What is the belly button and where is it located?
The belly button is a scar in your abdominal wall where the umbilical cord was attached when you were still in the mother’s womb.
Other names for the belly button: navel, umbilicus, umbilical dip, tummy button.
The belly button is located in the middle of the lower part of your abdomen, about 2-3 inches below your waist line. The only organs placed directly under the belly button are the abdominal wall muscles and the small intestine.
In most infants, the belly button bulges out a bit (“outie”), and in most children and adults it is more or less depressed (“innie”).
Causes of Belly Button Pain
1. Belly button pain with DISCHARGE
2. Pain AROUND the belly button
3. Pain ABOVE the belly button
4. Pain UNDER and BELOW the belly button
5. Pain on the RIGHT or LEFT SIDE of the belly button
6. Belly button pain in CHILDREN
7. Other causes of central abdominal pain
1. Pain and Smelly Discharge from the Belly Button
- Cause: the yeast Candida
- Risk factors: regular touching, bad hygiene, moist skin, obesity
- Symptoms: red, smelly, itchy, tender and mildly painful belly button surrounded by flaky skin and pus-filled blisters (pustules) with dark, yellow or white discharge or occasional bleeding (Picture 1)
- Treatment: anti-fungal creams
- Reference: (4)
Picture 1. Fungal infection (ringworm)
around the navel
(source: Samuel Freire da Silva, Dermatology Atlas)
- Causes: the bacteria Staphylococcus aureus (staph) or Streptococcus pyogenes (strep)
- Risk factors: bad hygiene, obesity, scratching or rubbing, a cut, piercing, an epidermoid cyst, a foreign object, steroids or immunosuppressant drugs (in Crohn’s disease), a wound after surgery or laparoscopy
- Folliculitis: red, itchy bumps with occasional white centers filled with pus
- Cellulitis: red, thick, tender and warm skin in and around the navel, possibly mild fever
- Abscess: a soft lump up to a size of a golf ball, occasionally draining pus
- Treatment: antibiotic creams, oral antibiotics, abscess drainage
- References: (9,14,15)
The urachal cyst develops from the urachus–a remnant of the duct withing the umbilical cord through which a fetus drains urine from the bladder. Rarely, this duct remains open in children or young adults and drains urine through the belly button or becomes infected.
- Symptoms: pain between the belly button and the pubic area. An abscess in the belly button or an opening (fistula) with clear or thick discharge from the belly button can develop.
- Treatment: antibiotics, drainage or surgical removal of the cyst.
- References: (5,6,10,13)
A pilonidal sinus is an abnormal tissue that develops as a reaction to an ingrown hair. It usually appears above the sacrum and rarely in or near the belly button. Symptoms may include a painful lump with hair and redness in the belly button and leaking pus or blood (31). Treatment may include antibiotics, drainage, hair removal or surgical removal of the sinus.
Endometriosis–the endometrial tissue outside the uterus–can present as a painful nodule in the belly button that can bleed during menstruation (32). Treatment is with excision of a nodule.
2. Pain AROUND the Belly Button
Umbilical or Paraumbilical Hernia in Adults
An umbilical or paraumbilical hernia is a protrusion of the small intestine between the muscles in or near the belly button.
- Risk factors: pregnancy, obesity, persistent coughing, abdominal surgery, a large abdominal tumor, accumulation of the fluid in the abdomen in liver or kidney disease (ascites)
- Symptoms: a soft bulge–of the skin color, red, gray or blue and up to few inches big–near the belly button; coughing and straining can cause discomfort, pressure, pain or burning feeling.
- Treatment is by surgical repair of the muscles near the belly button.
- Reference: (3)
In infants, an umbilical hernia is common but rarely painful (6).
Causes of pain around the belly button during pregnancy:
- Umbilical hernia
- Stretching of the abdominal wall muscles
- The pressure of the fetus upon the belly button (in late pregnancy)
Appendicitis is an inflammation (usually acute) of the appendix.
- Vague pain that initially appears in the belly button area and, within several hours, moves to the lower right abdominal quadrant or rarely to upper right abdomen, right flank or the rectum, becomes severe and stabbing and is aggravated by coughing (Picture 2)
- Nausea, vomiting, constipation and low-grade fever after the pain
- Tenderness in the lower right quadrant
- Rovsing sign (rebound tenderness): applying pressure upon the left lower abdomen and quickly releasing it triggers pain in the right lower abdomen.
- Treatment is by surgical removal of the appendix.
- Reference: (1)
Picture 2. Appendix pain location
(source: Emergencyus, CC license)
Psoriasis is a chronic inflammatory skin condition with red or silvery white, itchy or burning patches with occasional painful cracks around the belly button, knees, elbows, scalp, back, hands or feet (Picture 3) (8). Treatment includes topical and oral anti-psoriatic medications.
Picture 3. Psoriasis
(source: DermNet NZ, CC license)
In advanced stomach, colorectal, pancreatic or other abdominal cancer, irritating red rash around the belly button called “Sister Mary Joseph nodule of the umbilicus” can appear.
Picture 4. Sister Mary Joseph’s nodule
of the umbilicus caused by abdominal cancer
(source: DermNet NZ, CC license)
3. Pain ABOVE the Belly Button
- Acute gastritis (stomach infection): loss of appetite, burning pain and nausea, burping (33)
- Gastric ulcer: gnawing pain, which can be relieved or aggravated by eating, feeling of fullness, heartburn and–if bleeding–black stool (2)
- Duodenal ulcer: deep pain usually relieved by eating (2)
- Acute pancreatitis: severe, constant upper abdominal and back pain–which can last for several hours or days and can be worse after eating–, nausea, vomiting and fever (17).
- Ventral hernia: part of bowel protruding through the abdominal wall muscles
Picture 5. Ventral hernia
above the belly button
(source: Archana Ramaswamy, MD, SAGES)
4. Pain UNDER (BEHIND) and BELOW the Belly Button
- Bladder infection (cystitis): pain about 5 inches below the belly button, frequent urination, cloudy urine and low-grade fever
- Interstitial cystitis: very frequent urination, mainly in women; the pain is relieved by emptying the bladder
- Bladder cancer: pain in the bladder, blood in the urine
- Reference: (11)
Irritable Bowel Syndrome (IBS)
IBS pain is often located below the belly button but can appear anywhere else in the abdomen; other common symptoms include bloating, loose stools or constipation shortly after meals (16).
Crohn’s disease is a chronic inflammation of the gastrointestinal tract, mainly the small intestine, most commonly in young adults. Common symptoms include pain below the belly button or in the lower right abdominal quadrant, chronic diarrhea, nausea, weight loss, fatigue and skin rash (30).
Urachus with Pulling Pain
Some, mainly young, people describe a sharp, shooting pain in the belly button that travels down to the bladder, penis, vagina, clitoris, urethra or groin when they stand up quickly, urinate, or press or pull the belly button upwards, usually when they have full bladder; some describe it as a string going down from the belly button (21). The pain may originate from the urachus, which is a remnant of the duct that connects the bladder and umbilicus in the fetus. If necessary, the urachus can be surgically removed.
5. Pain on the RIGHT or LEFT Side of the Belly Button
- Shingles: burning, itchy, crusty rash that travels from the spine around the trunk toward the belly button
- Urinary stones: sudden, severe, colic pain on the left or right side of the abdomen, which can radiate to the groin, and burning urination
- Bulging or herniated discs or arthritis of the thoracic spine can be associated with pinched spinal nerves that can cause pain on the right or left side of the belly button.
6. Belly Button Pain in CHILDREN
Urinary Tract Infection (UTI)
Urinary tract infections in children can present with pain around the belly button, frequent urination and cloudy and smelly urine (29).
Umbilical Granuloma and Polyp
In newborns, a granuloma–1 mm to 1 cm pink, crumby lesion with or without drainage–can develop after the umbilical cord separation (6).
A polyp is a congenital lesion that appears as a 1 to 4 cm bright red, soft mass with occasional discharge in the belly button, mainly in male infants; rarely only in adulthood (6).
Omphalitis is a bacterial infection of the umbilical stump in newborns with purulent discharge (7).
- Abdominal migraine (mainly in children before puberty) refers to central abdominal pain of unknown reason lasting 1-72 hours, vomiting, dizziness and sensitivity to light (photophobia) (25).
- Henoch-Schönlein purpura is an inflammation of blood vessels (vasculitis) with generalized rash (small, red/purple spots) caused by bleeding into the skin, abdominal and joint pain (26).
7. Other Causes of Central Abdominal Pain
- Trapped wind can occur within few hours after eating high-fiber foods (fruits, beans) anywhere in the abdomen; the pain can be sharp, crampy and quite severe.
- Food poisoning: bouts of watery diarrhea and abdominal cramps several hours after eating
- Diabetic ketoacidosis: abdominal pain, excessive urination, excessive thirst (18)
- Uremia (accumulation of waste products in chronic kidney disease): abdominal pain, nausea, itchy skin (19)
- Rectus sheath hematoma (due to anticoagulant therapy, persistent coughing or straining at stool, injury): sharp, severe pain in the middle of the abdomen, bruising and a firm lump, which is only sometimes visible (20)
- Intestinal obstruction (due to adhesions or cancer; or a non-mechanical obstruction called ileus after surgery or in serious disease): central abdominal pain, nausea, vomiting and absence of bowel movements (22)
- Mesenteric venous thrombosis (blood clot in a vein that carries blood away from your intestine). Risk factors: appendicitis, pancreatitis, cancer, diverticulitis, cirrhosis. Symptoms: abdominal pain worse after eating, rectal bleeding (23).
- Acute intermittent porphyria is a genetic disorder of heme. Symptoms: sudden, severe, diffuse abdominal pain lasting for hours, pain and numbness in the limbs, muscle weakness (27).
- Aneurysm of the abdominal aorta or its rupture. Symptoms: severe or dull pain in the central abdomen, chest, lower back or groin (24).
- Acute lead poisoning can cause severe, cramping abdominal pain, vomiting, seizures and coma (28).
- Other references: (12)
- Food intolerances (lactose intolerance, fructose malabsorption): bloating and loose stools
- Intestinal parasites: abdominal pain and distension, parasites in the stool
- Fibroma–a benign abdominal tumor; palpation may reveal an abnormal mass
- Pediatric Appendicitis Clinical Presentation Emedicine
- Peptic Ulcer Disease Merck Manuals
- Umbilical hernia Drugs.com
- Yeast infection Canoe.ca
- Ekwueme KC et al, 2009, Infected urachal cyst in an adult: a case report and review of the literature PubMed Central
- Disorders of the Umbilicus Emedicine
- Omphalitis Emedicine
- Living With Psoriasis WebMD
- Yadav G et al, 2010, Clinical Profile Of Umbilical Discharge In Adults; A Multicentric Study In North India ISPUB
- El Amari JE et al, 2011, Urachal Sinus Presenting with Abscess Formation Hindawi
- Bladder Pain WebMD
- Abdominal Pain Causes Mayo Clinic
- Urachal Abnormalities University of California, San Francisco
- Folliculitis Skinsight
- Cellulitis NHS Choices
- Irritable Bowel Syndrome (IBS) and Functional Bowel Disorders Health System, University of Michigan
- Pancreatitis National Institute of Diabetes and Digestive and Kidney Diseases
- Ladhani S et al, 2002, Low back pain at presentation in a newly diagnosed diabetic Archives of Disease in Childhood
- Ramrakha P et al, 2010, Abdominal Pain Oxford Handbook of Acute Medicine, 3rd Edition
- Rectus Sheath Hematoma Clinical Presentation Medscape
- Sharp Pulling Pain In Belly Button SteadyHealth
- Intestinal Obstruction and Ileus Patient.info
- Mesenteric Venous Thrombosis MedlinePlus
- Abdominal Aortic Aneurysm John Hopkins Medicine
- Abdominal migraine Contact a family
- Henoch-Schönlein Purpura Patient.info
- Emergency Room Guidelines for Acute Porphyrias American Porphyria Foundation
- Lead Poisoning Delaware Health and Social Services
- Urinary Tract Infections National Kidney Foundation
- IBD – Ulcerative Colitis and Crohn’s Ohio Gastroenterology & Liver Institute
- Akkapalu N et al, 2011, Umbilical Pilonidal Sinus: A Case Report Journal of Medical Cases
- Fancellu A et al, 2013, Primary umbilical endometriosis. Case report and discussion on management options Case Reports
- Gastritis Better Health