An epigastric hernia occurs when abdominal contents, often fatty tissue or a part of the intestine, push through a weak spot in the abdominal wall. This protrusion happens specifically in the midline area, known as the linea alba, located between the lower part of the rib cage and the belly button. While some epigastric hernias are small and cause no noticeable symptoms, others create a visible bulge and result in discomfort. The severity of symptoms depends largely on the size of the defect and the tissue that has pushed through the opening.
The Primary Physical Signs
The most common sign of an epigastric hernia is a palpable or visible lump in the upper middle abdomen. This bulge is often small, soft to the touch, and becomes more noticeable when standing or engaging in activities that increase abdominal pressure, such as coughing.
A key characteristic is that the bulge may temporarily disappear or reduce in size when the person lies down or gently pushes on it, a feature known as reducibility. Many individuals also experience localized pain or discomfort directly at the hernia site. This pain is described as a dull, intermittent ache that may worsen after physical activity.
When Discomfort Increases
Activities that increase pressure within the abdominal cavity, such as heavy lifting or strenuous exercise, tend to exacerbate symptoms and make the hernia bulge more prominent. Actions like sneezing, coughing, or straining during a bowel movement can suddenly push more tissue into the defect, leading to a temporary spike in discomfort.
Beyond the localized pain, some people experience secondary symptoms related to digestive function, particularly with larger hernias. A feeling of uncomfortable fullness or mild nausea can occur, especially following a large meal. This discomfort is related to pressure changes caused by the hernia near the digestive tract.
Symptoms Requiring Immediate Care
A sudden and severe change in symptoms can signal a serious medical complication, known as an incarcerated or strangulated hernia. Incarceration occurs when the herniated tissue becomes trapped outside the abdominal wall and can no longer be pushed back inside. The primary sign of this is a bulge that becomes firm, very tender, and irreducible.
Strangulation is a more dangerous progression where the blood supply to the trapped tissue is cut off, leading to tissue death. Symptoms escalate rapidly and include sudden, intense, and worsening pain at the hernia site, often accompanied by signs of bowel obstruction. These signs include persistent vomiting, abdominal distension, and the inability to pass gas or have a bowel movement. A change in the skin color over the bulge, such as a purplish or reddish hue, or the development of a fever, are severe indicators of strangulation that require emergency medical care.
Consulting a Healthcare Provider
Anyone who notices a persistent lump or experiences recurring pain in the upper middle abdomen should seek an evaluation from a healthcare provider. A medical professional will perform a physical examination, often asking the person to cough or strain to better identify the hernia. This examination determines the size and nature of the defect and rules out other possible causes of the symptoms. The management of a symptomatic epigastric hernia typically involves surgical repair, known as a herniorrhaphy, to prevent complications like incarceration or strangulation. Even if symptoms are mild, consultation allows for a discussion of the best course of action.