Epigastric Hernia

What is an epigastric hernia?

Epigastric (eh-puh-GA-struhk) hernias develop in the upper middle area of your belly (abdomen). They appear in the space below your breastbone and above your belly button. They’re a common type of ventral hernia (a hernia in your front abdominal wall). You can have more than one epigastric hernia.

These hernias are small. They measure less than ½ inch (1 centimeter) or about as long as a staple. Large hernias are 1 ½ inches (4 cm) or about the size of a walnut. You may not have symptoms unless the hernia grows. A large hernia may make a noticeable bulge that you can see and feel.

Epigastric hernias aren’t a serious health condition. But larger hernias may cause life-threatening complications.

What are the symptoms of an epigastric hernia?

An epigastric hernia may not cause symptoms. When it does, symptoms may include:

• A bulge under your skin between your belly button and your breastbone. You notice the bulge when you’re standing. It may go away when you sit down.
• A dull ache in the middle of your upper belly. The ache may get worse during the day.
• A sharp pain that happens when you cough, lift a heavy object or strain to poop.

What causes an epigastric hernia?

This condition happens when fatty tissue or a piece of large intestine pushes through your linea alba. This is the thin band of connective tissue that runs down the front of your abdomen. Fatty tissue or intestine may push through a defect (hole) or weak spot in your linea alba. You can develop an epigastric hernia if you have weak abdominal muscles.

You can be born with an epigastric hernia. This hernia forms during fetal development. But these hernias typically develop over time (acquired epigastric hernia). This happens as you get older. It may also happen if you have other issues that put pressure on your linea alba or your abdominal muscles. Epigastric hernias most commonly affect people ages 30 to 50.

Many things can cause an epigastric hernia. Some common causes are:

• Your linea alba thins out as you age
• Chronic cough
• Constipation so you strain to poop
• Having obesity
• Lifting heavy weights or objects
• Pregnancy

What are the complications of an epigastric hernia?

An epigastric hernia can lead to an incarcerated hernia and a strangulated hernia. Incarcerated hernias and strangulated hernias are serious medical issues. They may be life-threatening.

An incarcerated epigastric hernia is when a hernia gets stuck in your abdominal muscles. It doesn’t move back into your abdomen on its own or when you push on it.

How is an epigastric hernia diagnosed?

A healthcare provider will do a physical examination. They may do imaging tests to check the hernia’s size and location. Those tests may be:

• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI) scan
• Ultrasound

How do you manage an epigastric hernia?

Hernia repair surgery is the only treatment for an epigastric hernia. But you may not need surgery right away. Your provider may recommend regular checkups instead of surgery if:

• The hernia is small (less than 1 inch or about 1 centimeter)
• The hernia doesn’t cause pain or irritation
• The bulge doesn’t bother you
• The hernia isn’t likely to cause complications

How long is recovery from epigastric hernia repair?

That depends on your situation. You may return to work or your daily activities within two weeks. But it may be four weeks before you can go back to work if your job involves lifting heavy things. Everyone’s situation is a bit different. Ask your healthcare provider how long it may take for you to recover from surgery.

Can you prevent an epigastric hernia?

There are some things you can do to reduce your risk:

• Maintain a weight that’s right for you
• Get help for conditions that put pressure on your abdominal muscles, like a chronic cough or constipation
• Take it easy when lifting heavy weights

Outlook for epigastric hernia

Surgery cures an epigastric hernia. But the hernia may come back, or you may develop a new one. That can happen if there’s pressure on your abdominal muscles or your linea alba weakens. Wondering if a hernia will come back? Ask your healthcare provider about the chance that could happen. They may also suggest ways you can reduce that risk.

When should I see my healthcare provider?

Contact your provider if the bulge in your upper belly is getting bigger. Larger epigastric hernias may get stuck (incarcerated hernia) or become strangulated. An incarcerated or strangulated hernia is a medical emergency. Call 911 (or your local emergency service number) or go to the emergency room if you have the following symptoms:

• New pain in your upper belly that’s severe and quickly gets worse
• Nausea and vomiting
• The skin around the hernia turns dark in color (your skin may be reddish, purple, blue or black)

What questions should I ask my doctor?

You may want to ask your healthcare provider the following questions:

• Why do I have this hernia?
• Will it keep growing?
• What could happen if it grows?
• Will I need surgery?

Can an epigastric hernia cause acid reflux?

Acid reflux is a common symptom of a hiatal hernia. An epigastric hernia may cause a dull ache or a sharp pain in your upper abdomen. But it doesn’t cause acid reflux symptoms like heartburn or indigestion.