Umbilical Hernia

Learn symptoms, causes, management of paediatric umbilical hernia, and when to contact a paediatric surgeon in Singapore.

What Is An Umbilical Hernia?

An umbilical hernia occurs in children when part of the intestine or abdominal tissue pushes through a weak spot in the abdominal wall near the belly button. This creates an abdominal bulge that you can see and feel - a soft lump or swelling at or around the navel.
Umbilical hernias are very common in babies and young children. They happen when the opening in the abdominal muscles where the umbilical cord passed through doesn't close completely after birth. This leaves a weak spot where abdominal contents can push through, especially when your child cries, coughs, or strains.
Many small umbilical hernias close on their own as children grow, typically by age 4 to 5. However, larger hernias or those that persist beyond this age often require umbilical hernia repair surgery.

Common Symptoms of Umbilical Hernia

What You’ll Notice

Soft bulge or swelling at or near the belly button
The bulge gets bigger when your child cries, coughs, laughs, or strains
The bulge gets smaller or disappears when your child is calm or lying down
You can gently push it back in (called a reducible hernia)
Size varies from small (marble-sized) to larger (golf ball-sized or bigger)

In Babies and Toddlers

Most umbilical hernias in this age group cause no symptoms other than the visible bulge:

No pain or discomfort
Doesn't bother the baby
Baby acts normally and feeds well
The bulge is soft and doesn't cause problems

Many parents first notice the hernia when their baby cries and the belly button area bulges out prominently.

In Older Children

Children who still have umbilical hernias after age 4-5 may experience:

Visible abdominal bulge near the belly button that persists
Mild discomfort or aching around the belly button
Pain when coughing, bending, or being very active
Self-consciousness about the appearance

Emergency Symptoms

Rarely, an umbilical hernia can become stuck (incarcerated) or lose blood supply (strangulated). Contact us immediately if you see these signs:

The bulge becomes firm and cannot be pushed back in
Severe pain around the belly button
Tender, swollen belly button that's painful to touch
Red or dark purple skin over the hernia
Vomiting
No bowel movements
Baby is crying inconsolably and can't be comforted

These symptoms require immediate medical attention and may need emergency umbilical hernia repair surgery.

What Causes Umbilical Hernia in Children?

Umbilical hernias in children are almost always present from birth, though they may not be noticed immediately.
During pregnancy, the umbilical cord passes through an opening in the baby's abdominal muscles. After birth, when the umbilical cord is cut, this opening should close naturally as the abdominal muscles come together. The belly button forms as the cord stump heals.
In some babies, the muscles don't close completely. A small gap or weak spot remains in the abdominal wall right at the belly button. When the baby cries or strains, pressure from inside the abdomen pushes intestine or fatty tissue through this gap, creating the abdominal bulge of an umbilical hernia.

Several factors make umbilical hernias more likely:
Premature babies are more prone to umbilical hernias because their abdominal wall muscles haven't had enough time to develop and strengthen.
Babies born with low birth weight, whether premature or not, have higher rates of umbilical hernias.
Umbilical hernias tend to run in families, suggesting a genetic component to the development of the abdominal wall.
Twins, triplets, and other multiples have higher rates of umbilical hernias, likely related to both prematurity and lower birth weights.

It's important to understand that umbilical hernias in babies and young children are NOT caused by:

How the umbilical cord was cut or clamped
Anything the mother did during pregnancy
How the belly button was cared for after birth

Parents should know you didn't cause your child's umbilical hernia. It's simply a variation in how the abdominal wall closed after birth.

Consequences of Untreated Umbilical Hernia

The approach to umbilical hernias differs by age, but persistence beyond certain ages can lead to complications.
In babies and toddlers under age 4-5, most small to medium umbilical hernias close on their own. During this time, watchful waiting is appropriate for most hernias. This is why navel hernia infant treatment often involves observation rather than immediate surgery.
If the umbilical hernia hasn't closed by this age, it's unlikely to close on its own. At this point, umbilical hernia repair surgery becomes important as continued waiting rarely helps.

Complications of Persistent Hernias

A risk of persistent hernias is incarceration - when intestine or fatty tissue gets stuck in the hernia and can't be pushed back in. The opening acts like a trap. While less common with umbilical hernias than inguinal hernias, it can still happen and cause:

Severe pain
Firm, tender bulge that won't reduce
Vomiting
Inability to pass stool
Need for emergency umbilical hernia repair surgery

If incarcerated tissue loses its blood supply, strangulation occurs. This is life-threatening and requires emergency umbilical hernia closure surgery. Without blood flow, the trapped intestine begins to die within hours.

Discomfort and Limitations

Without emergency symptoms, larger persistent hernias still cause:

Aching or discomfort around the belly button
Pain with physical activity
Limitations on sports or active play
Worries about the bulge getting worse

A prominent abdominal bulge can cause your child to be self-conscious and experience emotional distress. Large hernias can also cause the skin over the belly button to stretch and thin, leading to irritation or breakdown of the skin and increased risk of infection.

Damage to Reproductive Organs

In the male body, if a hernia contains a testicle or if an incarcerated hernia presses on blood vessels to the testicle, it can cause:

Damage to the testicle
Testicular atrophy (shrinking)
Potential fertility issues in the future

In the female body, if a hernia contains the ovary or the fallopian tube, complications can include:

Damage to the ovary from loss of blood flow
Loss of the ovary if strangulation occurs
Potential impact on future fertility

Discomfort and Activity Limitations

Even without serious complications, untreated hernias can cause:

Ongoing discomfort or pain
Limitations on physical activity
Risk that increases over time as your child grows and becomes more active

How to Treat Inguinal Hernia in Children

The treatment for an inguinal hernia in children is surgical repair. At The Little Surgery, we provide expert paediatric inguinal hernia repair, offering a safe and effective operation.

Why Surgery is Needed

Unlike some conditions that can be watched or treated with medicine, inguinal hernias in children require surgery because:
The hernia won't heal or close on its own
There's no effective non-surgical treatment
The risk of complications (incarceration, strangulation) is significant
The hernia often gets worse over time
Surgery is safe and highly successful when performed by experienced paediatric surgeons
Trusses (support garments) that are sometimes used in adults are not recommended for children. They don't fix the problem and can actually cause complications.

Diagnosis and Evaluation

Dr. Ong will examine your child's groin area to feel the hernia, assess the size and location, check if the hernia can be reduced (pushed back in), and evaluate the other side (since hernias can occur on both sides).
Usually, inguinal hernias are diagnosed by physical examination alone. Occasionally, an ultrasound may be done if the diagnosis is uncertain or to check for any complications.
We'll discuss your child's overall health, any previous surgeries or medical conditions, and timing for paediatric inguinal hernia repair.

Paediatric Inguinal Hernia Repair Surgery

For most children with inguinal hernias, surgery is scheduled within weeks to a few months of diagnosis. The timing depends on your child's age, whether any incarceration has occurred, and their overall health.
If your child has an incarcerated hernia that can't be reduced, an emergency groin hernia operation is performed as soon as possible, usually within hours.
The standard procedure is called herniotomy - surgical repair of the hernia. It is performed under general anaesthesia, so your child is completely asleep and comfortable. The operation typically takes 30-60 minutes, and your child can go home on the same day. Babies under 6 months, especially premature babies, may stay overnight for monitoring.

Recovery After Surgery

After a paediatric groin hernia operation, your child goes to the recovery room where they wake up from anaesthesia gradually. You can usually go home 2-4 hours after surgery once your child is awake, comfortable, able to drink fluids, and urinating normally.
At home, your child may have some discomfort for 2-3 days. Prescribed pain medication (acetaminophen or ibuprofen) usually controls it well. Your child should avoid rough play, climbing, or jumping for the first few days.
Some swelling and bruising in the groin or scrotum is normal and resolves within a week or two. Most children return to daycare or school within a week. We schedule a follow-up visit 2-3 weeks after the inguinal hernia paediatric treatment to check healing, ensure everything looks good, and answer any questions.

Why Choose The Little Surgery for Inguinal Hernia Repair

We provide expert paediatric inguinal hernia repair, offering safe and effective operation, typically performed as convenient day surgery.

Experienced Paediatric Surgeon

Dr. Ong Lin Yin has over 20 years of experience in paediatric surgery. As the former Head of Paediatric Surgery at KK Women's and Children's Hospital, she has extensive experience with routine paediatric groin hernia operations in all age groups, emergency repair of incarcerated hernias, and other complex cases.

Comprehensive Care

We provide thorough pre-operative evaluation, clear instructions to prepare your child for surgery, expert surgical operations, and follow-up care. For children with incarcerated hernias or complex cases needing urgent treatment, we provide emergency operations and coordinate with specialists to ensure your child receives expert care at every step.

Family Support

We understand that surgery can be scary for children and parents. We provide clear explanations of your child’s condition, detailed discussions on surgery, and compassionate support throughout the treatment journey.
As a mother herself, she understands family concerns and ensures you feel informed and comfortable.

Contact The Little Surgery Today

If your child has an inguinal hernia or groin bulge, we can help.
Contact The Little Surgery today and take the first step toward ensuring your child's health and happiness.