What is an umbilical hernia

An umbilical hernia is a bulge or protrusion that is seen or felt in the area of the belly button. This bulge is the result of a failure of the abdominal wall to completely close during development, leaving an opening for a portion of the intestine and fluid to come through. Umbilical hernias are present at birth but may become more noticeable during times when your child is bearing down – crying, coughing, or straining to have a bowel movement. The bulge may seem to disappear when the child is quiet or resting. Umbilical hernias do not usually cause pain.

Most umbilical hernias (about 90 percent) close on their own by the time the child is 4-5 years old. Therefore, your surgeon may recommend waiting until your child is 4-5 years old before undergoing a surgical repair. Waiting has benefits even if the hernia does not close on its own. The hernia generally gets smaller, which simplifies the repair procedure. Waiting also allows the muscle wall to thicken and mature, which makes the repair more robust.

In some cases, such as a large hernia or incarceration, surgical repair may be recommended prior to 4-5 years of age. Incarceration of the hernia occurs when the intestine gets trapped in the defect and is unable to go back into the abdomen. An incarcerated hernia will often cause a painful, firm, discolored bulge. If your child has signs of an incarcerated hernia, he or she should be brought to the Emergency Department for immediate evaluation by a medical professional to prevent any damage to the intestines.

It is estimated that umbilical hernias occur in 10-15 percent of all infants, with boys and girls affected equally. African Americans, low birth weight and premature infants are at a greater risk for having an umbilical hernia. How the umbilical cord is clamped or cut after birth has no effect on whether an umbilical hernia will develop or not develop.

Evaluation and diagnosis

The diagnosis of an umbilical hernia is confirmed by a thorough health history and physical examination. Imaging studies are almost never needed to diagnose umbilical hernias.

Treatment for umbilical hernia

If your child’s umbilical hernia does not close on its own by the time he or she is 4-5 years old, we will recommend a surgical procedure to repair the hernia. Visit our Guide to Your Child’s Surgery to learn more about what to expect when your child has surgery at The Children’s Hospital of Philadelphia.

Surgical repair of umbilical hernia

The surgery to repair an umbilical hernia is a day surgery, meaning your child will go home the same day as the procedure. The procedure will be done under general anesthesia.

A small curved incision (resembling a smile) will be made under your child’s belly button. The opening will be closed, usually with absorbable sutures, and the overlying skin will be closed with a combination of absorbable stitches below the skin and DERMABOND. If DERMABOND is not used, your child may have a dressing over the site, which should be removed 48 hours after surgery.

DERMABOND is a sterile, liquid adhesive that will hold the edges of your child’s wound together and act as a waterproof dressing. It usually stays in place for 5-10 days before it starts to fall off. You should not pick, peel or rub the DERMABOND, as this could cause your child’s wound to open before it is healed.

Once it sets, the adhesive can get wet (as in a shower) the same day as the procedure, but should not routinely be submerged under water (as in swimming) for 5-10 days. Do not apply any ointments such as Vaseline or Neosporin to the incision while the DERMABOND is in place.

Follow-up care

After surgery, your child’s belly button may appear to be slightly swollen, but this will go away over the next few weeks. Your child will not be able to participate in physical education or sports for 2-3 weeks after surgery. We will schedule your child for a follow-up appointment 2-4 weeks after the procedure, at which time we will evaluate the repair and your child’s recovery.

Even after repair, there is a very small risk of recurrence of the hernia. If it appears that your child’s hernia has come back at any point, please make an appointment with your doctor to be evaluated.

When to call the doctor

Seek medical care immediately if your child has any signs or symptoms of incarceration:

• A hernia that is stuck out and not able to be reduced (gently pushed back into the abdomen)
• A painful, firm, discolored bulge

Please call the Division of Pediatric General, Thoracic and Fetal Surgery at 215-590-2730 if your child has any of the following symptoms:

• Fever (a temperature of 101.5 degrees or higher)
• Any signs of infection, including redness, swelling or pain
• Any drainage from the incision
• Any pain that is not controlled with the prescribed pain medicine
• A bulge at the belly button
• Any further questions or concerns