An umbilical hernia and an incisional hernia are among the most common abdominal wall hernias. They look similar — a bulge that appears when you strain or lift — but they arise differently and are managed differently. This article explains how they are told apart, when watchful waiting is reasonable, and when it is not.
What each one actually is
Both are hernias of the anterior abdominal wall: there is a defect in the muscle and fascia through which fat or bowel protrudes.
- Umbilical hernia: the defect lies at the navel, a naturally weak point where the umbilical vessels once passed. It appears more often after pregnancy, significant weight gain, chronic cough or ascites.
- Incisional hernia: it develops in the scar of a previous operation, where the wall did not heal with enough strength. It may appear months or even years later.
Risk factors for incisional hernia include wound infection, smoking, diabetes, obesity, steroid use and repeated surgery through the same incision.
Diastasis recti — the separation of the rectus muscles, common after pregnancy — is not a hernia. There is no defect with a sac, only stretching of the tissue between the muscles. It often coexists with an umbilical hernia, however, and that changes the surgical plan. Clinical examination, and often an ultrasound or CT scan, are therefore essential before any decision.
Symptoms and warning signs
Most hernias present as a painless or mildly uncomfortable bulge that:
- enlarges on standing, coughing or lifting
- reduces or disappears when lying down
- causes a dragging or heavy sensation by the end of the day
Size is not a measure of severity. In fact, small hernias with a narrow neck carry a higher risk of strangulation, because what comes out does not easily go back.
If the hernia suddenly becomes firm, painful and irreducible, especially with nausea, vomiting or absence of flatus, this suggests strangulation. It is an emergency and requires immediate attendance at an emergency department, not an outpatient appointment.
Is surgery always necessary?
Not necessarily, but the reasoning differs between the two.
For a small, asymptomatic umbilical hernia in a patient without aggravating factors, observation is a reasonable option. The hernia will not resolve on its own, however, and tends to enlarge over time.
For an incisional hernia, repair is usually advised earlier, because the defect widens progressively and the operation becomes technically harder with time. Where symptoms are present, or the patient does physical work, waiting has less to offer.
Before a planned repair it is worth optimising modifiable factors: stopping smoking, controlling blood sugar and losing weight where feasible. These are not formalities — they measurably reduce the risk of recurrence and complications.
Repair techniques
The aim is to close the defect without tension and reinforce it with a synthetic mesh placed in the correct anatomical plane. Suture repair without mesh is reserved today for very small defects, as recurrence rates are otherwise high.
- Open mesh repair: a small incision over the hernia. Mainly suited to small umbilical hernias.
- Laparoscopic repair: through three small ports, with the mesh placed from inside the abdominal wall. Less pain and faster mobilisation.
- Robotic repair: allows precise endoscopic closure of the defect and placement of the mesh outside the peritoneal cavity, avoiding contact with bowel.
- eTEP-RS technique: an extraperitoneal approach creating a space behind the rectus muscles. It allows a large mesh and simultaneous correction of diastasis, with no contact with the viscera.
No single technique is superior in every case. The choice depends on the size and site of the defect, previous operations, coexisting diastasis and the patient's own characteristics.
Recovery
For a small umbilical hernia the procedure is usually day-case or involves a single overnight stay. For larger incisional hernias the stay is typically two to four days.
- First days: walking from the same day; pain is controlled with simple analgesia.
- 1–2 weeks: return to desk work and light activity.
- 4–6 weeks: gradual return to exercise and lifting, guided by your surgeon.
A sensation of tightness or of a "foreign body" during the first weeks is expected and settles as the mesh integrates. Persistent or increasing pain, redness, fever or wound discharge should always be reported.
Detailed information for each condition is available on the pages for umbilical hernia, incisional hernia and diastasis recti.
Can an umbilical hernia close on its own?
Not in adults. In infants most umbilical hernias close spontaneously by the age of 4–5 years, but in adults the defect does not heal by itself and usually widens gradually.
Is it dangerous to wait?
It depends. A small, asymptomatic hernia may be observed. The risk is strangulation, which is relatively uncommon but is an emergency. If the hernia is painful, enlarging or no longer reducible, assessment should not be postponed.
Is mesh safe? Will I feel it?
Modern synthetic meshes have been used for decades and integrate into the tissues. Most patients are unaware of it after the first few months. The type and position of mesh are chosen according to the technique used.
Will my navel look different?
In most repairs the navel is preserved and the cosmetic result is very good. In large or recurrent hernias reconstruction may be required; this is always discussed before surgery.
If I also have diastasis recti, can it be corrected at the same time?
Often yes. When significant diastasis coexists with an umbilical hernia, addressing both with techniques such as eTEP-RS restores the defect and the function of the abdominal wall. The indication is functional rather than cosmetic and is assessed individually.