Belly Button Pain

Belly Button and Location

Belly button is also commonly known as the navel, umbilicus or tummy button. It is the little scar located in the centre of the abdomen from where the umbilical cord during your fetus stage connected you to the inside of your mother’s womb. If the abdomen is divided into 9 quadrants with the help of two vertical and two horizontal lines, then the location of the umbilicus can be described as the central most that is the umbilical region just below the epigastrium. The organs just below it are the small intestines and the muscle walls of the abdomen. The division of the abdomen into sections facilitates the study and description of the organs just below them.

CAUSES OF GENERALIZED ABDOMEN PAIN

There can be some acute and chronic medical conditions which may give rise to abdomen pain and they are:

Acute Causes

• The commonest cause of acute pain in abdomen is gas formation due to eating high fibre foods or pulses. It can cause excessive wind formation which can give rise to crampy pain.
• Acute intermittent porphyria has symptoms of sharp abdominal pain along with muscle weakness and numbness of limbs. It is a genetic disorder.
• Lead poisoning can present with sudden pain in abdomen, vomiting and convulsions.
• Intestinal obstruction which may be caused due to blockage or twisting of the intestine presents with severe constipation, abdominal pain and vomiting. A similar situation can occur in absence of a blockage that is post surgical ileus.
• Food poisoning or acute gastroenteritis shows up as severe bouts of diarrhoea and vomiting along with pain in the abdomen.
• Mesentric venous thrombosis is the blockage of the vein that drains the intestines. It can lead to severe pain in abdomen after eating and bleeding in the stools.
• The abdominal aorta may rupture or get blocked with an aneurysm. This presents with abdominal pain that is severe and located in the centre of the abdomen, chest or lower back.
• Diabetic ketoacidosis
• Uremia

(2) CHRONIC CAUSES

• Tumours like fibroma
• Fructose intolerance
• Worms or parasites in the intestines
• Malabsorption syndrome

Belly Button Pain (Abdominal)

Abdominal pain can occur in any of the regions. We shall now discuss the causes of the pain in each quadrant of the abdomen in relation to the umbilicus.

PAIN IN UMBILICAL REGION: There can be multiple reasons for pain with or also without discharge in the belly button. The following are some of the common causes

• Urachal Cyst: This is a pathological cyst that forms from the urachus. The urachus is basically a remnant duct through which the urine is drained from the bladder in the fetus when it is growing inside the mother’s womb. In fetal life this duct is present within the umbilical cord and it closes after birth. In some cases, when this duct remains open, the urine drains into the umbilical cord leading to infection.

Symptoms: The most common symptom is pain in between the umbilical and pubic region. The belly button gets infected and becomes an abscess or fistula with discharge of pus.

Treatment: The infection needs to be treated with antibiotics and if the abscess is too big then it needs to be surgically drained by incision and drainage method.

• Infections: There are two types of infections that can occur:
• Bacterial: Bacterial infections are caused by Staphylococcus aureus and Streptococcus pyrogens. They are seen more commonly in persons with bad hygiene habits, obese individuals. A cut, scratching, piercing, etc can also lead to such infections. Other causes of bacterial infections are immunosuppressant drugs or post surgical wounds.

Symptoms:

• Abscess: A soft swelling that is filled with pus and painful to touch.
• Folliculitis: They are small, itchy red bumps which are pus filled. Here the hair follicles get infected.
• Cellulitis: the skin around the umbilicus becomes red, swollen and warm to touch. The infection here is more wide spread.

Treatment: The main treatment for bacterial infections is antibiotics and drainage of the abscess.

• Fungal: Fungal infections are caused by Candida albicans. The common risk factors are moist and damp areas of the body and poor hygiene.

(source: Samuel Freire da Silva, Dermatology Atlas)

Symptoms: The skin around the umbilicus becomes red and there is itching which may be mild to severe. The sin develops whitish flakes and at times pus filled blisters.

Treatment: The treatment involves keeping the affected area clean and dry and use of anti fungal creams.

Other Causes:

Endometriosis is the presence of endometrial tissue in parts other than the uterus. If the tissue is present in the umbilicus, it can form a nodule which may bleed under the effect of hormones during menstruation. The treatment includes excision of the nodule.

Pilonidal sinus, is just an abnormal opening that is seen in the sacral region or present by the umbilicus. The symptoms are pain and lump formation around the belly button with bleeding and pus discharge. The treatment includes antibiotics and drainage of the abscess.

Pain in Lumbar Region (Around the Belly Button)

• Hernia: The paraumbilical or umbilical hernia is the protrusion of a small portion of the intestine through a weak spot in the abdominal wall. The risk factors for development of a hernia are obesity, chronic cough, pregnancy, post abdominal surgery, tumour in the abdomen or accumulation of fluid within the abdominal cavity (ascites).

Symptoms: There is a bulging seen somewhere in the midline of the abdomen which gets more prominent on coughing or straining. The swelling protrudes on increase in abdominal pressure and then subsides. It causes pressure feeling and discomfort.

Treatment: Surgical treatment called meshplasty where the abdominal muscles are reinforced with a mesh and the intestines are pushed back into the abdominal cavity.

• Pregnancy: The commonest cause of abdominal pain in pregnancy is the stretching of the abdominal muscles due to the growing uterus. Another reasons could be the umbilical hernia
• Abdominal Cancer: In many cases of cancer of the stomach or pancreas there can be a typical rash seen around the umbilicus.

Abdominal Cancer | Copyrights DermNet NZ, CC license

• Psoriasis: Psoriasis is a skin disorder which is associated with redness of the affected skin and white flakes formation. It can occur over the umbilicus and bony prominences of the body.

Source: DermNet NZ

• Appendicitis: This is the commonest cause of abdominal pain.

Appendix area

Symptoms: The classic presentation is pain in the paraumbilical region which later on shifts to the right lower quadrant(iliac fossa) along with anorexia, nausea and at times vomiting. The onset of the pain is generally sudden. If there is some degree of intestinal obstruction, there can be severe constipation. There can be low fever.

Diagnosis: Clinical examination can confirm the diagnosis. There will be tenderness over the Mc Burneys point which is midway between the umbilicus and right iliac fossa. Guarding and rigidity over the abdomen may be present.

Treatment: It is treated by simply removing the inflamed appendix. The surgery is appendicentomy

• Kidney Stones: Stones in the kidney or ureter can give rise to sharp pain in the flanks which radiates to the back. It will be associated with obstructed urine and frequent urinary infections.
• Disc Herniation: Thoracic disc herniation can lead to compression of the nerves and give rise to pain on the left or right side of the belly button.

Pain in Hypochondrium and Epigastrium (Above the Belly Button)

Above the umbilical region is the epigastrium and hypochondrium below which anatomically located organs are the stomach and liver respectively. The following causes can give rise to pain above umbilicus.

• Gastric ulcer: It is an ulcer in the stomach and is diagnosed by pain after eating, heartburn, acidity and a sense of fullness.
• Acute Gastritis: Gastritis is the inflammation of the stomach mucosa. The symptoms are pain, acidity and decreased appetite.
• Duodenal ulcer: An ulcer in the duodenum will have a typical symptom of abdominal pain that is better by eating.
• Acute Pancreatitis: The inflammation of the pancreas will present with sever nausea, vomiting and pain in the epigastrium which is severe in intensity. The pain gets worse post eating fatty and oily food.

Ventral hernia – Image Source

Pain in Hypogastric and Illiac Region (Below the Belly Button)

The causes of pain in the region below the umbilicus can be because of pathologies of the urinary bladder, intestines and the rectum.

• Irritable bowel syndrome: The pain can occur in the lower abdomen and around the umbilicus. The patient will have alternating diarrhea and constipation with bloating. This disorder has a psychosomatic aetiology and the same should be investigated.
• Crohns disease: It is a disorder of the intestines and is characterized by pain in abdomen, chronic diarrhea, weight loss, nausea and decreased appetite.
• Urachus: Urahcus is a remnant organ of intrauterine life which connected the umbilicus and urinary bladder. In some cases, it fails to fuse even after birth giving rise to pain that is pulling in nature and it originates from the umbilicus and travels downwards to the vagina or penis.
• Urinary Bladder Pathology: any infection (cystitis), cyst or tumour arising in the urinary bladder will give rise to pain below the umbilical region. Associated symptoms will be changes in the normal urine, pain and frequency of urination.

After discussing the causes of pain in abdomen for each location, let us now see the reasons of belly button pain occurring in children

Abdomen Pain in Children

• Umbilical Granuloma: This condition is seen in newborn babies. After the umbilical cord separates within the first week, a small granuloma is formed in the umbilicus which can upto 1 cm big. It may be present with or also without discharge.
• Umbilical Polyp: Polyp is the small congenital lesion which looks like a red small mass within the umbilical cord. It is more common in male babies.
• Omphalitis: Normally, the umbilical (cord) stump dries up and falls out with the clamp within the first week of life. However in some cases it gets infected and there is a purulent discharge from it. This can give rise to pain in the umbilicus in small babies.
• UTI: Urinary tract infection is very common in babies. It is seen more in female babies than males. There is abdominal pain, frequent and burning urination. The child will be very cranky due to the burning and pain. It can be diagnosed by a routine urine examination.
• Abdominal migraine: This is the term used for abdominal pain which is seen in young adults and is often associated with nausea, vomiting and increased light sensitivity.
• Henoch-Schonlein purpura: It is a type of blood disorder characterized by vasculitis, purpuric rash on the body, abdominal pain and joint pains.