If you notice a small bulge in the upper part of your belly, you may have an epigastric hernia.
An epigastric hernia occurs above the belly button and below the breastbone. It’s generally not a serious problem, but it may need treatment if it becomes bothersome.
At UPMC, our general surgeons treat many different types of hernias, including epigastric hernias. Whether you need surgery or not, we can put your mind at ease about your symptoms.
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What Is an Epigastric Hernia?
An epigastric hernia is a lump in the middle of the abdomen, between the belly button and the breastbone. This type of hernia occurs along the linea alba. This is the fibrous band of tissue that runs through the center of your belly.
Some babies are born with epigastric hernia, but it might not be noticeable until later in childhood. Adults may develop epigastric hernias as they age.
Epigastric hernias occur when there’s a weak spot in the upper abdominal wall. A gap forms and allows fat to bulge through. Very rarely, part of the large intestine could push through the hole.
Epigastric hernias are usually small, less than half an inch long. You may have more than one epigastric hernia.
These hernias are often harmless, because they usually don’t contain internal organs like other hernias can. However, they can cause discomfort, especially if they get bigger. Surgery is the only treatment for an epigastric hernia.
What are the types of epigastric hernia?
Your provider may use these terms to talk about different types of epigastric hernias:
- Irreducible — Can’t get pushed back into the opening. Providers also call this an incarcerated hernia.
- Reducible — Can get pushed back into the opening. It also may decrease in size when you’re lying down.
- Strangulated — When part of the large intestine gets trapped in the hernia pouch. Hernial strangulation is a medical emergency because the blood supply to the intestine gets cut off. If it happens, you'll need surgery right away.
How common is epigastric hernia?
Upper abdominal hernias are not common.
In fact, epigastric hernias are the least common type of abdominal hernia. They only account for 1.5% to 3.6% of all abdominal hernias. Inguinal (groin) and umbilical (belly button) hernias are much more common.
Epigastric hernias happen more often in men than women.
What causes epigastric hernia?
You may develop a hernia in the upper abs when belly fat pushes through a weak spot in the linea alba. The linea alba is the tough band of tissue that runs down the middle of the chest and upper abdomen.
Weak abdominal muscles can contribute to the formation of an epigastric hernia.
Some children have an epigastric hernia at birth. It may close with time. If it doesn’t, your child may eventually need surgery.
Epigastric hernia risk factors
While you can’t always prevent getting an epigastric hernia, it’s important to be aware of risk factors and complications of the condition.
You’re more likely to get an epigastric hernia if you:
- Are a man — Men are more likely to develop epigastric hernias than women.
- Are middle-aged — Epigastric hernias occur most often in people between the ages of 30 and 50. Your abdominal muscles start to weaken at this age. The linea alba also tends to thin out.
- Are overweight — Being obese can put extra strain on the abdominal muscles. This can make them weaker and more susceptible to hernias.
- Experience chronic straining — Frequent coughing or chronic constipation can put strain on the abdominal muscles and eventually weaken them.
- Have a family history of abdominal hernias.
- Have had previous surgeries — Any operation on your abdomen can weaken the abdominal wall.
- Have had one or more pregnancies — Being pregnant and giving birth puts a great deal of strain on the abdominal muscles. Multiple pregnancies increase your risk.
- Lift heavy weights or work in a job that requires heavy lifting — Too much strain on the abdominal muscles from lifting can lead to an epigastric hernia.
Complications of epigastric hernia
If an epigastric hernia continues to grow, it can cause more discomfort. Rarely, it can lead to serious complications.
If tissue from the large intestine enters the hernial sac, it can get trapped and lead to:
- A blockage in your intestine.
- Sudden pain.
- Tissue damage from reduced blood supply.
- Vomiting.
If your epigastric hernia becomes strangulated (squeezed) in the hernia pouch, it is a medical emergency. You will need emergency surgery. In the worst-case scenario, a strangulated hernia could be life-threatening.
How can I reduce risks of epigastric hernia?
You may not be able to prevent getting an epigastric hernia.
But you can reduce your risks by making healthy lifestyle choices by trying to:
- Avoid alcohol.
- Drink plenty of water to avoid constipation.
- Eat a high-fiber diet to keep your bowels regular and avoid straining.
- Manage your weight.
- Quit smoking.
- Strengthen your core muscles with abdominal workouts.
- Use proper lifting techniques when working out.
What Are the Signs and Symptoms of Epigastric Hernia?
Epigastric hernia symptoms can feel subtle. The hernia is often small, and it doesn’t always cause pain.
Symptoms of epigastric hernias include:
- An ache in the middle of your upper belly.
- A bulge in your upper belly that gets smaller or goes away when you sit down.
- Pain when the fat gets pinched in the abdominal wall.
- Sharp pain when you strain, cough, or lift a heavy object.
- A small lump under the skin between your belly button and breastbone.
When should I see a doctor about epigastric hernia symptoms?
You should see a provider if your hernia symptoms get worse. If pain from the hernia interferes with your daily activities, you should get it checked out.
You should go to the nearest emergency department (ED) if you have:
- A blue or purple color in the bulging area.
- Nausea.
- Severe or sudden pain.
- Vomiting.
An epigastric hernia will not go away on its own. But it may stay the same size and not cause much discomfort.
But if the epigastric hernia gets worse or more painful, you will need surgery to repair it.
How Do You Diagnose Epigastric Hernia?
If you think you may have an epigastric hernia, see your primary care provider (PCP). They may refer you to a gastroenterologist or a general surgeon.
To diagnose an epigastric hernia, your provider will ask you about your medical history. They will perform a physical exam, pressing on your belly to check for the hernia. Usually, a physical exam is enough to diagnose an epigastric hernia.
Tests to diagnose epigastric hernia
If your doctor isn’t certain whether you have an epigastric hernia, they may order one or more of the following tests:
How Do You Treat an Epigastric Hernia?
The goal of epigastric hernia treatment is to remove the hernia and prevent it from coming back.
If your hernia doesn’t bother you, and it’s not getting any bigger, your doctor may delay treatment. They refer to this strategy as watchful waiting. They will want to see you for regular checkups to see if the hernia has gotten bigger.
Surgery is the only treatment for an epigastric hernia. There are no medicines or lifestyle changes that can cure it.
Epigastric hernia surgery may be an open or minimally invasive procedure. Both methods work well. The type of repair may depend on the size of the hernia and whether you’ve had hernia surgery before. Your age and overall health are also factors.
Your doctor may use a piece of surgical mesh to reinforce the abdominal wall. The mesh will help keep another hernia from forming.
Open surgery for epigastric hernia
If you have a strangulated hernia, you will need open surgery. It may also be the best choice for a large or complex hernia.
You will receive anesthesia before the surgery. Your doctor will talk to you about what kind of anesthesia will be best for your procedure.
With general anesthesia, you will be asleep and pain-free for the operation.
With local anesthesia, you will be awake but pain-free during the surgery. Your doctor will give you another type of medicine to relax you.
During open surgery, the surgeon will:
- Make an incision near the hernia.
- Find the hernia and separate it from the tissues around it.
- Remove the hernia sac.
- Gently push the bulging tissue — fat or intestine — back into the abdomen.
- Sew the tissue along the muscle edges back together.
For open mesh hernia repair, the surgeon will:
- Remove the hernia sac.
- Place a mesh patch over the weak area.
- Using sutures, attach the mesh to the tissue surrounding the hernia. The mesh will extend an inch or more beyond the hernia’s edges. The mesh will make the abdominal wall stronger and a hernia less like to happen again.
Minimally invasive (laparoscopic or robotic) hernia repair
If you have a high risk of wound infection, your doctor may recommend a laparoscopic procedure. Your chances of wound complication may be slightly lower than with open surgery.
For minimally invasive hernia repair, your doctor will:
- Make several small cuts in the abdomen.
- Insert hollow tubes or ports into the openings.
- Place a lighted camera and small surgical tools into the tubes.
- Inflate the belly with carbon dioxide gas to make it easier for doctors to see the hernia.
- Monitor the operation from a video screen.
- If needed, suture mesh around the hernia site.
- Close the incisions.
Robotic surgery for epigastric hernia
Your doctor may recommend a robotic approach to your hernia surgery.
Robotic procedures are very similar to regular laparoscopic operations. The difference is that robotic arms handle the surgical instruments. The surgeon controls the robotic device from a computer console in the operating room.
Robotic surgery allows for greater precision in certain procedures.
How effective is treatment?
Your doctor will recommend the best type of surgery for your epigastric hernia. It will likely depend on the size and complexity of your hernia. Both open and minimally invasive surgeries have similar long-term results.
Most people recover well after surgery for an epigastric hernia. It’s a common, very effective procedure. The risk of the hernia returning is low.
How long does it take to recover after surgery for epigastric hernia?
Most epigastric hernia surgeries are outpatient procedures. That means you’ll go home the same day as the surgery. If the hernia was very large or there were any complications, you might need to stay in the hospital overnight.
Your doctor will give you instructions on how to care for your wound. They will let you know when you can shower, drive, and go back to work.
Most people can resume normal activities in two to four weeks after the operation. You shouldn’t lift anything heavy for at least six weeks. Ask your doctor when it’s safe to return to normal activities.
What are the risks of epigastric hernia surgery?
Hernia surgery is a common, safe procedure.
But there are risks involved in any surgery with anesthesia, including:
- Allergic reaction to anesthesia.
- Bleeding.
- Blood clots.
- Breathing difficulties.
- Chest infection.
- Injury to other organs in your abdomen.
- Pneumonia.
It’s possible — but rare — for an epigastric hernia to come back after surgery. You can reduce your risk of recurrence by making healthy lifestyle choices. Maintaining a healthy weight, not smoking, and exercising can all help.
When should I call the doctor after hernia surgery?
Recovery from epigastric hernia surgery is usually routine. However, you should call your doctor if you have any of the following symptoms:
- A bad smell from your incision.
- Chills.
- Cramps in your stomach.
- High fever (over 101 F).
- Increased drainage from your incision.
- No bowel movements for three days.
- Severe pain.
- The skin around the surgery site turns a darker color (blue, black, purple).
