Trapped bowel or loss of blood supply can be an emergency
Go to an Emergency Department Now If
- A navel or scar lump becomes suddenly severe, increasingly painful, firm or very tender.
- A previously reducible lump no longer goes back in or disappears when lying down.
- The skin becomes red, purple, dark, hot or rapidly more swollen.
- There is repeated vomiting, abdominal distension or inability to pass stool or gas.
- There is fever, faintness, confusion, cold sweating, very little urine or rapidly worsening illness.
- A baby or child has a painful tender navel swelling, vomiting, abdominal swelling, poor feeding or unusual drowsiness.
- A recent operation wound opens, drains pus or bowel-like fluid, or is associated with severe pain or systemic illness.
Do not repeatedly force a painful lump inward or wait for a routine scan. Urgent examination, resuscitation, imaging or surgery may be needed.
What Is an Abdominal-Wall Hernia?
The abdominal wall has several layers. A hernia forms when abdominal fat, a fold of fatty tissue, bowel or another structure protrudes through a gap in the strong fascial layer. The skin may remain completely intact.
A hernia can be small even when the visible bulge looks large, because the sac beneath the skin may be wider than the opening. Conversely, a narrow opening can trap tissue. Size alone does not determine urgency.
Umbilical, Paraumbilical and Incisional Hernias
How Can These Hernias Feel?
A visible bulge
The swelling may increase while standing, coughing, lifting or straining and flatten while lying down.
Dragging or pressure
Some patients notice heaviness, pulling or a dull ache later in the day.
Pain with activity
Bending, exercise, coughing or physical work may reproduce discomfort.
A scar changing shape
An incisional hernia can make part of an old scar widen, bulge or become asymmetrical.
Intermittent symptoms
A small hernia may appear only under pressure and be absent during a relaxed examination.
No symptoms
Some defects are found during examination or imaging performed for another reason.
Discomfort without a true fascial defect can arise from scar tissue, abdominal muscles, nerves, rectus diastasis, a fluid collection or another abdominal condition.
What Do Reducible, Incarcerated and Strangulated Mean?
Why Does an Incisional Hernia Develop?
An abdominal incision must regain strength while it heals. An incisional hernia can develop when the fascial layer does not heal with lasting strength or later stretches under repeated pressure.
- Wound infection, wound separation or an emergency operation can impair early healing.
- Smoking, poor nutrition, severe obesity or conditions affecting connective tissue can reduce tissue strength.
- A longstanding cough, repeated straining or ascites can increase pressure on the repair.
- Multiple operations through the same site or a previous hernia repair can alter the abdominal wall.
- Some hernias occur despite careful closure and appropriate recovery; they are not proof that a patient or surgeon did something wrong.
Is Rectus Diastasis a Hernia?
Rectus diastasis is widening of the tissue between the two vertical abdominal muscles, often after pregnancy or major weight change. It can create a long midline ridge when sitting up, but the fascial layer is stretched rather than forming a true hole.
Diastasis and Hernia Can Occur Together
A small umbilical or epigastric defect may sit within a wider diastasis. The examination and imaging should describe both because exercise, simple hernia repair and complex abdominal-wall reconstruction address different problems.
How Are These Hernias Diagnosed?
- Map the historyThe clinician asks when the lump appeared, what operation preceded it, whether it reduces and which activities provoke symptoms.
- Examine standingThe navel and entire scar are inspected and felt while standing, coughing or gently straining.
- Examine lying downReducibility, tenderness, defect location, multiple openings and any skin problem are assessed.
- Check the whole abdomenBowel obstruction, another hernia, rectus diastasis, masses and previous scar patterns are considered.
- Select imagingUltrasound or CT may confirm an uncertain defect, map a larger hernia or investigate complications.
- Assess operative fitnessSymptoms, general health, wound-healing factors and the likely complexity of repair guide planning.
A clear small reducible umbilical hernia may be diagnosed clinically. Complex incisional hernias often need cross-sectional imaging before definitive planning.
Ultrasound, CT or MRI?
What Might a Scan Report Say?
Childhood Umbilical Hernia Is Different
In babies, the opening left after the umbilical cord passes through may take time to close. The bulge often becomes prominent while crying but is usually painless and reducible. Many uncomplicated childhood umbilical hernias close naturally during the preschool years.
- Routine early surgery is not automatically required for an otherwise well child.
- Persistence with increasing age, a very large defect, symptoms or another clinical concern may lead to planned paediatric surgical review.
- A painful irreducible swelling, vomiting or an unwell child needs urgent assessment.
- Coins, tight bandages, adhesive strapping and forceful pressure do not close the defect and can injure the skin.
An adult umbilical hernia generally does not close by itself and should not be managed using a childhood timetable.
Pregnancy, After Childbirth and Future Plans
Pregnancy can stretch the abdominal wall and make an umbilical hernia or rectus diastasis more noticeable. A stable, minimally symptomatic hernia can often be assessed without immediate surgery during pregnancy, while trapping or obstruction remains an emergency.
For planned repair after childbirth, symptom severity, recovery, future pregnancy plans, defect size and diastasis should be discussed. Another pregnancy can place renewed stress on any repair, but severe symptoms or complications may make delay inappropriate.
Does Every Hernia Need Immediate Repair?
How Are Umbilical and Incisional Hernias Repaired?
Where Can Mesh Be Placed?
The safest plane depends on the defect, adhesions, contamination, earlier mesh, available expertise and the planned approach. “Mesh repair” is not one single operation.
Preparing for Planned Repair
- Bring previous operation notes, discharge summaries, scan images and details of any earlier mesh.
- Provide a current prescription list, allergies and an accurate history of heart, lung, kidney, diabetic, bleeding and clotting conditions.
- Obtain an individual interruption and restart plan for treatment that affects bleeding; never alter it independently.
- Follow the hospital's instructions about fasting, bathing, transport and help at home.
- Smoking cessation, nutrition, safe weight optimisation, cough assessment and bowel regularity can improve wound healing when time permits.
- Discuss work, caregiving and lifting demands before surgery so recovery planning is realistic.
Preoperative optimisation is part of treatment, not a judgment about the patient. Emergency obstruction or strangulation may require surgery before every risk factor can be improved.
Possible Risks of Repair
- Bleeding, bruising, haematoma, wound infection or separation.
- Seroma or a temporary firm ridge that can resemble a recurrent bulge.
- Persistent pain, numbness, altered sensation or abdominal-wall stiffness.
- Hernia recurrence, bulging or development of another defect.
- Injury to bowel, blood vessels, bladder or another nearby structure.
- Temporary bowel slowing, obstruction from adhesions or need for bowel surgery in a complicated case.
- Mesh infection, exposure, migration, fistula or another mesh-related problem—uncommon but potentially requiring further treatment.
- Anaesthetic, chest, cardiovascular or clotting complications according to individual risk.
Recovery After Hernia Repair
Living Safely While Awaiting Review
- Remain gently active within comfort; complete bed rest does not close the defect.
- Avoid activities that consistently provoke significant pain or make the bulge difficult to reduce.
- Support bowel regularity with appropriate fluids, fibre and activity when medically suitable, and obtain help for persistent cough or constipation.
- A binder can support comfort only when correctly fitted and clinically appropriate; it does not heal the hernia.
- Know the change from a familiar reducible lump to pain, trapping, vomiting, distension or skin discolouration.
Common Myths
Frequently Asked Questions
Can an umbilical hernia come and go?
Yes. A reducible bulge may become visible while standing or straining and flatten when lying down.
Is a paraumbilical hernia different?
It lies immediately beside the navel rather than directly through the umbilical ring, but adult assessment and repair principles often overlap.
Can an incisional hernia appear years after surgery?
Yes. The deeper scar can gradually stretch and become apparent long after the skin has healed.
Can keyhole surgery cause an incisional hernia?
Yes. A port-site hernia can develop through an instrument opening, even when the skin scar is small.
Is rectus diastasis dangerous?
Diastasis is not bowel protruding through a hole, but it can affect function or appearance and may coexist with a true hernia.
Does a child’s umbilical hernia need immediate surgery?
Usually not when painless and reducible. Many close naturally, while persistence, symptoms or another concern prompts paediatric surgical review.
Should I tape a coin over my baby’s navel?
No. Coins, tight wrapping and adhesive strapping do not close the opening and can irritate or injure the skin.
Do I need ultrasound?
Not always. Ultrasound is useful for uncertain superficial defects, while CT often maps larger or complex incisional hernias more completely.
What does fat-containing hernia mean?
Abdominal fat lies within the hernia sac. It may be symptomatic, reducible or trapped and is interpreted with the clinical findings.
What does loss of domain mean?
A substantial part of the abdominal contents has remained within a large hernia sac, making return and wall closure more complex.
Will mesh be required?
Most adult symptomatic umbilical and incisional repairs use mesh to reduce recurrence, but selected small defects or special circumstances may use another technique.
Can the hernia return after repair?
Yes. Modern repair lowers but does not eliminate recurrence, particularly when the defect is large or wound-healing risks remain.
Is a lump after repair always recurrence?
No. Swelling, scar thickening or a seroma can resemble a bulge. New or persistent findings should be examined.
How long does recovery take?
Light activity often resumes early, but return to heavy work depends on the size, approach, complexity, complications and individual recovery.
When should a complex hernia be referred?
Very large, recurrent, contaminated or loss-of-domain defects and cases requiring component separation benefit from a specialised abdominal-wall centre.