An epigastric hernia is a common abdominal wall defect located in the upper, central part of the abdomen, between the breastbone and the navel (the epigastrium). A hernia forms when an internal structure, typically fatty tissue or a small part of an organ, pushes through a weakened area in the muscle wall.
Understanding the Epigastric Hernia
An epigastric hernia appears along the linea alba, the vertical band of connective tissue running down the midline of the abdomen. A weakness in this fascia allows a gap to form, through which abdominal contents, most often pre-peritoneal fat, begin to protrude.
The protrusion occurs due to increased pressure within the abdominal cavity pushing the internal contents outward. While the hernia sac often contains fat, larger defects can sometimes involve the peritoneum or a segment of the intestine. Symptoms arise from the mechanical irritation or compression of tissue forced through this tight, fibrous opening.
Primary Sensations and Discomfort
The most recognizable sensation of an epigastric hernia is the presence of a palpable lump or bulge in the upper abdomen. This swelling is usually situated centrally between the sternum and the belly button. This lump is often described as feeling soft and may disappear when the person lies down or gently pushes on it, indicating it is a reducible hernia.
Pain is a frequent symptom, though many small epigastric hernias cause no discomfort. When pain is present, it is often a dull ache or persistent pressure localized to the site of the bulge. The discomfort can also manifest as a burning sensation or localized tenderness when the area is touched.
This pain sometimes radiates slightly but remains concentrated in the epigastric region. The feeling is frequently intermittent, meaning it comes and goes depending on physical activity or body position. This routine discomfort is generally manageable and is related to the pressure and stretching of the surrounding tissue.
Factors That Worsen Symptoms
Actions that significantly increase intra-abdominal pressure intensify the discomfort felt from an epigastric hernia. Physical exertion, such as heavy lifting or intense exercise, makes the pain more noticeable. This increased pressure forces more tissue through the fascial defect, causing greater tension and irritation.
Straining actions, including forceful coughing, sneezing, laughing, or bearing down during a bowel movement, also exacerbate symptoms. The pressure spike during these moments makes the bulge more prominent and the pain more acute. People often notice the hernia more when they are standing upright for long periods, as gravity contributes to the outward protrusion.
Conversely, symptoms frequently subside or disappear entirely when the person is lying flat on their back. This change in position reduces the gravitational pull and internal pressure on the abdominal wall, allowing the herniated contents to easily retreat back into the abdominal cavity.
Identifying Potential Complications
While most epigastric hernias cause routine discomfort, a sudden change in sensation signals a serious complication. Incarceration occurs when the herniated tissue becomes trapped outside the abdominal wall and cannot be pushed back in. This presents as a noticeable lump that is firm and unmoving, accompanied by severe, constant pain that does not improve with rest.
Strangulation is a further complication where the tight opening cuts off the trapped tissue’s blood supply. This medical emergency is characterized by a rapid onset of intense, sharp, and unrelenting pain in the upper abdomen. The skin over the lump may become discolored (reddish, purple, or darker) and the lump will be extremely tender.
Systemic symptoms such as nausea, vomiting, fever, and the inability to pass gas or stool can accompany a strangulated hernia, indicating potential bowel obstruction and tissue death. These sensations represent an immediate threat, requiring prompt surgical intervention.