Dear Doctor:

I am a 64-year-old male in good health, although I have a bit of a gut in the middle. My issue is that I have developed an umbilical hernia that looks like a large “outie.” It is not very attractive, but it is not causing any pain or discomfort. What course of action should I take?

Dear Reader: Umbilical hernias, or so-called “belly-button hernias,” are quite common. They occur because of tissue weakness at the umbilical ring. The weakness allows the contents within the abdomen to bulge into the opening, thus making an “innie” appear like an “outie.” In children with umbilical hernias, the hernia develops because of incomplete closure of the belly-button (umbilicus) at birth. In adults, umbilical hernias develop because of increased pressure within the abdomen that stretches and weakens the tissue (fascia) at the umbilicus. Increased pressure in the abdomen can be caused by obesity, pregnancy or fluid in the belly from diseases such cirrhosis or ovarian cancer.

Umbilical hernias are three times more common in women than in men. The material that typically bulges within a hernia is fat from the abdomen and the lining of the abdominal cavity. In the majority of people, the herniation doesn’t hurt. However, when the lining of the abdominal cavity (the omentum) becomes stuck within a hernia, the area can become painful. Even worse is when the small intestine becomes stuck. Called an incarcerated hernia, this compression leads to a loss of blood flow to the intestine, which can cause severe pain, altered bowel movements and possible death of the bowel tissue. The omentum and the intestine are more likely to become entrapped in men. Women more commonly have umbilical hernias that are reducible, meaning the material that pushes into the hernia can easily be moved back into the abdomen.

A small umbilical hernia without symptoms doesn’t require treatment. That changes if a hernia causes pain or is not reducible. For a small, symptomatic hernia, a surgeon cuts into the skin and locates the hernia sac. He or she then removes the sac or pushes it back into the abdomen; sutures the surrounding fascial layers together; and thus closes the area of weakness. With a larger hernia, a surgeon will have difficulty bringing together the surrounding fascial layers. This is when he or she will place a mesh over the defect and attach the mesh to the surrounding fascial layers. Unless the hernia is very large (more than 9 centimeters in size), a surgically repaired hernia is unlikely to recur or cause pain.

Because of the lack of symptoms from your hernia, you’re unlikely to need surgical treatment. But you should be on the alert for pain in the umbilical area and for difficulty pushing the hernia back in to the abdomen. Either problem is a sign that surgery might be needed.