Umbilical / Ventral / Epigastric Hernias
What is an umbilical hernia?
A hernia is defined as a weakness in the abdominal wall in which organs or fat may pop through.
An umbilical hernia is when this occurs in the belly button. This occurs through the defect in which you originally had your umbilical cord.
Up to 2% of the adult population have an umbilical hernia, and is more common in those who are overweight, had multiple pregnancies, or with liver cirrhosis.
What is a ventral hernia?
A ventral hernia is defined as any hernia that occurs on the front of your abdominal wall. An umbilical hernia is actually a type of ventral hernia. Ventral is the opposite of dorsal, like the fin on a dolphin on its back.
What is an epigastric hernia?
An epigastric hernia is a ventral hernia which is higher up on the abdomen between the belly button and the chest.
What causes an umbilical hernia?
Umbilical hernias develop through the defect left behind from the umbilical cord. Most times the hernia closes after childhood but can open back up for many reasons. This can occur from repeated stress and “wear and tear” on the abdominal wall. Often, we do not know exactly why a person developed a hernia.
Some of the common risk factors of getting a hernia are believed to include:
Chronic cough
Chronic constipation
Repeated pregnancies
Lifting heavy objects
How do I know if I have an umbilical hernia?
You may notice a bulge in your belly button that is soft and may be reducible. You may also have associated symptoms such as:
Belly button pain or soreness
Bulging which may disappear when lying down
Discomfort while straining or lifting
Burning or gurgling sensation near the belly button
When should I be concerned?
If you are having severe pain in your belly button, redness, or signs of a bowel obstruction such as inability to have a bowel movement associated with nausea or vomiting, you may need surgical evaluation immediately, as the contents of the hernia may be stuck.
How is an umbilical hernia diagnosed?
The most common way umbilical hernias are diagnosed is through a physical exam during a visit with a physician. You may not even have any symptoms but may have an obvious bulge. Sometimes if your hernia is large or more complex, you may need medical images to see it better such as a CT scan or ultrasound.
What are my options for repair?
Some small hernias without symptoms may be monitored. Your surgeon will recommend whether and when to repair your hernia based on its size, symptoms, your health, and the risk of complications.
The 3 main reasons a hernia should be fixed electively are:
To improve or cure discomfort in the belly button due to a hernia
To prevent progression of the hernia to a larger, more difficult to treat condition
To avoid the need for an emergency intervention and prevent risks of the intestines being trapped or ”choked” within the hernia
The goal in fixing an umbilical hernia is to reduce the hernia “sac”, or the lining of the belly which goes through the hernia defect, and then cover the opening to prevent fat or organs from going through the defect again. This can be fixed through an incision near your belly button (known as an open approach) or using minimally-invasive options–either laparoscopically or robotically–to create several small incisions on either your left or right flank.
How does an open umbilical hernia repair work?
An incision is made as a curve on one side of your belly button and then the hernia is located and found. The hernia sac, or the lining of your belly which goes through the hernia defect, is reduced and the defect is closed using long lasting sutures.
For smaller umbilical hernias, an open approach is typically preferred, as the incision can be shaped to the outline of the belly button and the repair can be done without the need for mesh.
How does a laparoscopic or robotic hernia repair work?
Three incisions are made on either the right or left side of your belly and your belly is filled with carbon dioxide gas. This allows your surgeons to work with a wide viewing area. A small flap is created from the lining of your belly and the hernia is found and reduced. Then the area is covered with a mesh and secured into place. The flap is closed and the gas is sucked out.
For larger hernias, laparoscopic or robotic surgery are typically the preferred means of repair over an open repair. While these approaches require additional high-level of expertise, they also provide the benefits of reduction in pain, faster functional recovery, better cosmetic results, and faster return to work and exercise.
What is the typical recovery?
Most umbilical hernia surgery is ambulatory, meaning you will be able to go home the same day as your surgery. You should have someone drive you home from the hospital or surgery center as you will still be under the effects of anesthesia.
Pain and soreness are common early in recovery and usually improve gradually. The amount and duration vary with your repair and the complexity of your case. Ice packs are key in minimizing inflammation and pain after surgery.
Pain management after umbilical hernia repair
Pain management may vary widely depending on your doctor. At Columbia, our typical pain control regimen includes Acetaminophen (Tylenol) and Ibuprofen (Motrin or Advil). We recommend that you take 650mg of Tylenol every 6 hours combined with 600mg of Ibuprofen 3 times daily after each meal (unless otherwise contraindicated). If you only have minimal pain, you do not need to take anything, however try not to fall behind your pain medicine if the pain persists. Also, please remember that the maximum amount of Tylenol within 24 hours is 4000mg (it might be less if you have liver problems) and 3200mg/24 hours of Ibuprofen (unless you have history of ulcers or kidney disease)
Post-surgery restrictions and recommendations
We encourage application of ice packs to the belly button area for the first 24-48 hours. This should be done for 10-15 min at least 6 times daily.
We recommend you move around at least once an hour while awake. Long walks are not discouraged but should not be done through pain. Ask your surgeon when you can resume jogging.
If you are having discomfort, please stop whatever activity you are doing and rest.
Your return to work depends on your operation, recovery, and job demands. Your surgeon will advise you when to return, especially if your work involves lifting or strenuous activity.
Other recommendations:
Follow the activity and lifting restrictions in your discharge instructions. Your surgeon will tailor them to the type of repair, case complexity, and your progress. Feeling less pain does not replace surgical clearance.
Restart all preoperative activities gradually, starting with the least intense.
Resume strenuous exercise, squats, and heavy lifting only when your surgeon clears you.
Discuss your return to sports involving sudden movements, such as tennis, golf, or soccer, with your surgeon.
Ask your surgeon when to restart yoga and Pilates.
Do not drive while taking opioid pain medicine or while your movement or alertness is impaired. Confirm with your surgeon that you can safely operate the vehicle and respond in an emergency.
Discuss flights and long-distance travel with your surgeon before making plans. Timing depends on your repair, health, mobility, and risk of complications.
Follow up after surgery
Your doctor typically will want to see you back for a 2-3 week follow up appointment. If everything is normal there may not be a need to return for an in-person visit.
Your body will be healing from any surgery for about a year (you may not realize this). Your return to your usual activities will depend on the repair and your progress; healing continues for months.
If you overdo it with physical activity and get a recurrence of some mild pain, reduce the inflammation with ice, Ibuprofen (if possible) and rest. If pain persists, please contact your doctor. If you are worried, they are worried–give them a call.
Complications after surgery
Complications of umbilical hernia repair are rare, and include but are not limited to:
Seromas (fluid build-up) where the hernia used to be
These appear/feel like a walnut or lime; they may feel like an old “hernia”
More common in large hernias
Usually cause no symptoms and resolve without interventions
May last up to 90 days
Wound infection, wound dehiscence (falling apart), abscess
The risk varies by procedure and individual health factors.
Bleeding
It is normal to have some bruising around the belly button after surgery
Internal bleeding can occur and requires prompt assessment.
Persistent or chronic pain
Hernia recurrence
When to call the office
Please call your doctor’s office if you are experiencing any of the following:
Fever >100.4 which is sustained on 2 different readings. Temperatures less than this are normal after surgery, as the body heats up as it is healing
Redness surrounding incisions, drainage from incisions
Bleeding from your incisions that will not stop with pinpoint pressure (hold pinpoint pressure for 10 minutes first).
Vomiting or persistent nausea which does not go away with time
Inability to urinate more than 6-8 hours after surgery
We typically recommend trying to stand in a hot shower for 15-20 minutes
Severe abdominal pain unrelieved by prescription medications or increasing in intensity
Large amount bruising or discoloration over incisions or flanks
Some bruising around the cuts is not abnormal
If you feel that you are getting worse each day instead of better
When to go to the ER
Please call 911 and go to the nearest ER for the following:
Chest pain
Fainting spells
Shortness of breath or difficulty breathing
Trouble speaking, weakness on one side of your body or both, changes in your vision
Please let your surgeon know once this has happened in case there is a surgical problem
Next Steps
If you’re dealing with an umbilical or ventral hernia, the Hernia Experts are here for you.
Our team is highly experienced in all the most advanced treatment options.
Our team focuses on careful surgical technique and individualized care to reduce the risk of persistent pain and support recovery.
Our pain-management approach emphasizes non-opioid options whenever appropriate, while tailoring treatment to your needs.
After your procedure, our surgeons and office staff will be with you every step of the way.
To set up a consultation, please call us at (212) 305-5947 or use our online appointment request form. We look forward to answering your questions and meeting your hernia care needs. Prefer to avoid mesh? Learn about mesh-free hernia repair.