Whether you have an ‘innie’ or an ‘outie’ belly button is mostly down to how your umbilical cord stump healed after birth and how the skin and tissue around it settled. An outie is usually completely normal. Occasionally a bulge at the belly button is an umbilical hernia, and a painful, hard bulge that cannot be pushed back needs urgent medical attention.
How belly buttons form
The belly button (umbilicus) is the scar left where the umbilical cord was attached. After birth, the stump dries and falls off and the area heals. The final shape depends on how the scar tissue contracts, how much skin was left, how firmly the scar is anchored to the abdominal wall and how much fat surrounds it. It has nothing to do with how the cord was cut or clamped.
Innies and outies: both normal
Most people have an innie, where the scar sits below the level of the surrounding skin. An outie, where the scar protrudes, is simply a variation in how the skin and scar tissue healed. A normal outie is soft, painless, does not change size when you cough or strain and cannot be pushed ‘in’ into the abdomen. Belly button shape can change over life: pregnancy often stretches it outwards temporarily, weight gain can deepen it, and weight loss or ageing can make it longer, wider or hooded.
Is it an umbilical hernia?
An umbilical hernia happens when fat or bowel pushes through a weak spot in the abdominal wall at the belly button. They are common after pregnancy, with weight gain and in people who strain heavily. Signs that an outie may be a hernia include:
- A bulge that gets bigger when you cough, laugh, lift or strain, and smaller when you lie down.
- A bulge you can gently push back in.
- A new outie in adulthood, especially after pregnancy or weight gain.
- Aching or discomfort around the belly button.
If you think you have a hernia, see your GP. Many adult hernias are repaired with a routine operation, and your GP can arrange assessment.
Red flags: when it is urgent
Call 999 or go to A&E if you have a hernia or belly button bulge and:
- It becomes painful, hard or tender and cannot be pushed back in.
- The skin over it turns red, purple or dark.
- You feel sick or vomit, cannot pass wind or open your bowels, or have a swollen tummy.
These can be signs that the hernia has become trapped (incarcerated) or that its blood supply is cut off (strangulated), which needs emergency surgery. If you are unsure, call NHS 111 for advice.
Other belly button problems
Redness, discharge, a bad smell or pain can be signs of infection, a skin condition or, rarely, a cyst or remnant from development; see your GP. A lump that is firm and not a hernia should also be checked by your GP.
Changing the shape: umbilicoplasty
If your belly button shape bothers you and any hernia has been assessed, an umbilicoplasty can reshape it. The aim is usually a natural-looking, vertically oriented innie. Depending on the problem, the procedure can reduce a protruding outie, correct a stretched or hooded belly button after pregnancy or weight loss, or lift a belly button that has descended. A small umbilical hernia may be repaired at the same time, depending on its size and your general surgical assessment. It is usually done under local anaesthetic, with or without sedation, and the scars are placed inside the belly button where possible. Belly button reshaping is also part of a tummy tuck.
Recovery, risks and cost
Most people return to desk-based work within a few days and avoid heavy lifting and strenuous exercise for around four to six weeks, particularly if a hernia is repaired. Risks include infection, bleeding, visible or thickened scarring, asymmetry, narrowing of the belly button and, if a hernia is repaired, recurrence. Cosmetic belly button surgery is for adults aged 18 and over. The cost is quoted at consultation, which is £150.
Frequently Asked Questions
Is an outie belly button a hernia?
Usually not. Most outies are just the way the scar healed. An outie that bulges more when you cough or can be pushed in may be a hernia and should be checked by your GP.
Can an innie turn into an outie?
Yes. Pregnancy, weight gain or a new hernia can push a belly button outwards. A new outie in adulthood is worth getting checked.
When is a belly button bulge an emergency?
If it becomes painful, hard and cannot be pushed back, the skin changes colour, or you vomit. Call 999 or go to A&E.
Can an outie be changed to an innie?
Yes, an umbilicoplasty can reshape an outie into an innie. Any hernia is assessed first and may be repaired at the same time.
