JAMA PATIENT PAGE | Umbilical Hernia

A hernia is a defect in the muscles and connective tissue of the abdomen. Sometimes fat or bowel can push through this defect, causing pain defects can be repaired by just closing the weakness in the muscles and a noticeable bulge. An umbilical hernia is a defect of the ab- and larger defects are repaired with plastic mesh. The chance of um- dominal wall near the belly button (umbilicus). This is caused by the bilical returning tends to be lower with mesh placement. muscles not closing around the hole left by the umbilical cord and is usually present at birth. Adults usually notice a bulge at their belly button that is caused What causes an umbilical hernia? by increases in abdominal pressure. Chronic , , accu- mulation of fluid in the belly due to (), and fre- In the developing baby, quent pregnancies can cause umbilical hernias. Most people who the umbilical cord passes through an opening have umbilical hernias have no problems related to the hernia apart in the abdominal wall. from the noticeable bulge, if present. ABDOMINAL What to Do If You Have an Umbilical Hernia MUSCLES If you notice a hernia (or bulge), it is best to see your doctor to de- termine the appropriate course of action. In children, umbilical her- nias usually close by themselves as the child ages. If the hernia is no- Opening for the ticed in children older than 5 years, then it is usually repaired umbilical cord surgically. For adults, very small umbilical hernias that do not cause symptoms are often watched, but adult umbilical hernias that be- Umbilical hernia come painful or increase in size are often surgically repaired. The sur- Abdominal contents can push out through the opening if it gery can be a minimally invasive repair or open repair. does not close after birth. Mesh for Mesh is a material that provides additional support to the weak- ened abdominal wall during hernia repair. It can be made of plastic SIDE VIEW or animal tissue. Your doctor may use mesh when repairing the her- nia to reduce the chance of the hernia returning. Although this may be beneficial, meshes can become infected or cause pain and fluid can collect on top of them. For this reason, mesh is used only when necessary.For children, hernias are often repaired without mesh by Muscle pulling the muscle edges together to close the weak area. For adults, Fat use of mesh is generally based on the size of the defect; smaller Skin Abdominal lining ABDOMINAL CAVITY Intestine

FOR MORE INFORMATION • Medline Plus https://medlineplus.gov/ency/article/000987.htm • Mayo Clinic http://www.mayoclinic.org/diseases-conditions/umbilical-hernia /basics/definition/con-20025630

Authors: Eddie Blay Jr, MD; Jonah J. Stulberg, MD, PhD The JAMA Patient Page is a public service of JAMA. The information and Conflict of Interest Disclosures: The authors have completed and submitted the recommendations appearing on this page are appropriate in most instances, but they ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page Sources: Porrero JL, Cano-Valderrama O, Marcos A, et al. Umbilical hernia repair: may be photocopied noncommercially by physicians and other health care analysis after 934 procedures. Am Surg. 2015;81(9):899-903. professionals to share with patients. To purchase bulk reprints, call 312/464-0776. Berger RL, Li LT, Hicks SC, Liang MK. Suture vs preperitoneal polyprolene mesh for elective umbilical hernia repair. J Surg Res. 2014;192(2):426-431.

2248 JAMA June 6, 2017 Volume 317, Number 21 (Reprinted) jama.com

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