An umbilical hernia is a gap at the navel, where the abdominal wall is naturally thin — it is the point where the umbilical cord once passed. Fat, or sometimes a loop of bowel, pushes through, creating a bulge at or beside the belly button. An epigastric hernia is the same idea a little higher: a small defect in the midline between the navel and the breastbone.
In adults these defects do not close on their own. Many stay small and cause little trouble; some enlarge slowly, and a narrow-necked one can trap its contents, which is the reason they are taken seriously despite often being small.
Signs and symptoms
- A bulge at or near the navel, or a tender lump in the upper midline, more obvious on standing or straining.
- Discomfort or a dragging sensation, sometimes sharper than the size of the lump would suggest.
- A bulge that comes and goes, or that becomes harder to push back over time.
When to seek care the same day. If the lump becomes firm, painful and cannot be pushed back, particularly with nausea or vomiting, the contents may be trapped. Go to an emergency department.
When surgery is the right call
A very small, soft, symptom-free umbilical hernia can reasonably be watched. Repair is advised when it is painful, enlarging, difficult to reduce, or large enough to put bowel at risk. A narrow neck — common in small umbilical hernias — actually raises rather than lowers the case for repair, because it is the narrow ones that trap contents.
The repair
The operation is usually short and done as day surgery. Through a small incision hidden at or near the navel, the contents are reduced and the defect is closed.
Suture repair
For a very small defect, closing the gap directly with strong sutures may be all that is needed.
Mesh repair
For anything larger, a small piece of mesh reinforces the repair and markedly lowers the chance of recurrence. The decision between the two follows the size of the gap and is discussed with you beforehand.
Keyhole & robotic repair
Larger umbilical and epigastric defects, and those alongside a wider midline weakness, can be repaired through keyhole incisions — laparoscopically or with a robotic platform — placing mesh behind the muscle wall rather than through an open incision.
Recovery
Most people go home the same day. Expect some bruising and tenderness around the navel for a week or two. Desk work is usually possible within one to two weeks, and heavier lifting by three to four weeks. The wound is small and the scar settles well.
Risks, honestly
This is a low-risk operation. The main issues are bruising, a small fluid collection, and occasionally wound infection. Recurrence is uncommon, particularly with mesh. Larger defects, obesity and smoking raise the risk and are discussed in consultation.
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