Epigastric Hernia

Overview

An epigastric hernia is a small bulge that forms in the upper middle part of your belly, between your belly button and the bottom of your breastbone. It happens when a tiny gap or weak spot appears in the firm tissue that runs down the centre of your tummy muscles (this tissue is called the abdominal wall). A bit of the soft fat that lies just under the skin, and sometimes part of the bowel, can push through that gap. You may feel it as a small lump under the skin. Unlike some other hernias, an epigastric hernia is not caused by anything you did wrong, and it is not a sign that you are unhealthy.

Yes, epigastric hernias are fairly common. They are one of the more frequent types of hernia seen in general practice, especially in adults. Many are small and never cause serious problems.

They can affect anyone, including children and babies. In adults they are more often noticed between the ages of 20 and 60, and they tend to be more common in men. They are also more likely in people who are overweight, who do a lot of heavy lifting, or who have repeated coughing or straining.

Symptoms

Common symptoms

• A small lump or swelling in the upper middle of your belly, between the belly button and the breastbone
• The lump may be easier to feel when you sit up, cough, strain or lift something heavy
• Mild aching or discomfort around the lump, especially after eating, bending or physical activity
• The lump may feel soft and may be gently pushable back in, though sometimes it stays put
• Sometimes there are no symptoms at all and the lump is only found by chance

Symptoms in children

• A small, usually painless lump in the upper middle of the tummy
• Often noticed when the child cries, coughs or strains
• Most children with a small epigastric hernia are otherwise well and growing normally
• Any lump that is hard, tender, or that comes with vomiting or distress needs urgent medical review

Symptoms in older adults

• The lump may gradually get bigger over the years
• More chance of discomfort or a dragging ache, particularly with activity
• Symptoms may be confused with indigestion or stomach problems, so it is worth pointing the lump out to your doctor
• Weaker muscles and long-term coughing or constipation can make hernias more noticeable

Causes

Main causes

• A small gap or weak point in the tissue that runs down the middle of the tummy muscles, often there from birth
• Increased pressure inside the belly over time, which pushes fat or tissue through the gap
• Repeated straining from coughing, constipation or heavy lifting
• Being overweight, which raises pressure inside the abdomen

Risk factors

• Being overweight or obese
• A job or hobby that involves heavy lifting or repeated straining
• Long-term cough, such as from smoking or a chronic lung condition
• Constipation that causes frequent straining
• Pregnancy, which stretches and pressures the tummy wall
• A family history of hernias
• Previous surgery on the abdomen
• Being male and being middle-aged

When to see a doctor

See a doctor urgently if:

• The lump becomes hard, very tender or cannot be pushed back in
• You have severe belly pain, vomiting, or cannot pass wind or stools
• The skin over the lump changes colour or becomes hot and red
• The lump grows quickly or you feel generally unwell

Book a routine appointment if:

• You notice a new lump in the upper middle of your belly
• The lump is uncomfortable or aches with activity
• The lump is getting bigger over weeks or months
• You are unsure what the lump is and want it checked

Diagnosis

In most cases your doctor can recognise an epigastric hernia simply by talking to you and examining your tummy. They will usually ask you to cough or sit up slightly while they feel the area, because this makes the small gap and lump easier to find. The examination is quick and painless. If anything is unclear, or if you have other tummy symptoms, they may arrange a scan.

Tests that may be done

• A physical examination of your abdomen, often while you cough or lift your head
• An ultrasound scan, which uses sound waves to look at the gap and the tissue inside it
• A CT or MRI scan, used less often, if the diagnosis is uncertain or surgery is being planned
• Blood tests or other checks only if your doctor suspects a different cause for your symptoms

What to expect at your appointment

You will usually lie on a couch while your doctor gently feels your tummy. They may ask you to cough or tense your stomach muscles. The appointment is short, and you can ask questions at any point. If a scan is needed, it is usually quick and does not hurt. You should hear the results within a few days to a couple of weeks, depending on your local service.

Treatment

Treatment depends on how much trouble the hernia is causing. Small hernias with no symptoms can often be left alone and simply watched. If the hernia is painful, growing, or affecting your daily life, your doctor may refer you to a surgeon to talk about repair. There is no medicine that closes the gap — but simple lifestyle changes can ease pressure on the tummy wall and reduce discomfort.

Self-care at home

• Keep to a healthy weight — losing extra weight lowers pressure inside the belly
• Avoid heavy lifting where you can, and learn safe lifting techniques (bend your knees, keep the load close, breathe out as you lift)
• Treat constipation by eating plenty of fibre, drinking enough water and staying active
• If you smoke, getting support to stop can reduce coughing that strains the tummy wall
• Support the area with your hand when you cough or sneeze if it feels uncomfortable
• Note any changes in the lump — its size, tenderness, or whether it can still be pushed back — so you can tell your doctor

Medical treatments

There is no medication that repairs a hernia. Painkillers available from a pharmacy may help with discomfort, and your pharmacist can advise on what is suitable for you, especially if you take other medicines or have other health conditions. Support garments such as a hernia belt are sometimes suggested for short-term comfort, but they do not fix the gap and should be discussed with your doctor or pharmacist first. Any medicine should be chosen with advice from a qualified healthcare professional.

When is surgery considered?

Surgery is usually considered when the hernia is painful, is getting bigger, is causing problems with eating or bowel habits, or if there is a risk of the tissue becoming trapped. It is also often offered to children with a hernia that has not closed on its own. The operation is usually straightforward: the surgeon closes the gap and may strengthen the area with a small piece of mesh. Many people go home the same day or the next day. Your surgeon will explain the benefits, the risks and the recovery time so you can decide together whether it is right for you.

Living with this condition

Most people with an epigastric hernia carry on with normal life. You may notice the lump from time to time, particularly after eating a big meal, coughing, or doing physical work. Keeping an eye on it and mentioning any changes at your next appointment is usually enough. If the lump starts to limit what you can do, that is a good moment to talk to your doctor about treatment options.

Lifestyle tips

• Stay active with gentle, regular exercise such as walking, swimming or cycling
• Build core strength gradually with advice from a physiotherapist if you are unsure what is safe
• Avoid sudden heavy lifting, and ask for help with moving furniture or heavy shopping
• Eat a balanced diet with plenty of fruit, vegetables and whole grains to avoid constipation
• Drink water regularly through the day
• Get support to stop smoking if you smoke, to reduce coughing
• Sleep well and manage stress, which can help you cope with discomfort

Diet and exercise

There is no special diet for a hernia, but eating well matters. Fibre-rich foods and enough fluids keep stools soft so you do not have to strain. Smaller, more frequent meals may feel more comfortable if a large meal makes the lump ache. For exercise, start gently and build up. Walking, swimming and light strength work are good choices. If a particular movement causes pain at the lump, ease off and mention it to your doctor or a physiotherapist. After surgery, follow your surgeon's advice about how much to lift and when to return to exercise.

Mental health and emotional wellbeing

Noticing a lump in your body can be worrying, and it is completely normal to feel anxious about it. Some people find the ache distracting or worry about it getting worse. Talking about your concerns with your doctor often helps, because understanding what is happening usually makes it feel less frightening. If worry is affecting your sleep, mood or daily life, tell your doctor — support is available, and you do not have to cope alone.

Prevention

You cannot always prevent an epigastric hernia, because the small gap in the muscle wall is often there from birth. But you can lower the pressure on your tummy wall, which may reduce the chance of a hernia getting bigger or causing trouble. Keeping a healthy weight, avoiding straining, treating constipation and not smoking are all sensible steps.

Screening programmes

There is no routine screening programme for epigastric hernias. The best approach is simply to check your own tummy from time to time and mention any new lump to your doctor.

Complications

If left untreated

• The hernia may slowly get bigger over time
• Discomfort or pain may increase with activity or after eating
• Rarely, bowel or fat can become trapped in the gap (an incarcerated hernia), which is painful and needs urgent treatment
• Very rarely, the trapped tissue can lose its blood supply (a strangulated hernia), which is a medical emergency
• Some people develop a small amount of fat trapped in the gap, which can be tender

Long-term outlook

The outlook is generally good. Many small epigastric hernias never cause serious problems and can simply be watched. If you need surgery, the operation is usually straightforward and most people recover well within a few weeks. The important thing is to know the warning signs of a trapped hernia, so you can get help quickly if they ever appear.

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