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Ask the doctor: What is causing the sharp pain in my belly button?

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An umbilical hernia is fairly common and can be caused by a wide range of factors

An umbilical hernia is fairly common and can be caused by a wide range of factors

An umbilical hernia is fairly common and can be caused by a wide range of factors

Q: I have noticed a strange pain in my belly button recently. It doesn’t bother me most of the time but sometimes I get a sharp pain. If I push on it, I also get the pain. What could it be?

Dr Grant replies:  It sounds like you may have developed a type of abdominal wall hernia known as an umbilical hernia. A hernia occurs when a part of an organ is displaced and protrudes through the wall of the cavity containing it. Most abdominal wall hernias contain a small portion of bowel protruding through the weak point in the abdominal wall.

Umbilical hernias are common and it is estimated they can be found in 25-50pc of individuals screened by physical exam or ultrasound scan. Up to 90pc of women at the end of their 40-week pregnancy will have a small umbilical hernia that tends to regress after the body recovers from the pregnancy. The clinical presentation of abdominal wall hernias can vary depending on their location and size. In patients with small hernias, they may have no symptoms at all. Varying degrees of pain/discomfort may present as the hernia enlarges or the contents of the hernia protrude through the defect. Another common presentation is the sensation of a bulge or easily reducible (easy to push back inside the abdomen) mass somewhere in the abdominal wall. Often by coughing or straining, a bulge at the site of the hernia can be felt.

In adults, umbilical hernias are most often acquired due to increased intra-abdominal pressure related to heavy lifting, weight gain, pregnancy, swelling or fluid in the abdomen brought on by liver/kidney/heart failure. Other types of hernias that can occur on the abdomen include epigastric, para-stomal (around a stoma site) hernias, or incisional hernias that can occur due to previous abdominal surgery and resultant scar formation.

When it comes to umbilical hernias, they often contain a portion of omentum which is a large ‘apron-like’ layer of fat tissue that rests on the surface of the abdomen just beneath the skin protecting the internal organs. Sometimes umbilical hernias contain peritoneal fat within the hernia sac rather than the bowel itself. This makes umbilical hernias less likely to cause an episode of acute bowel obstruction and lead to an acute ischaemia of the bowel that needs emergency surgery.

The diagnosis of an umbilical hernia can typically be made by taking a clinical history and performing a physical examination by palpating a soft mass either at, slightly above, slightly below, or to one side or another of the umbilicus. The abdominal wall is usually examined with the patient both standing and lying down.

On examination of patients with a normal healthy BMI, the hernia may be easy to identify, and the edges of the fascial defect can often be felt. Umbilical hernias can be small (<1 cm), medium (1-4 cm), or large (>4 cm). Larger umbilical hernias may be associated with skin erythema (redness), ulceration, or ischaemia. An ultrasound scan can help confirm the suspected diagnosis.

Surgical repair offers the best chance for definitive treatment of an umbilical hernia that is causing pain or a significant bulge. This can be performed by opening the abdomen or through laparoscopic camera ports into the abdomen. The decision to have surgery depends not only on the size of hernia but how symptomatic it is, the patient’s preference and other risk factors.

Dr Jennifer Grant is a GP with Beacon HealthCheck

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