the child cries, coughs or strains. The bulge may disappear spontaneously when the baby is calm. They can vary in size and are rarely bigger than about 2.5 cm. In childhood, the umbilical hernias are usually painless. Sometimes the intestine gets trapped within the umbilical hernia. This is referred to as an incarcerated hernia and the child usually has a severe pain with red and firm bulge through the umbilicus  .
In adults, umbilical hernia is more common in obese women and between 35 to 50 years of age. The hernia appears as small, round or oval shaped swelling, more prominent on coughing. These hernia may become irreducible because of the formation of omental adhesions . Large umbilical hernias cause dragging pain because of their weight. Gastrointestinal symptoms such as abdominal pain and constipation are common in these patients. Often there are transient attacks of intestinal colic because of partial intestinal obstruction.
Umbilical hernias usually close on their own in infants and young children within the first three years of life. If the hernia persists over 5 years of age or if there is an episode of incarceration or if the hernia is very large, surgical repair may be recommended .
Surgical repair is usually done by the small incision made at the base of the umbilicus. Most children are able to return home within a few hours after surgery. Taping a coin down over the bulge does not usually help, this may rather lead to infections and complications.
For adults, surgery alone is the treatment of choice to avoid possible complications, especially if the umbilical hernia gets bigger or becomes painful due to intestinal strangulation within the hernia. The two surgical treatment options available to correct an umbilical hernia are laparoscopic hernia repair and open hernia repair  .
An umbilical hernia can be treated completely by surgical repair in most of the cases. There is always a chance that the hernia can come back . However, for healthy patients, the risk of recurrence is usually low. If left untreated, umbilical hernia can expand and result into serious complications such as strangulated hernia, rupture of the hernial sac, infections, pneumonia and pulmonary edema   .
Umbilical hernias are most common in low birth weight babies and premature infants. For adults, being overweight or having multiple pregnancies may increase the risk of developing an umbilical hernia. This type of hernia is more common in women in their fifties and sixties.
Moreover, directly increased intraabdominal pressure caused by a history of prolonged cough, heavy weightlifting, previous abdominal surgery, ascites, straining with urination or defecation, and chronic obstructive pulmonary disease may also increase the risk for the development of umbilical hernia.
Umbilical hernias comprise 10% of abdominal wall hernias. Of the half million hernia operations performed in the United States every year, about 14% are umbilical hernia repairs. The female to male ratio of umbilical hernia is 1.7:1. Over 95% of these hernia close spontaneously in the first three years of life. Persistence after third birthday is an indication for elective repair.
As with all abdominal hernias, the persistence of umbilical hernia increases with age. They are equally common in men and women, and umbilical hernias are more common in individuals of African ancestry.
During pregnancy, the umbilical cord passes through a small opening in the baby’s abdominal muscles, connecting mother to baby. This opening is known as the umbilical ring. The ring usually closes before the baby is born. If due to any pathology, the muscles do not join completely in the midline of the abdomen, the ring does not close and the weakness in the abdominal wall results in the protrusion of abdominal contents through umbilicus at birth or later in life. This results into infantile umbilical hernia.
In adults, umbilical hernia is usually secondary to raised intraabdominal pressure caused by obesity or fluid in the abdomen. The raised intraabdominal pressure pushes the contents out of the weak abdominal wall.
An umbilical hernia is an abnormal bulge present at the umbilicus, the belly button. The condition is more common in infants and young children than adults. The hernia usually is not painful and it often resolves on its own without treatment. Preventive measures such as controlling weight and reducing intraabdominal pressure can reduce the risk of umbilical hernia.