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 [5] [6].

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 [7]. 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.

• Inguinal Hernia

  Groin or Inguinal Hernias A paediatric inguinal hernia can occur at any age, but the peak incidence is during infancy and early childhood with 80-90% occurring in boys. [hernia.org]

  The risk of strangulation is greater with a femoral hernia than with an inguinal hernia. The risk is also greater with smaller hernias. How are hernias repaired? A small operation is recommended. [patient.info]

  How common are hernias in babies? More common than you may think. About 10 percent of all babies have an umbilical hernia. And 1 to 3 percent of all kids develop an inguinal hernia. How did my baby get a hernia? Babies aren’t fully developed. [thebump.com]

  Inguinal hernia Surgery is needed to treat an inguinal hernia. In many cases, surgery is done soon after the hernia is found. That’s because the intestine can become stuck in the inguinal canal. [cedars-sinai.org]

• Fever

  If your child develops painful swelling or fever, contact your surgeon or local doctor immediately. What is an umbilical hernia? An Umbilical hernia is an abnormal bulge that can be seen or felt at the umbilicus (belly button). [schn.health.nsw.gov.au]

  Contact your doctor if you notice the following symptoms: infection at the wound site recurrence of the hernia headache numbness in the legs nausea/vomiting fever The majority of cases in babies will resolve on their own by age 3 or 4. [healthline.com]

  Symptoms of a strangulated umbilical hernia include: Abdominal pain and tenderness Constipation Fever Full, round abdomen Red, purple, dark or discolored bulge Vomiting The provider may order blood tests to look for signs of infection resulting from the [hopkinsmedicine.org]

• Inflammation

  Several etiologies are supposed to induce the herniation of intraabdominal structures, including surgeon's incaution, abdominal obesity, intense wound inflammation and fibrosis, and the native weak point of the abdominal wall around the umbilicus. [ncbi.nlm.nih.gov]

  Infection, inflammation, tissue death or bleeding can be detected with blood tests. In adults, a painful and enlarged bulge is usually treated with surgery. [caseysurgicalgroup.com.au]

  Other surgical problems in children: INGUINAL SWELLING Inguinal hernia SCROTAL SWELLING Hydrocele Torsion of testis Inflammation of testis ABSENT TESTIS FROM SCROTUM DIFFICULTY IN PASSING URINE Phimosis Urethral valves ABNORMAL EXTERNAL URINARY OPENING [web.archive.org]

  Henoch-Schonlein purpura (HSP) is a disease involving inflammation of small blood vessels. It most commonly occurs in children. The inflammation causes blood vessels in the skin, intestines, kidneys, and joints to start leaking. [webmd.com]

  Infection, inflammation, tissue death or bleeding can be detected with blood tests. What are the treatment options? In adults, a painful and enlarged bulge is usually treated with surgery. [southwestaustinsurgical.com]

• Burning Pain

  pain, which often worsens with exercise or straining (eg, coughing) Spigelian hernia - Local pain and signs of obstruction from incarceration; pain increases with contraction of the abdominal musculature Interparietal hernia - Similar to spigelian hernia [emedicine.medscape.com]

• Sneezing

  Activities that indicate the incision should be protected include: Rising from a seated position Sneezing Coughing Bearing down during a bowel movement Vomiting Thanks for your feedback! [surgery.about.com]

  Recent studies have confirmed that an unwanted cough or sneeze can put much more strain on the surgical site than any form of muscle-supported physical exercise. [hernia-centre.com]

  The umbilical hernia is accompanied by pain in the abdomen; a burning sensation; and may become more severe when lifting, coughing or sneezing. [herniaonline.com]

  The bulge that results can be painful in the events of coughing, sneezing or lifting heavyweight. Mostly a hernia is not a serious health issue however in some cases it can lead to severe complications. [marham.pk]

  Any activity or medical problem that increases pressure on the tissue in the belly wall and muscles may lead to a hernia, including: Long-term (chronic) constipation and pushing hard (straining) to have a bowel movement Chronic coughing or sneezing Cystic [medlineplus.gov]

• Sore Throat

  If a breathing tube is used, your child might have a sore throat after the surgery. To keep your child asleep during the surgery, he or she might be given anesthetic medication by mask, through the IV tube or both. [chp.edu]

• Overeating

  An umbilical hernia is an abnormal bulge, or protrusion, that can be seen or felt over the belly button (the umbilicus). [my.clevelandclinic.org]

  The surgeon can opt to stitch the walls of the abdomen or he/she can place mesh over the opening and stitch it to the abdominal walls. The latter is of a stronger hold and is commonly used for larger defects in the abdominal wall. [en.wikipedia.org]

  Taping a coin down over the bulge does not usually help, this may rather lead to infections and complications. [symptoma.com]

• Nausea

  A 61-yr-old woman was admitted to the hospital with severe abdominal pain, an umbilical mass, nausea and vomiting. On examination, a large, irreducible umbilical hernia was found. [ncbi.nlm.nih.gov]

  Contact your doctor if you notice the following symptoms: infection at the wound site recurrence of the hernia headache numbness in the legs nausea/vomiting fever The majority of cases in babies will resolve on their own by age 3 or 4. [healthline.com]

  Umbilical hernias carry the risk of becoming stuck or “incarcerated,” which could cause strong pain, nausea, vomiting, or the inability to pass gas from the rectum. [mountsinai.org]

• Abdominal Pain

  Urachal abnormalities are a rare cause of lower abdominal pain. They are often initially mistaken for more common causes of lower abdominal pain, and the diagnosis is usually made during evaluation for one of these more common conditions. [ncbi.nlm.nih.gov]

• Diarrhea

  Nausea, vomiting, diarrhea and abdominal swelling may also be present. Umbilical Hernia Surgery Once anesthesia is given and the patient is asleep, surgery begins with an incision under the umbilicus or belly button. [surgery.about.com]

  Call your doctor right away if your child has: A fever Redness, swelling, or pain A bulge near the navel Blood or smelly fluid near the incision Nausea, vomiting, diarrhea, or constipation that doesn’t get better [webmd.com]

  Some patients also find that they have diarrhea or "loose bowels" for the first days after their hernia repair – in the vast majority of cases, the bowel function normalizes with time. Constipation may also be common due to the pain medication. [uhhospitals.org]

• Choking

  A hernia is said to be strangulated when an incarcerated hernia’s blood supply gets choked off. When this happens, the organs or tissues stuck in the hernia can become injured and lead to more serious problems. [hopkinsallchildrens.org]

• Muscle Weakness

  For an operation to be successful the cause of hernia has to be eliminated—abdominal muscle stress as in lifting heavy weights, constipation, cough, muscle weakness etc. It is advisable to first eliminate the cause and then go for surgery. [medhelp.org]

  The Basics of an Umbilical Hernia The umbilicus is prone to muscle weakness since it’s where the greatest stress is placed on the muscles when we do anything physical. [californiaherniaspecialists.com]

  Other important contributory factor is abdominal wall muscle weakness due to hypoalbuminemia and recanalization, dilation and varices formation of the umbilical vein at the umbilicus as a result of portal hypertension[ 16, 17 ]. [ncbi.nlm.nih.gov]

• Urinary Retention

  Tract Including Urinary Retention پیشاب کے امراض اور پیشاب کا رک جانا Dysentery خونی پیچش Dysmenorrhea حیض کا درد کے ساتھ آنا E Eczema ایگزیما Elephantitis فیل پا Excessive Sleep نیند کا زیادہ آنا F Facial Palsy چہرے کا لقوہ Fatigue تھکاوٹ Female Infertility [hijamainmumbai.com]

• Apathy

  Psychological one, which helps to eliminate the mental disorders which may occur as a result of a disease (phobias, depression, apathy), to increase the human motivation, and to adapt to the changed living conditions. [bookinghealth.com]

• Stroke

  Thrombotic thrombocytopenic purpura associated with ticlopidine in the setting of coronary artery stents and stroke prevention. Arch Intern Med 1999;159:2524-2528 14. CAPRIE Steering Committee. [nejm.org]

• Lethargy

  Other signs include worsening abdominal pain, increased vomiting, liver enlargement, high haematocrit with low platelet count, lethargy or restlessness. [dermatologytimes.com]

• Hyperactivity

  Effect of tyrosine on attention deficit disorder with hyperactivity. J Clin Psychiatr 1988;49:193-5. 7210 Reimherr FW, Wender PH, Wood DR, Ward M. An open trial of L-tyrosine in the treatment of attention deficit disorder, residual type. [sohf.nl]

• History: The patients with umbilical hernia usually complain of umbilical bulge with raised intraabdominal pressure when the individual coughs or strains the abdomen.
• General physical examination: An umbilical hernia can be seen or felt as a bulge through the umbilicus when the patient coughs. There may be discoloration of the skin at the site of hernia.
• Laboratory tests: An umbilical hernia is diagnosed on the basis of history and physical examination. Sometimes imaging studies such as abdominal ultrasound, CT scan or X-ray may be necessary to rule out complications.

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 [8].

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 [9] [10].

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 [1]. 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 [2] [3] [4].

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.

The opening in the muscle is then repaired with multiple layers of stitches to prevent another hernia. A dressing is placed to keep the belly button flat. [cincinnatichildrens.org]

The sutures will remain in place permanently, preventing the hernia from returning in the future. For large defects, the surgeon may feel that suturing is not an adequate way to repair the hole in the muscle. [surgery.about.com]

How can umbilical hernia be prevented? No preventive measures are known, except good prenatal care to reduce the risk of pre-term delivery. [drgreene.com]

This is called an incarcerated hernia and needs to be evaluated by a medical professional to prevent damage to the intestines. With an incarcerated hernia, the child usually has severe pain and the bulge may be red and firm. [my.clevelandclinic.org]

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.

1. Halm JA, Heisterkamp J, Veen HF, Weidema WF. Long-term follow-up after umbilical hernia repair: are there risk factors for recurrence after simple and mesh repair. Hernia : the journal of hernias and abdominal wall surgery. Dec 2005;9(4):334-337.
2. Haworth JC. Strangulation of umbilical hernia in children. British medical journal. Apr 13 1957;1(5023):869.
3. Stranger SL. Spontaneous rupture of umbilical hernia in an infant. Postgraduate medical journal. Jan 1956;32(363):39.
4. Schairer AE, Cox LM, Keeley JL. Spontaneous perforation of umbilical hernia in cirrhosis of the liver. American journal of surgery. Jul 1963;106:94-98.
5. Vrsansky P, Bourdelat D. Incarcerated umbilical hernia in children. Pediatric surgery international. 1997;12(1):61-62.
6. Chatterjee H, Bhat SM. Incarcerated umbilical hernia in children. Journal of the Indian Medical Association. Aug 1986;84(8):238-239.
7. Bieber EJ, Levrant S. The Risk of Anterior Abdominal Wall Adhesions in Patients with Previous Umbilical Hernia Repair. The Journal of the American Association of Gynecologic Laparoscopists. Aug 1994;1(4, Part 2):S4.
8. Burattini MF, Bussotti C, Scalercio V, et al. [Surgical treatment of umbilical hernia in children. Our experience]. Minerva chirurgica. Jun 2004;59(3):277-282.
9. Gonzalez R, Mason E, Duncan T, Wilson R, Ramshaw BJ. Laparoscopic versus open umbilical hernia repair. JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons. Oct-Dec 2003;7(4):323-328.
10. Ma B, Tian W, Chen L, Liu PF. [Laparoscopic tension-free repair of umbilical hernia]. Zhonghua wai ke za zhi [Chinese journal of surgery]. Mar 1 2010;48(5):345-347.