Epigastric Hernia

An epigastric hernia is a type of ventral hernia that develops in the upper middle abdomen between the belly button and breastbone. It occurs when fatty tissue or, in some cases, part of the intestine pushes through a weak area in the abdominal wall.

Some epigastric hernias are small and cause few or no symptoms. Others may produce a noticeable lump, tenderness, or pain that becomes more noticeable during coughing, lifting, or straining.

What Is an Epigastric Hernia?

The epigastric region is the upper middle portion of the abdomen between the navel and the lower end of the breastbone.

Running down the center of the abdominal wall is a band of connective tissue called the linea alba. An epigastric hernia can develop when fatty tissue or intestine pushes through a weak spot or opening in this tissue.

Epigastric hernias may be small, and some people have more than one.

Learn about umbilical hernias, which develop around the belly button rather than higher in the abdomen.

What Does an Epigastric Hernia Look or Feel Like?

The most noticeable sign is often a small lump or bulge in the upper abdomen.

Symptoms may include:

• A lump between the belly button and breastbone
• A bulge that becomes more noticeable while standing or straining
• Dull aching in the upper abdomen
• Sharp pain with coughing, lifting, or straining
• Tenderness around the hernia
• Discomfort during certain movements or activities

Some epigastric hernias cause no symptoms and are discovered during a routine examination.

What Causes an Epigastric Hernia?

An epigastric hernia develops when tissue pushes through a weakened area in the abdominal wall.

The exact reason the weakness develops is not always clear. Some epigastric hernias are present from birth, while others develop later in life.

Factors that can increase pressure on the abdominal wall may include:

• Chronic coughing
• Constipation and repeated straining
• Pregnancy
• Obesity
• Repeated heavy lifting
• Age-related weakening of abdominal tissues

These factors do not necessarily cause a hernia by themselves, but increased abdominal pressure may contribute when an area of the abdominal wall is already vulnerable.

Is an Epigastric Hernia the Same as an Umbilical Hernia?

No. Both are ventral hernias, but they occur in different locations.

An epigastric hernia develops above the belly button along the upper middle abdominal wall.

An umbilical hernia develops at or around the belly button.

Because both may appear as abdominal lumps, an examination can help determine which type of hernia is present.

How Is an Epigastric Hernia Diagnosed?

Diagnosis usually begins with a physical examination.

A provider may examine the abdomen while you are standing or lying down and may ask you to cough or strain so the hernia becomes easier to identify.

In some cases, imaging may be used to determine the location or size of the hernia or to evaluate another possible cause of the abdominal lump.

Imaging may include:

• Ultrasound
• CT scan
• MRI in selected cases

Does an Epigastric Hernia Need Surgery?

Not every epigastric hernia needs immediate surgery.

A small hernia that is not painful or bothersome may sometimes be monitored. However, an epigastric hernia generally does not close on its own.

Surgical repair may be considered when:

• The hernia causes pain or discomfort
• The bulge is increasing in size
• Symptoms interfere with everyday activities
• The hernia becomes difficult or impossible to push back in
• There is concern about incarceration or strangulation
• The patient prefers definitive repair after discussing the risks and benefits

The appropriate treatment depends on the size and location of the hernia, symptoms, overall health, and other individual factors.

How Is an Epigastric Hernia Repaired?

Epigastric hernias may be repaired using open or minimally invasive surgical techniques.

Open Epigastric Hernia Repair

During open repair, the surgeon makes an incision near the hernia, returns the protruding tissue to the abdomen, and closes the defect in the abdominal wall.

Depending on the size and characteristics of the hernia, sutures or surgical mesh may be used to reinforce the repair.

Laparoscopic or Robotic Hernia Repair

Some epigastric hernias may be repaired using laparoscopic or robotic-assisted techniques.

These minimally invasive approaches use small incisions and specialized instruments to access and repair the abdominal wall.

The best surgical approach depends on factors such as the size and location of the hernia, whether multiple defects are present, previous abdominal surgeries, and the patient's overall health.

Learn more about laparoscopic hernia surgery.

What Is Recovery Like After Epigastric Hernia Surgery?

Recovery varies depending on the size of the hernia, surgical technique, complexity of the repair, and the patient's overall health.

Patients may receive instructions regarding:

• Walking and light activity
• Incision care
• Pain management
• Lifting restrictions
• Returning to work
• Resuming exercise
• Follow-up appointments

Your surgeon will provide individualized recommendations about when you can safely return to lifting, strenuous exercise, work, and other normal activities.

Can an Epigastric Hernia Become an Emergency?

Most epigastric hernias are not emergencies, but complications can occur.

An incarcerated hernia occurs when tissue becomes trapped and cannot return to the abdomen. A strangulated hernia occurs when the blood supply to trapped tissue becomes compromised.

Seek prompt medical attention for symptoms such as:

• Sudden or severe abdominal pain
• A painful or firm hernia that does not go back in
• Nausea or vomiting
• Rapidly worsening symptoms
• Changes in the skin over the hernia

These symptoms require urgent medical evaluation.

Epigastric Hernia Surgery in the East Bay

Hernia Innovations provides evaluation and surgical treatment for epigastric and other abdominal wall hernias throughout the East Bay.

Our board-certified surgeons evaluate each patient's symptoms, hernia size and location, medical history, and treatment goals to determine whether monitoring or surgical repair may be appropriate.

When surgery is recommended, treatment may include open, laparoscopic, or robotic-assisted repair based on the patient's individual condition.

Call (925) 940-1025 or request an appointment online.

Frequently Asked Questions About Epigastric Hernias

Can an epigastric hernia go away on its own?

Epigastric hernias generally do not close on their own. However, a small hernia that does not cause symptoms may not require immediate surgery and may sometimes be monitored.

Where is an epigastric hernia located?

An epigastric hernia develops in the upper middle abdomen between the belly button and breastbone, usually along the linea alba in the center of the abdominal wall.

What does an epigastric hernia feel like?

An epigastric hernia may feel like a small lump or bulge in the upper abdomen. Some people experience no discomfort, while others may have aching, tenderness, or sharp pain during coughing, lifting, or straining.

Is an epigastric hernia dangerous?

Many epigastric hernias are not dangerous. However, complications can occur if tissue becomes trapped or loses its blood supply. Sudden severe pain, vomiting, or a firm and painful hernia should be evaluated promptly.

What is the difference between an epigastric and umbilical hernia?

The primary difference is location. An epigastric hernia occurs above the belly button in the upper middle abdomen, while an umbilical hernia develops at or around the belly button.