hernia, umbilical

Parents sometimes are concerned because the umbilicus, or belly button, protrudes out, rather than in. This may occur only with crying and straining, or all the time. This fairly common condition is called an umbilical hernia.

There exists in the abdominal wall a potential weak spot where the umbilical cord with its three vessels passed through. Once the cord has sloughed and healed, the abdominal musculature pushes this hole closed and the natural scar formation causes it to shrink to nothing. In some babies, there is a significant congenital weakness in this area and the normal closure does not occur. When this happens, the pressure of crying and straining on the abdominal contents makes the umbilicus pooch outward. The hernia thus created is filled with a loop of small intestine, however there is absolutely no danger of entrapment as with an inguinal hernia.

These hernias are harmless, and generally disappear by two to four years of age. They are more common in African-American children. If the hernia is excessively large, it may be surgically repaired. My surgeon friends usually wait until the child is at least several years old to repair them, since so many umbilical hernias spontaneously disappear (in contrast to inguinal hernias, which never go away by themselves).

This type of hernia is almost never painful - pain in that area is usually from some other cause. I have heard that rarely, a bit of tissue called omentum (the fan of tissue through which the blood supply of the intestine travels) can get stuck in a small umbilical hernia and cause some pain, but this must be a pretty rare occurrence.

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