Ep 232 – Umbilical hernia

Umbilical hernias are common in infancy but can also occur in adulthood. In this episode, Dr Kate Chesterman discusses how these hernias are likely to present in childhood. She covers the chances of spontaneous resolution and the indications for referral and surgery. She then compares this with the presentation and management of an umbilical hernia in an adult, again considering underlying causes and indications for treatment.

Key take-home points

• An umbilical hernia occurs when a defect in the abdominal wall lets tissue or intestine bulge through the navel.
• In children, umbilical hernias are often caused by delayed closure of the umbilical ring after birth. They cannot be prevented.
• Umbilical hernias in children are more common in premature babies and those of African or Afro-Caribbean descent.
• Up to 90% of umbilical hernias in children resolve spontaneously by 4 years of age without treatment. On examination, an umbilical hernia should be distinguished from a paraumbilical hernia, which does not have the potential to close spontaneously.
• Umbilical hernias in children are usually painless, and surgery is rarely needed before the age of 4 unless complications arise.
• Management of umbilical hernias in children focuses on reassurance and watchful waiting.
• After the age of 4, an umbilical hernia is unlikely to resolve spontaneously, and surgery may be undertaken because of concerns about the appearance of the bulge.
• In adults, an umbilical hernia is often linked to increased pressure in the abdomen, such as from being overweight, heavy lifting, chronic coughing, straining from constipation, ascites or pregnancy.
• Umbilical hernias in adults do not close spontaneously and carry a higher risk of complications such as strangulation.
• Adults often require surgery if the hernia causes pain, interferes with daily activities, grows larger or becomes irreducible.
• Following surgery at any age, the wound should be kept clean and dry, loose-fitting clothing is recommended, simple analgesia can help with pain, and heavy lifting and strenuous exercise should be avoided for several weeks.
• In both adults and children, severe pain, fever, vomiting, constipation, or a red or purple bulge that cannot be reduced can indicate strangulation, which requires immediate medical attention.

Key references

1. Cambridge University Hospitals. https://www.cuh.nhs.uk/patient-information/umbilical-hernia-in-children/.
2. Guy's and St Thomas' Specialist Care. https://guysandstthomasspecialistcare.co.uk/conditions/umbilical-hernia/.
3. BMJ Best Practice. 2023. https://bestpractice.bmj.com/topics/en-gb/438.
4. NHS. https://www.nhs.uk/conditions/umbilical-hernia/.
5. Oxford University Hospitals. https://www.ouh.nhs.uk/media/qiffwknl/79834phernia.pdf.
6. Knowledge NoW. https://nwknowledgenow.nhs.uk/content/hernia/.
7. Barreto L, et al. BMJ. 2013;347:f4252. doi: 10.1136/bmj.f4252.
8. American College of Surgeons. https://www.facs.org/for-patients/the-day-of-your-surgery/adult-umbilical-hernia/.