Introduction to umbilical hernia:
When parents come to me about an umbilical hernia, their concern is both about the word “hernia” and about the appearance of the soft lump on their baby’s belly. They want the belly button to look “normal”.
Parents almost never ask me about taping a coin to the belly button to “hold it in.” But when I bring up the idea, most parents report that they have heard from someone that the coin worked. Many report that they are coin-taping at home.
Does it work? If not, what does?
What is an umbilical hernia?
The umbilical cord is a strong, flexible pipeline. It carries nutrition, oxygen, and life support from a mother’s lifeblood to her child. And in the other direction, waste products from the child are eliminated by her mother. This conduit enters the baby between the two rectus abdominus muscles of the abdominal wall. These two muscles (which we later try to keep firm with sit-ups) are connected by a white line of tough fibrous tissue called the linea alba. The umbilical ring is a small hole (about 1/2 inch in diameter) through which the umbilical cord passes into the belly. Usually, after the umbilical cord is cut and the stump begins to wither and fall off, the umbilical ring closes and the linea alba becomes a smooth, unbroken band.
If the umbilical ring is still open, the child has an umbilical hernia. The belly button “pooches” out, and gets bigger if the baby is crying or straining. Sometimes it looks almost like a balloon. When the baby is relaxed, this balloon can be gently pushed back into the belly — only to reemerge a few minutes later.
Who gets an umbilical hernia?
Umbilical hernias are quite common. They are found in about 10 percent of all babies, and as many as 90 percent in some ethnic groups.
They are also much more common in girls and in premature babies.
What are the symptoms of umbilical hernia?
Often, the hernia isn’t noticed when the child is very young, since the hernia may not pop out until the baby begins tightening the abdominal muscles and building up pressure in the belly. When sticking out, the hernia might be as small as a cherry or as large as a lime.
This type of hernia does not cause pain or other symptoms.
Is an umbilical hernia contagious?
How long does an umbilical hernia last?
Most umbilical hernias disappear within the first year. Some last until school age or beyond.
How is an umbilical hernia diagnosed?
Umbilical hernias are diagnosed during a physical exam. Further studies are usually not necessary.
How is an umbilical hernia treated?
The word hernia conjures up thoughts of surgery, and appropriately so, since many types of hernia are best treated with surgery. Umbilical hernias are usually an exception to this and are not a cause for alarm.
In the not too distant past, the most popular medical treatment for umbilical hernias was to push in the pouch and tape a coin over the belly button to prevent it from pooching out again. Most of the time this worked and the umbilical hernia disappeared by the time the baby was a year old. Umbilical bands or straps were a variation on this theme.
We now know that not using a coin, band, or strap works just as well — and avoids skin irritation. Over 85 percent of umbilical hernias will disappear by age one even if you do nothing at all.
Predictably, the smaller the hernia (not the smaller the balloon, but the smaller the opening in the belly wall) the more likely the hernia is to close by itself. Still, even large hernias (6 cm opening) have been known to close spontaneously by kindergarten. Those that first appear after 6 months of age are less likely to correct themselves.
There are a wide variety of opinions about when, if ever, surgery is useful. I would consider surgery if the ring is still bigger than 2 cm across at one year, if the defect grows after one year, or if it is still present at kindergarten (when further spontaneous closure becomes very unlikely). There is certainly no rush.
The surgery itself is simple and safe. The incision is tiny, and a couple of stitches usually suffice to close the remaining hole in the linea alba. Voila! An innie!
There is one caveat to this! Children with umbilical hernias are at a slight risk of having some abdominal contents get stuck inside the herniated sac. This is called an incarcerated umbilical hernia. This is a medical emergency, since the abdominal contents, potentially including the intestines, must be released from inside the hernia before they lose their blood supply. Generally the symptoms include a hard, firm hernia that may be painful or have a color-change.
How can umbilical hernia be prevented?
No preventive measures are known, except good prenatal care to reduce the risk of pre-term delivery.