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Overview

What Is an Epigastric Hernia?

An epigastric hernia is a weakness or opening in the upper midline of the abdominal wall, usually between the breastbone and belly button. Fat or other tissue can push through this opening and create a small bulge in the epigastric region. It is not a hernia inside the stomach, although people may describe it as a stomach hernia or abdominal hernia. An epigastric hernia can develop in children or adults.

Symptoms

Epigastric Hernia Symptoms

  • A small lump or bulge in the upper middle abdomen.
  • Tenderness over the bulge.
  • Epigastric pain.
  • Epigastric discomfort during movement or activity.
  • Pain that increases with coughing, lifting, or straining.
  • No noticeable symptoms.

Causes

What Causes an Epigastric Hernia?

An epigastric hernia develops when tissue pushes through a weak spot in the linea alba, the band of connective tissue along the upper midline of the abdomen. This weakness may be present from birth or develop over time. Increased pressure inside the abdomen can make the bulge more noticeable, but no single activity or condition causes every abdominal hernia.

  • A congenital or developmental weakness in the abdominal wall.
  • Repeated heavy lifting or straining.
  • Chronic coughing or frequent constipation.
  • Pregnancy or significant weight changes.
  • Previous abdominal surgery or injury that weakens the abdominal wall.

Risk Factors

Epigastric Hernia Risk Factors

Structural factors

These include a family tendency toward hernias, a weakness present from birth, age-related tissue changes, and previous damage to the abdominal wall.

Pressure-related factors

Obesity, pregnancy, heavy lifting, chronic cough, constipation, and repeated straining can increase pressure on the abdominal wall.

Complications

Epigastric Hernia Complications

Many epigastric hernias contain only fat and remain stable, but some gradually enlarge or become painful. A hernia is incarcerated when its contents become trapped and cannot be pushed back into the abdomen. It is strangulated when the trapped tissue loses its blood supply, which is an emergency requiring urgent treatment.

Urgent symptoms

A trapped hernia needs prompt care

Get urgent medical help if you have:

  • Sudden severe or increasing pain.
  • A firm or discolored bulge.
  • Nausea or vomiting.
  • Abdominal swelling.
  • Inability to pass stool or gas.

Diagnosis

How Is an Epigastric Hernia Diagnosed?

A clinician usually diagnoses an epigastric hernia by asking about your symptoms and examining your abdomen. The examination may take place while you are standing, coughing, or straining so the bulge is easier to see or feel. The clinician may also check whether it is tender and whether it can be gently pushed back, or reduced.

When is imaging needed?

Ultrasound or CT may be considered when the lump is small or difficult to feel, the diagnosis is uncertain, or complications are suspected. Imaging can help distinguish an epigastric hernia from other causes of upper-abdominal pain or a lump, but routine imaging is not always necessary.

Treatment & Management

Epigastric Hernia Treatment and Management

Small epigastric hernias that cause no symptoms may be monitored with guidance from a clinician. Surgery is the only definitive repair and is commonly considered when the hernia causes pain, enlarges, limits activity, or has a concern for trapping. The best approach depends on the hernia and the person’s overall health.

ApproachWhen it may be consideredWhat it involvesKey considerations
ObservationSmall, reducible, symptom-free herniaRegular clinical monitoring and attention to changesDoes not close the defect; symptoms or size may change
Open repairMany symptomatic or accessible herniasAn incision over the hernia with closure of the abdominal-wall defect, sometimes using meshApproach depends on defect size, location, and surgeon assessment
Minimally invasive repairSelected patients with suitable hernia featuresRepair through small incisions using laparoscopic or robotic techniquesMay not be appropriate for every hernia and still carries surgical risks

Before surgery, discuss your health conditions and medicines with the surgical team and follow instructions about eating, activity, and preparation. Recovery usually involves a gradual return to normal activity according to your surgeon’s advice. Report worsening pain, fever, redness around the wound, or drainage.

Outlook and Prognosis

Outlook for an Epigastric Hernia

Many epigastric hernias are treatable, and elective repair often provides durable relief. However, an epigastric hernia will not usually close on its own and may enlarge or become painful over time. Recovery and the risk of recurrence vary with the repair, hernia size, overall health, and activity guidance.

When Should You See a Doctor

When Should You See a Doctor?

Arrange a medical appointment for a new lump above the belly button, persistent epigastric pain or discomfort, a growing bulge, or symptoms that interfere with activity. A clinician can distinguish an epigastric hernia from an umbilical hernia or another abdominal condition, including other causes of pain near the navel or upper abdomen.

Seek urgent care

Do not wait with severe symptoms

Seek urgent medical help if you have:

  • Severe or rapidly worsening pain.
  • A hard or discolored bulge.
  • A bulge that cannot be gently pushed back.
  • Vomiting.
  • Abdominal swelling.
  • Inability to pass stool or gas.

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