Introduction
Umbilicus is formed at birth after the umbilical cords are cut short. Most of the time, the area is not maintained hygienically, leading to dirt and bacterial build-up. The area is also an ideal spot for beginning an incision during surgery to avoid any marks. Bleeding from the umbilicus can indicate a serious underlying condition.
What Is Umbilical Bleeding in Adults?
Umbilical bleeding is also known as bleeding from the belly button and is caused by various factors like infection, complications from portal hypertension, or preliminary umbilical endometriosis. However, umbilical bleeding in adults is rare and includes various causative factors. Most of these factors are treatable.
What Are the Factors Causing Umbilical Bleeding in Adults?
1. Infection: Umbilicus is frequently prone to infection, and the risk increases if piercings are present close to the naval or belly button region. Poor hygiene can also make the individual susceptible to umbilical infections. Bacterial infections occur due to streptococcus or staphylococcus bacteria, and fungal infections due to candidiasis.
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Symptoms: The most frequent symptoms include tenderness, pain, redness, and skin discoloration near the naval area. There may also be an itching, burning, or tingling sensation. Swelling and temperature changes (warm) are noticeable around the belly button. If the infection is caused by bacteria, a pus-filled abscess may develop. The pus or discharge from the umbilicus may appear white, yellow, green, gray, or brown. In rare instances, fever, nausea, vomiting, bleeding, and dizziness may develop.
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Diagnosis: Physical exam and a sample from the umbilicus can aid in the diagnosis, identifying the cause, and treatment planning.
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Treatment: If the presence of infection is confirmed, it is better to remove any piercing near the belly button, maintain the region, dry, and wear loose clothing. It is necessary to follow good hygiene to prevent subsequent infections. If the infection is caused by yeast, cream or antifungal powder is prescribed. In case of bacterial infection rinsing the area with saline followed by application of antibiotic cream is recommended. Severe infections require oral antibiotics.
2. Portal Hypertension: A higher than normal blood pressure in the large portal vein responsible for carrying blood from the intestine to the liver leads to portal hypertension. The major cause of portal hypertension is hepatitis C and liver cirrhosis.
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Symptoms: The most frequent symptoms are abdominal swelling, pain, and discomfort. Bleeding in the digestive tract may cause the stool to appear black or tarry. The vomit may be dark or coffee-ground color. Few patients develop confusion.
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Diagnosis: Physical examination and medical history are important for establishing the diagnosis. If there is suspicion of portal hypertension CT (computed tomography), MRI (magnetic resonance imaging), or ultrasound may be performed. White blood cell (WBC) count and platelet count are necessary as an increase in platelet and reduction in WBC may indicate an enlarged spleen.
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Treatment: The first line of treatment is to prescribe medications to control blood pressure in portal veins. In patients with severe bleeding, blood transfusion is advised. In rare instances, liver transplants are suggested.
3. Primary Umbilical Endometriosis: This condition exclusively develops in women where the tissue lining the uterus develops in other body organs. Primary umbilical endometriosis is a rare phenomenon where the tissue lining the uterus forms in the umbilicus causing bleeding.
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Symptoms: Swelling, pain, bleeding, and discoloration around the belly button are common. A lump or nodule may develop on or near the belly button.
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Diagnosis: CT (computed tomography), MRI (magnetic resonance imaging), or ultrasound are necessary for diagnosis. The lumps on the belly button are imaged to analyze causes. The condition develops in four percent of women with endometriosis.
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Treatment: Hormonal therapy is advised to prevent endometriosis. In a few cases, surgery is advised to remove the lumps. The rate of lump recurrence is less in the surgical approach than in hormonal therapy.
4. Cyst: An epidermoid cyst (small cyst filled with dead cells forming under the skin) is a fluid-filled sac forming in the belly button. The epidermoid cyst forms when a hair follicle becomes clogged by oil or dirt. The cysts can also form due to sun damage, infections, or trauma. A urachal cyst (remnant of tissue found between the umbilical cord and bladder) or infected cyst in the belly button can bleed or produce pus discharge.
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Symptoms: The belly button area may develop tenderness, swelling, and pain. A red skin appearance with palpable moveable mass under the skin can be felt. In a few patients, pain may appear while urinating.
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Diagnosis: Physical exam and clinical presentation may aid in diagnosis. A sample is taken from the bleeding site for laboratory examination. If the cyst is present, radiographic imaging with computed tomography (CT) is necessary.
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Treatment: Small cysts resolve on their own and do not require treatment. Infected cysts require antibiotic medication, and large cysts require surgical removal.
5. Pregnancy: In pregnant women, skin and muscles around the abdomen stretch to accommodate the fetus within the uterus. It leads to belly button changes causing the skin to stretch and tear. Also, wearing clothes that rub the umbilicus can lead to redness, swelling, and bleeding. It can be avoided by keeping the area dry and applying aloevera gel to soothe the skin.
6. Umbilical Hernia: It can develop due to the gap forming by the loosening of muscle just behind the belly button. A segment of the intestine bulges from the gap leading to the appearance outer belly button. It can cause spontaneous and recurrent bleeding. In adults, umbilical hernias are rare and require surgical intervention to treat them. Umbilical hernia-associated portal hypertension and varices (enlarged vein) rupture can have life-threatening consequences.
7. Injury to Umbilicus: External trauma to the umbilicus region can cause abrasion and wound. An injury where severe bruising develops can cause seepage of blood underneath the skin. Individuals who have given birth recently, accident victims, and abdominal surgery develop umbilical injuries. Many surgical procedures lead to bleeding in the umbilicus area. A laparoscopic procedure that uses a belly button as an opening is a frequent cause of umbilical bleeding.
How to Manage Umbilical Bleeding in Adults?
If bleeding is noticed in the belly button area, it is essential to seek medical care. The bleeding can be a sign of an infection that can lead to adverse outcomes if left untreated. The doctors may perform examinations, tests, and imaging for diagnosis. Good hygiene maintenance and keeping the area clean and dry can prevent further worsening of symptoms.
Conclusion
Umbilical bleeding is uncommon in adults and can be caused by multiple factors. Medical attention is necessary if bleeding, tenderness, redness, and warmth of the under skin can be felt. If the region is infected, a blood or pus discharge can be observed and must be treated immediately. Good hygiene practices and timely treatment can reduce abdomen complications from developing.
