Umbilical hernia repair in adults: what to expect

Before birth the abdominal wall has a small opening where the umbilical cord passed. In some adults the tissue around that area gives way, allowing fat or a piece of bowel to push forward under the skin. The result is a soft lump at or beside the navel that may be more obvious when coughing, straining or standing.

In babies and young children umbilical hernias frequently close on their own. In adults that is much less likely, which is the main reason the advice differs from the paediatric picture. This page covers adults only.

The NHS states that surgery is usually recommended for adults because the hernia is unlikely to get better by itself. It also notes that some people, for example those with serious liver disease, may be too unwell for an operation, and in such cases the risks have to be weighed individually.

A very small hernia with no discomfort can sometimes be monitored. Underlying liver disease can change the timing and the risks, so your doctors will tailor the advice. Your surgeon may also ask you to lose weight or stop smoking before a planned repair, as these affect healing.

• Repair is more urgent if the lump becomes tender, discoloured or fixed.

• Women who are planning a pregnancy should say so, since it can affect the choice of repair.

• Truss belts or support garments are not a cure; they only press on the area.

Pre-assessment checks fitness for anaesthesia, medicines and any previous abdominal surgery. Expect fasting instructions for the day, and a request not to smoke. Many units ask you to arrive with someone who can take you home. The Guy's and St Thomas' hernia guidance mentions a 24-hour escort and avoiding smoking for at least 4 weeks beforehand.

The operation is normally a day case. Depending on the unit, anaesthesia may be general, or regional or local with sedation for a small defect, and your anaesthetist will explain which is proposed.

The NHS lists four steps: a cut near the hernia, pushing the contents back into place, closing the gap in the muscle with stitches (with a mesh in some larger hernias), then closing the skin with stitches or clips. A small curved cut under the navel often hides the scar.

Mesh lowers the chance of the hernia returning for larger defects, but it adds its own small risks, such as infection or a lump of scar tissue around it. A very small defect may be closed by stitching alone. The choice depends on the size of the hole, your weight and your surgeon's usual practice.

The NHS lists infection, blood clots, lasting pain and recurrence of the hernia as possible complications. Bruising and a firm area under the scar are common and usually settle. A Plymouth hospital leaflet on hernia repair also mentions sharp twinges from internal stitches as you become more active.

The pages consulted do not give reliable recurrence figures for umbilical repair specifically, so none are quoted. Ask your surgeon about your own risk, which tends to be higher with a larger defect, smoking and a higher body weight.

Gentle walking is encouraged. The NHS says full recovery usually takes up to 4 to 6 weeks and advises staying off work for at least 1 to 2 weeks, or up to 6 if the job involves heavy lifting. The Plymouth leaflet gives driving as 7 to 10 days and heavy lifting at 6 weeks.

Call 999 for very severe abdominal pain that does not ease, repeated vomiting, a swelling with discoloured skin, or being unable to open your bowels or pass wind, since these may indicate a trapped or strangulated hernia, which the NHS says needs emergency surgery. For a red, hot or leaking wound use NHS 111 or your hospital's contact number.

The surgery itself does not differ, but the route to it does. NHS referral may include weight or smoking thresholds in some areas, and timing follows local waiting lists. Private care usually allows quicker scheduling and a choice of surgeon; check what happens, and what is charged, if a complication needs another visit.

• Is my hernia small enough for stitches alone, or do you recommend mesh?

• Should I lose weight or stop smoking before the operation?

• Will the scar sit in the navel?

• What activity limits apply for the first six weeks?