Expert Advice -- Outey belly buttons

My daughter Katelyn is two years and four months of age and has had a slightly protruding navel which our family doctor has assessed as being an umbilical hernia. She has had this since about six months of age. We are being told to see a surgeon, but would like to know as much about this as possible, and the likelihood of non-surgical remedies.

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

An umbilical hernia is often the cause of an "outey" belly button. As the abdomen of the fetus is being formed, there is a hole where the umbilical cord is located. This hole is there for a very good reason. Early in the pregnancy, the intestines actually develop mostly outside the body. Then, before the first trimester ends, the intestines migrate back inside the body through this hole in the abdomen. As the pregnancy continues, the hole gets smaller as the muscles of the abdomen grow and meet in the middle. However, sometimes a small part of the intestines poke through this small hole preventing the muscles to meet. What is left is a small circular defect in the abdominal wall that can allow fluid and possibly a small area of the intestines to come through giving the belly button a protrusion.

It is estimated that between 10 and 30 percent of children are born with this hernia. However, most babies with this outey belly button no longer have it by the time they are one year of age. This is primarily due to the fact that the abdominal muscles continue to grow and come together over the early years of childhood. The doctor determines the size of the hernia by sticking a finger down into the belly button and feeling the edges of it. Umbilical hernias in which the diameter of the hole is less than two centimeters (just under one inch) are likely to close on their own usually by the time the child reaches age four.

Problems associated with umbilical hernias are quite uncommon. Those children with hernias large enough (usually bigger than one inch in diameter) to allow intestines to easily pass may on occasion have some abdominal discomfort which is relieved by simply pushing them back through the hole. Very rarely does a child have an episode in which the intestines cannot be pushed back through, but when it occurs, it is an emergency.

Because most umbilical hernias close by themselves by age four, surgically repairing them is usually deferred at least until then. In fact, there are reports of these hernias closing as late as age ten years. On the other hand, those that are greater than an inch in diameter are much less likely to completely close, so many surgeons will often recommend having these surgically closed earlier rather than later. Your daughter is still quite young, and if she has a relatively small hernia, the likelihood of it closing over the next couple of years is pretty good. Unfortunately, when a hernia does not close on its own, there are no other effective ways to get it to close other than surgery.

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