Diagnosis and Treatment for Umbilical Hernias
An umbilical hernia is a weakness or opening of the abdominal muscle at the belly button, called the “umbilicus” in medical terms. This opening allows the bowel or intestine to be pushed into a sac beneath the skin. Around 10 to 20 percent of infants may have an umbilical hernia. It is equally common in boys and girls, although premature and African American babies are more likely to get them.
Signs and Symptoms
- A “bulge” at the belly button, most noticeable when the infant or child cries or strains
- A ring may be felt in the area when the child is relaxed
If the bulge is above the belly button, a different type of hernia, called an epigastric hernia, may be present.
An umbilical hernia is not painful unless the intestine becomes trapped in the sac, which happens in less than 1 percent of children with umbilical hernias. The medical term for this problem is "incarceration." An incarcerated hernia will be painful, there may be redness over the area, and the child may have vomiting. If these signs appear, the child should be seen by a doctor right away.
An umbilical hernia is diagnosed by physical examination. Additional X-ray tests or ultrasounds are usually not required.
Unlike other types of hernias, most umbilical hernias will close on their own during the first five years of life and do not require surgery. The size of the bulge does not determine if an umbilical hernia will close over time, although if the ring that can be felt is larger than 5/8 inch, or 1.5 cm, the hernia is less likely to close. “Taping” a hernia closed from the outside does not speed healing and may cause a rash.
Office consultation is recommended if the hernia has not closed by age 2 to 5. If the hernia does not close by age 3 to 5, if the ring is large or if the hernia becomes incarcerated, surgery may be needed.
Surgery, if needed, is performed as an outpatient under general anesthesia. The operation usually takes under an hour, with total time spent at the hospital usually about six hours. If necessary, the child will be given sedation before going to the operating room. After he or she is asleep, an IV or intravenous will be started. A small incision is made beneath or in the belly button and the muscle is closed.
The skin is sewn with sutures, or stitches, beneath the skin and a dressing is placed. The stitches will dissolve on their own. At the time of the operation local medication may be injected at the incision.
At discharge, your surgeon will give instructions regarding bathing, activity, pain management and removal of the dressing.
A return visit is usually scheduled in one to two weeks, or a phone follow-up may be planned. If redness, yellow or clear drainage, or a temperature of 101.5 or greater that is not relieved by acetaminophen or ibuprofen (used in children older than six months) occurs, please call our office.
Families can call Child Life Services at 253-403-5315 to schedule a pre-surgery tour.