An umbilical hernia is a protrusion of the muscles that hold in the stomach contents and fluid, or of part of the abdominal organs, which pushes through the umbilical ring, the muscle around the belly button.

This happens when the ring doesn’t close while babies are in the womb. It usually looks like a soft swelling through the skin around the belly button and sticks our further when the baby is sitting upright, crying or straining. It can be as small as one-half inch and up to about two inches. The smallest ones usually close up by themselves by the time the infant is three or four years old. Those that don’t close may require surgery.

Umbilical hernias usually are painless and are very common in babies, occurring in as many as one in every six babies. Usually they are not related to any other disease process, but can be seen in children with Down syndrome and other diseases.

Treatment normally is not needed unless the hernia is still present when the child is about two years old. Hernias that are still present typically require surgery. It’s rare, but in some cases, the hernia can become strangulated – meaning that it loses its blood supply. If this happens, emergency surgery is necessary. If you have a child with an umbilical hernia and it suddenly becomes tender, reddened or swollen, you should contact your pediatrician immediately.

In surgery, general anesthesia is used, unless the hernia is very small. An incision is made under the belly button, and the hernia sac is pushed back inside the stomach where it belongs. If it’s very small, the tissue it pushed through is closed with stitches. If it’s bigger, it will be closed with stitches and a small piece of mesh to make the area stronger.

Most of the time, this procedure is done on an outpatient basis unless the hernia is very large. The long-term prognosis is excellent. Unless the hernia is very large, it’s unlikely to occur again. Full activity can be resumed in two to four weeks.

For an appointment with a Washington University pediatric surgeon, call (314) 454-6022, Monday-Friday, 8 a.m.-5 p.m.