Definition

An umbilical granuloma is a small growth of tissue on a newborn's umbilicus (belly button) that forms within the first few weeks after the umbilical cord is cut. After the cord is cut, parents need to take care of the belly button to ensure proper healing. Post-cord-cutting concerns include infection, bleeding, and the formation of an umbilical granuloma.

An umbilical granuloma is one of the most common umbilical abnormalities in newborns. Approximately 1 in 500 newborns experience this condition. While it usually occurs in infants, umbilical granulomas can also develop in adults.

Causes

The umbilical cord connects the fetus to the placenta during pregnancy, carrying nutrients, oxygen, and waste products between the mother and fetus. After birth, the cord is cut, separating the baby from the placenta. A small stump usually remains at the umbilicus, which typically dries and falls off within one to two weeks without any problems. However, in some cases, an umbilical granuloma forms after the stump falls off. Essentially, it is granulation tissue that forms as part of the healing process after the umbilical cord is cut.

In adults, an umbilical granuloma may result from an injury to the belly button. One of the most common causes in adults is a belly button piercing. As the piercing heals, granulation tissue (or healing tissue) forms around the area, which is rich in small blood vessels. However, a granuloma will develop if an excessive amount of granulation tissue forms.

Risk Factor

The exact reasons why some babies develop umbilical granulomas are not well understood. The condition is not related to the quality of care provided by parents or caregivers, nor is it associated with other medical conditions. But if it takes more than two weeks for the umbilical cord stump to fall off, granulomas are more likely to develop.

Symptoms

An umbilical granuloma appears as a small, reddish, shiny, moist lump that may be covered with a sticky, clear, or yellowish discharge. This condition may cause mild irritation of the surrounding skin. Many babies with an umbilical granuloma experience no discomfort or pain. However, if the granuloma becomes infected, it can lead to symptoms such as:

• Fever above 38°C (100.4°F)
• Bleeding around the granuloma
• Swelling or redness around the area
• Pain near the belly button
• Foul-smelling or pus-like discharge from the belly button
• Rash around the umbilicus
• The baby seems in pain when the belly button is touched

Though granulomas in babies are usually painless, adults may experience discomfort. If there is pain or swelling near the belly button, it could also indicate an umbilical hernia.

Diagnosis

Doctors routinely check a newborn's belly button during each visit, particularly after the cord stump has fallen off. If a granuloma is found, the doctor will provide appropriate treatment.

Management

Umbilical granulomas need to be treated, as they do not go away on their own. Most granulomas will continue to grow without intervention. Treatment is also essential to prevent the risk of infection, as granulomas can become easily infected. Fortunately, the condition is usually treated easily using a small amount of a chemical called silver nitrate, which works by breaking down the tissue. Since there are no nerve endings in the granuloma, this procedure is painless for babies. However, in adults, this procedure may cause discomfort, so a local anesthetic may be applied before using silver nitrate.

If silver nitrate treatment does not work or another procedure is preferred, other options include:

• Liquid Nitrogen. This involves applying liquid nitrogen, which is very cold, to quickly freeze the tissue. A small amount is applied to the granuloma, freezing it on contact, causing the tissue to fall off.
• Surgical thread. In some cases, the doctor may tie off the granuloma with surgical thread. This cuts off the blood supply to the granuloma, causing it to dry, shrink, and eventually fall off.
• Salt Treatment. Another method to dry out the granuloma involves using salt. Since the granuloma is covered with a sticky fluid, salt helps absorb moisture. A small amount of salt is applied to the granuloma and covered with gauze for 10 to 30 minutes. Afterward, the area is cleaned with warm, moist gauze. This procedure is repeated twice a day for two to three days. If the granuloma does not shrink or dry up, medical attention is still needed. If it starts to reduce in size, continue the treatment until the granuloma disappears and the belly button heals.
• Surgery. In rare cases, surgery may be required to remove the granuloma, particularly if it becomes infected. Surgery is a quick way to remove the granuloma and stop the spread of infection, promoting faster healing.

After any medical procedure, it’s essential to keep the area clean and dry. Gently clean the belly button with warm water and soap. It’s advised not to cover the belly button. When using diapers, fold the front part to avoid covering the area. During baths, avoid submerging the baby in water until the area is fully healed.

For adults, treatment is similar to that for babies. However, if the granuloma does not heal, removing the belly button piercing may facilitate recovery.

Complications

Umbilical granulomas usually resolve without complications if treated properly. However, if left untreated, infected granulomas can become a serious health issue. Since the granuloma connects to the belly button's opening, infections can spread quickly.

Prevention

As granulomas form as part of the wound healing process, they can be difficult to prevent. However, if a granuloma forms, measures can be taken to prevent infection. The best way to avoid infection is by protecting the belly button and keeping the area clean. Gently wipe the area with soap and warm water to prevent fluid accumulation and bacterial growth.

When to See a Doctor?

If you notice any growth or lump around your or your child’s belly button, especially if accompanied by signs of infection, it’s essential to consult a doctor for proper diagnosis and treatment. All granulomas should be treated by a doctor. If infection is present, prompt treatment is necessary. The baby may need antibiotics to prevent the infection from worsening.

Early granuloma detection and prompt therapy initiation lead to faster recovery.

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