The Belly Button: The Facts
Known as the navel, umbilicus and tummy button, the belly button is considered as a scar. It is what remains from both the placenta and umbilical cord, back from the days when mother provides all nutrients required by her offspring. The belly button marks the spot where the umbilical cord was once attached, lying at the level corresponding to the junction between the L3 and L4. It forms a depression on the skin of the abdomen, presenting as a concavity. [1, 2, 3, 4]
A photo of the navel or belly button, a scar and remnant of the placenta and umbilical cord.
Though rare, conditions and illnesses affecting the umbilicus can still occur. This article will discuss those different conditions, providing you a bird’s eye view on how to take care of the umbilicus, and what to expect if it is severed.
Belly Button Infections
Unlike the other parts of the body, it does not produce any form of protective substance, thus, the microorganisms present on the belly button represents those found on the entire body, and, consequently, it can harbor pathogenic flora, causing infections. 
Symptoms of Navel Infections
The belly button serves as an environment favorable for the growth of bacteria, and even yeast. Infection of these organisms would lead to manifestations: itching, pain, swelling, redness, bleeding and presence of discharge. This can also be associated with nausea, chills, and fever, if patients are with severe infections. [6, 7, 8]
Body Piercing as A Source of Belly Button Infections
One of the most common reasons for belly button infections is body, particularly navel, piercing. As of April 2013, 83% of the Americans had their earlobes pierced, while 14% have body piercings done on parts other than the ear lobes. In this fraction of American population, 72% are women, with navel as their most pierced part, accounting for 33%. Unfortunately, 31% of them have complications, 15.2% needed outpatient consultation, and 0.9% were even hospitalized for treatment. 
An image of an infected belly button brought about by navel piercing, presented with erythema, blood and pus.
Belly Button Infections Among Newborns
A persistent umbilical discharge among newborns can require prompt referral and treatment. Neonatal sepsis may present as a purulent, foul smelling umbilical discharge, and may require IV antibiotics to prevent complication like meningitis. A persistent clear or serous umbilical discharge, on the other hand, may be a manifestation of a patent vitello-intestinal duct, warranting exploration and complete excision. [10, 11]
An image showing newborn with an umbilicus having purulent foul smelling discharge indicative of sepsis.
Treating Belly Button Infections
Proper medical management of belly button infections entails the use of appropriate antibiotics. This can be administered with an anti-inflammatory medication or a pain reliever. Antisepsis technique can be done by washing with saline solution, diluted hydrogen peroxide and alcohol. [6, 7]
As for belly button piercings, healing process is quite long, usually three months to a year. Pain, redness, inflammation, crusting, and bleeding are signs of still an incompletely healed piercing. Avoidance of constant touching, as well as swimming in sea or pool water, must be done. 
Belly Button (Umbilical) Hernia
Aside from infections, the belly button can also have problems brought about by its structural weakness. Because of the thin muscular layers found at the area of its concavity, the umbilicus is also prone to the development of hernia. 
Umbilical hernia refers to the protrusion seen or felt around the area of the belly button. This develops when a part of the abdomen, either the lining, the intestine or the fluid, sticks out through the abdominal wall musculature. 
Types of Hernia
An hernia is deems reducible if it can be placed back to the abdominal cavity. If it cannot be reduced, it is termed as an incarcerated hernia. The latter type is at increased preponderance for strangulation, further decreasing, and even completely cutting off, blood circulation needed for tissue perfusion. [14, 17]
Causes of Umbilical Hernia
Common among infants, it usually occurs when there is incomplete closure of the abdominal muscles after birth. It is through these muscles the blood vessels pass, providing nutrients to the then developing fetus. Once the small opening remains, protrusion of a part of the abdomen occurs, hence, creating the bulging hernia. [13, 15, 16]
A photo of an infant with umbilical hernia, or protrusion in the belly button area
These can also be present among adults, particularly those who are pregnant, and with certain conditions such as obesity, ascites, and history of previous abdominal surgery. In these conditions, weakness of abdominal muscles may be present due to the enlarged womb, increased size of liver, and huge amount of adipose tissues, respectively. Hence, hernation of these abdominal contents thru the destabilized abdominal muscles may ensue. 
Symptoms of Herniation of the Belly Button
The bulge at the navel can be clearly visible when a person laughs, cries or coughs. Pain and tenderness is usually absent, yet, presence of which may indicate complications. [13, 16, 17]
How to Diagnose Umbilical Hernia
An umbilical hernia may be diagnosed by a thorough physical examination. Imaging studies and diagnostics, like abdominal xray and ultrasound, can confirm the presence of complications. 
Treatment of Navel Herniation
Among infants, umbilical hernia closes spontaneously, usually at 1 to 2 years of age. Repair, on the other hand, is indicated in all adults. Immediate surgery is warranted if there is presence of abdominal discoloration and pain, and the possibility of incarceration and especially strangulation, is at hand. [14, 16]
Physiologic Changes of the Belly Button During Pregnancy
During pregnancy, particularly in the second trimester, navel protrusion is usually noted. The pregnant woman might have an “innie” type of belly button but can acquire “outie” at the time of pregnancy. [1, 18]
A photo showing the popping out of the belly button at the second trimester of pregnancy.
Why Does the Belly Button Protrude At Pregnancy?
This “popped out” belly button is due to the rapidly enlargement of the uterus. The uterus pushes the abdomen anteriorly, and, in turn, the navel bulges and protrudes. 
What Happens Then?
This is just a temporary change and the belly button will gain its original shape after the pregnancy. It is an inevitable and harmless change at pregnancy. However, the belly button, at this time, has significant changes and is much prone to pain as there is vital skin stretching as the pregnancy progresses. Thus, avoidance of tightly waisted clothes and undergarments is recommended. 
- Ellis, H. (2006). Clinical Anatomy: Applied Anatomy for Students and Junior Doctors. New York: Wiley.
- Mshelbwala, P. et al. Persistent Umbilical Discharge in Infants and Children. Annals in Tropical Pediatrics. 2006 Jun; 26 (2): 133-5.
- Disorders of the Umbilicus in Infants and Children: A Consensus Statement of the Canadian Association of Pediatric Surgeons. Pediatric Child Health. 2001 July – Aug; 6 (6): 312-313.
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