Written by Dr.Bayat

Associate Professor of Orthopedic expert,Brigham Hostpital

If you have sharp pain around the umbilicus (pre-umbilical), finding the exact cause may not be easy and sometimes remains unknown.

What causes sharp and pulling-like pain around the belly button?

There are lots of various disease and condition in which someone may experience sharp pulling pain in belly varying from appendicitis and ileus to aorta aneurysm and dissection.

Causes of sharp pains around the belly button

Pre-umbilical pain or pain around the belly button is generally perceived in the back or around the belly button.

Doctors have termed the umbilical region into an area of ​​the abdomen that includes structures such as the stomach, small intestine, and large intestine and pancreas.

According to the above explanation, it can be expected that the problems of each of these organs may be associated with peri-umbilical pain that actually originates from the umbilical region.

As the embryonic origin of umbilicus sensation is the same on intestine and genital system, therefore any problem in digestive system and genital system may be felt in belly button.

The followings are the major and important causative factors.

Notice the fact that each has lots of important tips to consider before making that the exact diagnosis for your belly button pain. 

Gastroenteritis or Inflammation of the stomach (gastritis) and intestinal inflammation (enteritis):

Inflammation of the stomach and intestines, and inflammation of the gastrointestinal tract in general, may cause acute umbilical cord pain that is generally felt around belly button.

Inflammation of intestine and stomach has lots of causes ranging from some medication to viral or bacterial infections.

If some signs and symptoms be associated with belly button pain then infectious inflammation may be the best diagnosis:

• Fever
• nausea
• Vomit
• Diarrhea
• Dehydration of the body
• sweating

Viral gastroenteritis usually does not require special treatment and you will recover spontaneously within a few days by hydrating yourself, resting your digestive system and not eating fatty and bulky spicy foods.

If you have severe diarrhea or vomiting that has led to lethargy and severe dehydration, you will need emergent medical treatment and intravenous fluids.

Dehydration can be very dangerous in infants, toddlers and young children and the elderly, as well as in one with weak immune system.

Inflammation of the appendix or appendicitis:

The clinical manifestations of Inflammation of the appendix, or so-called appendicitis by doctors, can begin with sharp pain around the belly button. 

Sharp pain and pulling pain around the belly button in appendicitis will gradually shift over time to the lower right side of the abdomen.

Doctors believe that the shift of sharp pain from around the belly button to the lower right of the abdomen is a characteristic of appendicitis, but appendicitis is not the only cause of sharp pain around the belly button.

Doctors consider sharp pain around the umbilicus to be the first sign of appendicitis.

This pain will gradually shift down and to the right side of the abdomen, which is very unique to appendicitis.

Other symptoms include:

• loss of appetite
• Diarrhea
• Constipation
• Nausea or vomiting
• Abdominal pain that is exacerbated by coughing, sneezing, and changing body position.
• Fever

Inflammation of the appendix or appendicitis is a surgical emergency and you should not wait for it to heal on its own.

Delay in going to the emergency room causes an inflamed appendix to rupture, and then there will be more dangerous conditions that are very life threatening.

The only treatment for appendicitis is removal during surgery. Doctors call this surgery an appendectomy.

Acute inflammation of the pancreas or acute pancreatitis:

Pancreas is an organ that lies near back wall of stomach and is part of digestive system and plays an essential role in blood sugar control.

When inflammation happens, whether because of infection or occlusion in enzyme secretion passage, sharp pain around belly button will be felt.

The onset of symptoms in acute pancreatitis is sudden and usually triggers with some factors.

Some of the most common triggering factors are:

• Drinking alcohol
• Infections like mumps and others
• Gallstones
• Some medications
• Fatty foods

Acute and chronic pancreatitis treatments mostly consist of digestive system rest and some medications to lessen the pancreatic enzyme secretion.

Some other problems that may associated with pancreatitis:

• Fever
• nausea
• Vomit
• Heart palpitation
• And very severe abdominal pain that gets worse every single minutes.

The patient may not be allowed to drink or eat anything for hours or days in order to rest the digestive system.

Pain in acute pancreatitis is one of the worst pains that one would experience throughout his or her life, therefore prescribing painkillers plays an important role in management of this disorder.

During this period, the patient must be hospitalized.

In severe cases of acute pancreatitis or mild cases of failure to respond to the above supportive treatments, surgery is required.

As gallstones are responsible for most of acute pancreatitis, in many cases, treatment of gallstones with cholecystectomy will also be necessary.

Peptic ulcers:

Gastrointestinal ulcers on the stomach wall and at the beginning of the small intestine or duodenum are all together called peptic ulcers.

There are many known and some unknown factors that may cause peptic ulcers, some of them are:

• Infection with H. pylori (Helicobacter pylori)
• Mucosal damage following chronic use of drugs such as aspirin, ibuprofen, naproxen, indomethacin or NSAIDs in general.
• Stresses
• Some rare endocrine tumors

Belly button pain associated with peptic ulcers may have other problems such as:

• Nausea
• Vomit
• Feeling full and premature satiety
• Decreased appetite
• bloating
• Burping

Umbilical hernia:

When there is weakness is abdomen muscle near belly button then the intestine will pass partially through it and cause lots of problems including inflammation and strangulation of the passed part.

It is common for infants to develop umbilical hernias.

Adults, especially obese or pregnant women, may also develop umbilical hernias.

Umbilical hernias in infants often resolve by age two, but umbilical hernias in adults will generally require surgery.

Some of the common signs associated with umbilical hernias are:

• Pain around the navel or behind the navel
• Feeling of heaviness or pressure around the navel
• Existence of a bulge in the umbilicus

In adults, there is a high risk of intestinal obstruction following umbilical hernias, so surgery is often necessary in adults.

Ileus:

Ileus is medical term for dysfunction of intestine movement that can be happened by lots of different causes like some medications or infections.

The lumen of the small intestine may become completely or partially occluded. In this situation, gas and fecal cannot move in the intestine towards the anus and accumulate behind the obstruction site. this will lead to:

• Gradually, the abdomen expands.
• Severe abdominal pain occurs.
• There is sharp pain behind belly button or around the belly button.
• Nausea
• Vomit
• Dehydration
• Lack of appetite
• Fever

In partial obstructions, there is very severe constipation and incomplete block in stool passage and there is no excretion of gas and feces.

If the ileus left untreated it may cause intestinal rupture and it will be accompanied by life-threatening events.

Major and common causes of ileus and intestinal occlusion are:

• Infections
• Some types of hernias
• Tumors
• IBDs
• Volvulus

the presence of a previous history of abdominal surgery and the presence of adhesions as a result of previous abdominal surgery, which are called adhesion band, are also among the causes of intestinal obstruction.

Intestinal obstructions are a medical emergency. In most cases, surgery is needed to repair and remove the bowel obstruction. 

Abdominal aortic aneurysm:

When the inner wall of the descending aorta weakens in the abdomen, it leads to bulging of the weakened wall.

Aortic aneurysm is a severely life-threatening condition. Death often occurs if the aneurysm ruptures.

When part of the aortic wall is bulged, the pulse of an artery can be detected beyond the skin of the abdomen in skinny ones.

When the abdominal aortic aneurysm ruptures, a very sharp pain is suddenly felt in the abdomen, which can spread to other parts of the body.

Here are some of the common manifestations of ruptured aortic aneurysm:

• Shortness of breath
• Progressive hypotension
• Heart palpitation reaction
• Fainting
• Sudden weakness
• Rupture of the aortic aneurysm is a medical emergency and requires immediate surgical intervention.

Intestinal artery disease and mesenteric ischemia:

As the coronary arteries of the heart suffer from narrowing of the lumen and wall stiffness and deposition of inflammatory compounds in the wall (atherosclerosis), the same may happen in intestinal vessels and they disrupt blood flow and nutrition to the intestine and lead to abdominal pain around belly button.

The common signs and symptoms accompany intestine vessel occlusion are:

• Severe abdominal pain
• Sensitivity to the touch of the abdomen
• If the condition worsens, the pain will increase and

heart palpitations and blood in the stool are usually accompanied by other symptoms.

One with mesenteric ischemia, may have a blood clot that blocks the blood vessels in the intestines.

In these cases, immediate initiation of anticoagulants and in some cases, surgery is required.

In the following cases, you should go to the emergency room if you experience sharp pre-umbilical cord pain and have history of blood thrombosis or heart arrhythmia.

Heart attack:

Although not common for heart pain to be felt in belly button, but there is specific heart stroke called “Inferior wall MI” that is happened when there is damage to the lower part of heart.

This part of heart is very close to stomach and can cause discomfort and pain around belly button.

How to find out the cause of sharp umbilical cord pain

In addition to taking a history and clinical examination, the following diagnostic aid modalities are used to determine the cause of acute umbilical cord pain according to the patient's condition:

• Urine analysis and culture
• Blood samples
• Electrolyte like blood sodium and potassium
• Stool sample analysis and stool culture
• Endoscopy
• Plain X-ray of the abdomen.
• CT scan of the abdomen

We emphasize that you take the persistence of umbilical cord pain seriously and see a doctor to evaluate its causes.