Epigastric Hernia: Get the Facts

A hernia is a condition in which some part of an internal organ grows through an opening and protrudes to some other area, thereby altering its normal location.

There are many types of hernia, but the epigastric hernia is the most common form. An epigastric hernia occurs when abdominal tissue squeezes through a weakness in the abdominal muscle. In an epigastric hernia, the fibrous tissue located between the belly button and the breastbone is weakened. This type of hernia is more common in infants as a congenital condition and is quite similar to an umbilical hernia. Location is what distinguishes them from each other.

An umbilical hernia is present around the belly button, while an epigastric hernia is present in the middle of the belly button and the chest. It is possible for an umbilical hernia to heal without any treatment as the infant grows, because the abdominal muscles get strengthened over time. The main cause of an umbilical hernia is the incomplete closing of the abdominal fibrous tissue during fetal development. Sometimes, the trapping or incarceration of a portion of intra-abdominal fat can be the cause of this condition.

Like an umbilical hernia, an epigastric hernia is also very small, and only the lining of the abdominal cavity or the peritoneum squeezes through the abdominal muscle. However, in severe cases, some parts of the organ may protrude through a weak opening in the muscle. The best way to identify an epigastric hernia is by noticing the abdomen of the child as he or she passes stool, cries, or bears down, because if the child has this condition, a small bump (filled with fat or fluid) may be seen bulging out from within the abdomen. The bump sinks back into the abdomen as soon as the child relaxes. Usually, an epigastric hernia is an asymptomatic condition and therefore has no symptoms. However, in some children, there might be mild to severe pain in the affected site.

Diagnosis of Epigastric Hernia

Epigastric hernias are reducible. They mainly become noticeable when the patient is laughing, crying, straining during a bowel movement, or doing another activity that puts pressure on the abdomen. When a hernia is visible, it is easy to diagnose and often requires no testing other than a physical examination.

Treatment of Epigastric Hernia

Unlike umbilical hernia, an epigastric hernia cannot heal on its own and requires surgery. The surgery can, however, be delayed until the child is a bit older, provided that there is no medical emergency. There are many treatment options that can be used for an epigastric hernia, but these options are determined by the age of the patient and the severity of the condition. Toddlers have more strength in tolerating a surgery than infants.

The severity of the condition is determined by the entrapment of the part of the intestine. If fat is entrapped, then it is not severe. However, if the protrusion entraps the intestine, then the condition is severe as it can lead to damage or blockage of the intestine. This severe condition can only be treated with an emergency surgery because the blood flow to the intestine can be compromised in such a situation. If pain occurs, it can be controlled by giving over-the-counter (OTC) pain medications, including children’s Advil and Tylenol.

When Epigastric Hernia Becomes an Emergency

A hernia becomes a condition requiring immediate attention when it gets stuck in the “out” position, a condition known as "incarcerated hernia." Although it is not a medical emergency, it should be diagnosed and treated as soon as possible.

However, an incarcerated hernia can become a medical emergency when it gets strangulated and the tissue that bulges outside of the muscle lacks blood supply. As a result, the tissue that bulges through the hernia can die.

A strangulated hernia is deep red or purple in color. With a strangulated hernia, the person may experience severe pain. Sometimes, the pain is not prominent, and other symptoms such as nausea, diarrhea, vomiting, and abdominal swelling are present.

Epigastric Hernia Surgery

An epigastric hernia surgery is performed using local anesthesia, which numbs the area to make the procedure painless. Parents need to prepare their children for the surgery to ease their stress. This surgery is done by a pediatric colorectal specialist or a general surgeon.

After anesthesia is administered, the doctor begins the surgery by making an incision on either side of the hernia. He then inserts a laparoscope and additional surgical instruments into the incisions. The surgeon then isolates the area of the abdominal lining that is protruding through the muscle.

The hernia sac is then returned to its proper position. After that, the muscle defect is repaired. If the muscle has a small defect, it is closed with sutures that stay in place forever and inhibit the hernia from returning. If the defects are quite large, a mesh graft is used instead of suturing to cover the hole. Like sutures, the mesh graft also stays forever and prevents the hernia from recurring. Sometimes, using a mesh is not appropriate for certain patients.

Your doctor will examine you to find which method works best for you. After placing the mesh, stitching the muscle, and removing the laparoscope, the incision is closed with sutures or Steri-Strips.

Recovering from Epigastric Hernia Surgery

Often, hernia patients return to their normal routine within two to four weeks after surgery. However, you need to observe precautions to protect the incision during this time. The child needs to keep the Steri-Strips in place after the surgery for about 10 days. The child is not allowed to go for a swim or take a tub bath until the incisions are completely healed. However, the child is allowed to take a shower to maintain cleanliness and hygiene. Moreover, there should be no strenuous physical activity for almost two weeks post-surgery. A postoperative visit should be made after two weeks so that the doctor can follow up on the progress of the patient and guide him or her accordingly.

You should be careful with your incisions when you:

• move
• cough
• sneeze
• cry 
• vomit
• bear down during a bowel movement

An epigastric hernia is mainly due to a congenital disorder that might have occurred during the time of birth. It can cause abdominal strain and even intense pressure on the muscle wall, which sometimes becomes a critical health issue. Epigastric hernias are the ones that are acute and very painful. To treat an epigastric hernia, surgery is necessary.

Lifestyle Modifications for Epigastric Hernia 

When one has epigastric hernia, it is important to maintain a diet suited to your condition and avoid any gastric disturbances that can cause or worsen pain and other symptoms. 

The diet recommended for persons with epigastric hernia is one that is high in protein and low in fat. The reverse, or a diet that is high in fat and low in protein, should be avoided, as it can weaken the stomach walls and worsen epigastric hernia. Protein-rich chicken, tuna, and cottage cheese are preferred, and low-fat milk and other low-fat daily products should be chosen to control one's fat intake. Foods rich in fiber, such as fruits, vegetables, beans, and whole grains prevent constipation and thus help prevent epigastric hernia.

Alcohol must be completely avoided, as it is dangerous for an epigastric hernia patient. Stress, which can contributes to acid reflux and stomachaches, should also be avoided, or managed through relaxation techniques such as meditation, breathing exercises, and yoga.

Loose clothes that do not compress the hernia site should be worn, and protect the area from any heat or pressure. One should also take care not to exercise, sleep, lie down, or bend after a meal. Large meals should also be avoided.   

After completely recovering from epigastric hernia surgery, regaining muscle strength in the abdomen is important, although one should start off with light exercises that have been given prior clearance by your doctor. Regular exercise will also help you shed excess weight, which can exert added pressure on your healed hernia and stomach muscles.  

Maintaining a healthy weight through a good diet and gaining good muscle tone, especially in the abdominal area, through exercise are also effective ways to prevent epigastric hernia. When lifting objects or weights, use the legs and bend from the knees rather than the waist. 

Words of Advice

To avoid developing a hernia, one needs to take care and observe these pieces of advice:

• Do not smoke or quit smoking, to prevent respiratory ailments that can lead to epigastric hernia
• Maintain a healthy weight, or shed excess weight  
• Never gain weight or lose weight too quickly
• Avoid lifting objects that are too heavy, and bend from the knees when lifting
• Get treatment for any allergies and illness that cause you to cough or vomit frequently

Follow a regular diet, exercise, and consult doctors in case of any health issue.