In this guide14 sections
- Key Points
- What Is a Hernia?
- What Is an Umbilical Hernia?
- When Should You Worry About an Umbilical Hernia?
- What Causes an Umbilical Hernia in Adults?
- Umbilical Hernia After Pregnancy
- Is It Diastasis Recti or a Hernia?
- Does an Umbilical Hernia Need Surgery?
- How Is an Umbilical Hernia Repaired?
- Can an Umbilical Hernia Be Fixed During a Tummy Tuck?
- Hernia Repair and Tummy Tuck Before and After
- Frequently Asked Questions
- References
- Talk to a Surgeon About a Tummy Tuck
Key Points
- An umbilical hernia is a bulge at the belly button where fat, and sometimes bowel, pushes through a weak spot in the abdominal wall.
- In adults it is linked with pregnancy, weight gain, a long-term cough and heavy lifting. It often appears alongside diastasis recti, the stretching apart of the stomach muscles after pregnancy.
- A hernia that becomes hard, very painful or cannot be pushed back in needs urgent medical help, as the trapped tissue can lose its blood supply.
- Most adult umbilical hernias are repaired by a general surgeon, often on the NHS. International guidelines recommend a mesh repair for most hernias of 1 cm or more.
- At Centre for Surgery, a small umbilical or midline hernia can be repaired during a tummy tuck. We do not offer standalone hernia surgery, and large or complex hernias are referred to a general surgeon.
- If you are planning more children, it is usually better to wait before an elective repair or a tummy tuck.
A lump at the belly button that gets bigger when you cough, strain or stand up is very often an umbilical hernia. Many women first notice one during or after pregnancy, sometimes at the same time as a soft dome down the middle of the tummy. This guide explains what an umbilical hernia is, how to tell it apart from diastasis recti, when to get help quickly, how hernias are usually repaired, and when a small hernia can be fixed during a tummy tuck.
For general hernia information, the NHS hernia guide ↗ is a good place to start. If you already know you want a tummy tuck and have a hernia, our guide to combining a tummy tuck and hernia repair covers the combined operation in full.
What Is a Hernia?
A hernia happens when part of an organ or fatty tissue pushes through a weak spot in the muscle or tissue wall that normally holds it in place. The most common types are inguinal hernias in the groin, umbilical hernias at the belly button, epigastric hernias between the belly button and the breastbone, and incisional hernias through an old surgical scar. The NHS ↗ describes the main types and their symptoms.
This guide focuses on umbilical and small midline hernias, as these are the ones most often found in people considering tummy surgery.
What Is an Umbilical Hernia?
An umbilical hernia forms at the belly button, where the abdominal wall is naturally a little thinner. Babies are often born with one that closes by itself. In adults, the opening usually develops later in life, when pressure inside the tummy stretches the tissue around the belly button.
The bulge is usually fat from inside the abdomen. In larger hernias, a loop of bowel can push through too. The size of the hernia is described by the width of the hole in the muscle layer, not the size of the lump you can see.
What does an umbilical hernia look like in adults?
Most adults notice:
- A soft lump in or just next to the belly button
- A lump that gets bigger when you cough, laugh, strain or stand, and smaller when you lie down
- A belly button that has changed shape, for example from an “innie” to an “outie”
- An ache or dragging feeling around the belly button, especially after exercise or a long day on your feet
Some hernias cause no symptoms at all. A change in the shape of the belly button can also happen without a hernia, which our guide to outie to innie belly button surgery explains.
When Should You Worry About an Umbilical Hernia?
Go to A&E or call 999 if your hernia:
- Becomes suddenly painful, tender or firm
- Can no longer be pushed back in
- Turns red, purple or dark
- Comes with being sick, a swollen tummy, or not being able to pass wind or poo
These can be signs that the hernia is trapped (incarcerated) or that its blood supply has been cut off (strangulated), which needs emergency surgery. The NHS umbilical hernia page ↗ lists the urgent signs.
For a hernia that is not causing these problems, see your GP. They can confirm the diagnosis, usually by examining you, and may arrange an ultrasound scan.
What Causes an Umbilical Hernia in Adults?
Anything that raises the pressure inside the tummy over a long period can stretch the tissue at the belly button. Common causes include:
- Pregnancy, especially more than one, twins or a large baby
- Being overweight
- A long-term cough or straining on the toilet
- Heavy lifting
- Fluid in the abdomen
- Previous surgery near the belly button, such as keyhole surgery
Umbilical Hernia After Pregnancy
During pregnancy, the growing womb pushes the abdominal wall outwards and the tissue at the belly button stretches. A small bulge may appear in late pregnancy or be noticed in the months after birth.
True umbilical hernias during pregnancy are less common than many women think. A Danish study of 20,714 pregnant women found that a primary hernia of the abdominal wall was recorded in fewer than 1 in 1,000, none needed surgery during pregnancy, and all had an uncomplicated birth[3]. A 2018 systematic review in the American Journal of Surgery ↗ concluded that umbilical hernia in pregnancy rarely needs repair before or after birth, and that elective repair is best postponed until after your last pregnancy if possible[4].
Waiting matters, as pregnancy after a repair can bring the hernia back. In a nationwide Danish cohort of 224 women who became pregnant after an umbilical or epigastric hernia repair, the hernia came back in 16.3% after mesh repair and 10.9% after stitch repair[5].
Is It Diastasis Recti or a Hernia?
Diastasis recti and umbilical hernias are often confused, and many women have both.
Diastasis recti is a widening of the gap between the two vertical “six-pack” muscles. The connective tissue between them (the linea alba) stretches, but there is no hole. It shows as a ridge or dome down the middle of the tummy when you sit up, and it is common after pregnancy.
An umbilical hernia is an actual hole in the abdominal wall at the belly button, which fat or bowel can push through. It shows as a lump at a single point and may be tender.
Both conditions are caused by the same pressure on the abdominal wall, so they often appear together. In a 2024 series of 20 patients who had diastasis and a hernia repaired in the same operation, most of the hernias were at the belly button, and some patients had the repair as part of a tummy tuck. All the operations were completed successfully, and a fluid collection (seroma) was the most common problem afterwards[6]. An examination, sometimes with an ultrasound scan, tells the two apart. Our diastasis recti guide covers the muscle gap in more detail.
What is a lump above my belly button?
A small lump in the midline between the belly button and the breastbone is often an epigastric hernia, a small hole in the linea alba with fat pushing through. It behaves much like an umbilical hernia and is treated in the same way. A soft ridge running the length of the tummy, with no single lump, is more likely to be diastasis recti.
Does an Umbilical Hernia Need Surgery?
An umbilical hernia in an adult does not go away by itself. Surgery is the only way to close it, but not every hernia needs an operation straight away. If yours is small, causes no symptoms and pushes back easily, your GP or surgeon may suggest keeping an eye on it, especially if you are planning another pregnancy.
Repair is usually recommended if the hernia is painful, getting bigger, hard to push back, or has ever become trapped.
A hernia belt or support garment can make a hernia more comfortable day to day, but it will not close the hole.
How Is an Umbilical Hernia Repaired?
Most umbilical hernia repairs in adults are carried out by a general surgeon, often as a day case on the NHS. The NHS ↗ explains how to get a referral and what the operation involves.
The surgeon pushes the bulging tissue back inside and closes the hole, either with stitches alone or with a piece of mesh to reinforce it. The European and Americas Hernia Societies’ 2020 guidelines in the British Journal of Surgery ↗ recommend mesh for most umbilical and epigastric hernias to lower the chance of the hernia coming back, with stitches alone an option for very small defects under 1 cm[1].
That advice is based partly on a 2018 randomised trial of 300 adults in The Lancet ↗. For hernias of 1 to 4 cm, the hernia came back in 4% of people after mesh repair and 12% after stitch repair over about two years[2].
Most people go home the same day and return to light activity within a couple of weeks, avoiding heavy lifting for longer. Your surgeon will give you advice for your own repair.
Can an Umbilical Hernia Be Fixed During a Tummy Tuck?
Yes, if the hernia is small. During a full tummy tuck, the surgeon lifts the skin and fat away from the abdominal wall and frees the belly button. That gives direct access to the area around the belly button and the midline, so a small umbilical or epigastric hernia can be closed in the same operation as any muscle repair for diastasis recti.
At Centre for Surgery:
- Small umbilical and midline hernias can be repaired during a tummy tuck.
- Large or complex hernias, recurrent hernias and hernias through an old scar are referred to a general surgeon for repair first.
- We do not offer hernia surgery on its own. If you have a hernia but do not want a tummy tuck, your GP is the best first step.
A tummy tuck is an elective cosmetic operation. A hernia is a reason to check that the abdominal wall is sound, not a reason on its own to have a tummy tuck. Your surgeon will examine you, and may arrange a scan, to measure the hernia and plan the safest approach.
In a mini tummy tuck the belly button is not usually freed, so access to an umbilical hernia is more limited. Your surgeon will tell you whether a mini tummy tuck or a full tummy tuck suits you. Tummy tucks at Centre for Surgery are performed under total intravenous anaesthesia (TIVA).
The details of the combined operation, its benefits, risks and recovery are covered in our guide to combining a tummy tuck and hernia repair. Our tummy tuck with muscle repair guide explains how diastasis recti is tightened at the same time.
Hernia Repair and Tummy Tuck Before and After
Real Centre for Surgery patients before and after a tummy tuck, including tummy tuck with muscle repair. Results vary from person to person.
Frequently Asked Questions
Do umbilical hernias go away after pregnancy?
A bulge at the belly button sometimes becomes less noticeable in the months after birth as the tummy recovers, but a true umbilical hernia in an adult does not close by itself. If a small hernia is not causing symptoms, it is usually reasonable to wait until you have finished having children before having it repaired. See your GP if it is painful or getting bigger.
Is an umbilical hernia serious?
Most adult umbilical hernias are not dangerous, but they can occasionally become trapped and lose their blood supply. Get urgent help if the hernia becomes hard, very painful, discoloured or cannot be pushed back in, or if you are being sick or cannot pass wind.
When does an umbilical hernia need surgery?
Repair is usually advised if the hernia is painful, growing, difficult to push back or has ever become trapped. A small hernia with no symptoms can often be watched. Your GP or a general surgeon can advise on the right timing for you.
Can a postpartum umbilical hernia be treated without surgery?
Exercises, a support garment or a hernia belt can make a hernia more comfortable, and core rehabilitation can help diastasis recti. None of these closes the hole in the abdominal wall, so surgery is the only way to repair an umbilical hernia.
Can I have a tummy tuck if I have an umbilical hernia?
Often, yes. At Centre for Surgery, a small umbilical or midline hernia can be repaired during a tummy tuck. Large or complex hernias are referred to a general surgeon to be repaired first. Our guide to combining a tummy tuck and hernia repair has more detail.
References
- Henriksen NA, Montgomery A, Kaufmann R, et al. Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society. Br J Surg. 2020;107(3):171-190. doi:10.1002/bjs.11489 ↗
- Kaufmann R, Halm JA, Eker HH, et al. Mesh versus suture repair of umbilical hernia in adults: a randomised, double-blind, controlled, multicentre trial. Lancet. 2018;391(10123):860-869. doi:10.1016/S0140-6736(18)30298-8 ↗
- Oma E, Bay-Nielsen M, Jensen KK, et al. Primary ventral or groin hernia in pregnancy: a cohort study of 20,714 women. Hernia. 2017;21(3):335-339. doi:10.1007/s10029-017-1618-7 ↗
- Oma E, Henriksen NA, Jensen KK. Ventral hernia and pregnancy: a systematic review. Am J Surg. 2019;217(1):163-168. doi:10.1016/j.amjsurg.2018.04.016 ↗
- Oma E, Jensen KK, Jorgensen LN. Recurrent umbilical or epigastric hernia during and after pregnancy: a nationwide cohort study. Surgery. 2016;159(6):1677-1683. doi:10.1016/j.surg.2015.12.025 ↗
- Guerron AD, Restrepo-Rodas G, Barajas-Gamboa JS, et al. Diastasis recti with concomitant ventral hernia repair: an initial experience in the United Arab Emirates population. J Laparoendosc Adv Surg Tech A. 2024;34(10):904-909. doi:10.1089/lap.2024.0216 ↗
Talk to a Surgeon About a Tummy Tuck
If you have a small umbilical hernia or diastasis recti and are considering a tummy tuck, you can book a consultation at our Baker Street clinic by calling 020 7993 4849 or using the form below. Our tummy tuck recovery guide and tummy tuck cost guide explain what to expect.
