Umbilical Hernia: Should I Have Surgery?

An umbilical hernia is a bulge near the belly button, or navel. The hernia has a sac that may hold some intestine, fat, or fluid. These tissues may bulge through an opening or a weak spot in the stomach muscles. You may have had this weak spot since you were born, when muscle and other tissue around your umbilical cord didn't close properly.

In adults, umbilical hernias are more common in women who have been pregnant several times, in people who are overweight, and in people who have had surgery in the belly.

Repairing the hernia can relieve pain and discomfort and make the bulge go away. The hernia won't heal on its own.

Your doctor may recommend surgery if:

• Your hernia is very large.
• Your hernia bothers you.

Your doctor will recommend surgery right away if:

• You have pain, a swollen belly, or other signs of a rare but major problem called strangulation or incarcerated hernia. This can occur when the intestine gets trapped in the hernia sac and loses its blood supply.

During the surgery, the doctor makes a small cut, or incision, just below the belly button. Any tissue that bulges into the hernia sac is pushed back inside the belly. The muscles and tissues around the belly button are repaired, and the cut is closed with stitches.

Usually there is only a small scar, but if the hernia is very large, the belly button may not look normal. Most of the time, a surgeon can fix this. This surgery has few risks.

There are two types of hernia repair surgeries:

• Open hernia repair surgery. The hernia is repaired through a cut (incision) in the belly. Open surgery is safe and effective and has been done for many years.
• Laparoscopic hernia repair. A surgeon inserts a thin, lighted scope through a small incision in the belly. Surgical tools to repair the hernia are inserted through other small incisions in the belly. Laparoscopic hernia surgery may have some advantages over open surgery in certain cases. Studies show that people have less pain after this type of surgery and can return to work and other activities more quickly than after open repair. But this surgery costs more than open repair.

It can take up to 4 weeks after open hernia surgery before you can begin normal strenuous activities. If you have laparoscopic surgery, you may recover sooner.

You and your doctor may want to put off surgery if:

• The hernia is small and you don't have any symptoms, or if the symptoms don't bother you much.
• The hernia can be pushed back into the belly or it goes away when you lie down. (If it cannot be pushed back, surgery must be done sooner.)

It may also be a good idea to put off surgery if:

• You are pregnant.
• You have other health problems that make surgery dangerous.

Talk with your doctor before wearing a corset or truss for a hernia. These devices aren't recommended for treating hernias and sometimes can do more harm than good. There may be certain cases when your doctor thinks a truss would work, but these are rare.

Your hernia may get worse, but it may not. Over time, hernias tend to get bigger as the muscle wall of the belly gets weaker and more tissue bulges through. But some small, painless hernias never need repair.