Brief overview
- Symptoms: Often asymptomatic, possibly pain, pulling or pressure when tightening the abdominal muscles. Sudden severe pain, nausea and vomiting indicate possible life-threatening entrapment of organs in hernia sac.
- Treatment: no treatment for small hernias without symptoms, surgery for larger hernias or in an emergency if organs are trapped
- Causes and risk factors: Congenital or acquired connective tissue weakness, smaller hernias may enlarge when lifting heavy loads, pressing or coughing hard; risk factors: Obesity, pregnancy, high pressure in the abdomen due to tumors or water retention; runs in families.
- Diagnosis: palpation of the abdomen with and without coughing or straining, rarely additional ultrasound examination
- Prognosis: Usually harmless disease without treatment in case of small hernias, in case of larger hernias well curable after surgery with sufficient rest for recovery
- Prevention: Avoid risk factors like overweight, pay attention to good lifting technique when lifting heavy loads
What is an epigastric hernia?
A hernia is either congenital or acquired later. Epigastric hernia occurs in children and adults, typically between the sternum and the belly button – sometimes in several places at once.
Epigastric hernia is distinguished from inguinal hernia and the so-called rectus diastasis. In inguinal hernia, which occurs in male infants and young children, a connection between the scrotum and the abdominal cavity remains due to the late migration of the testicles into the scrotum during the first year of life. In some cases, organs slip into this connection and the condition is called inguinal hernia (inguinal hernia).
In rectus diastasis, the left and right strands of the straight abdominal muscles (six-pack, rectus abdominis muscle) diverge. This results in an equal elevation of the midline (linea alba) between the navel and sternum. This is not a hernia because there is no hernial sac. There is a risk of incarceration of viscera. Surgery is primarily for aesthetic reasons.
Epigastric hernia: What are the symptoms?
An abdominal wall hernia often causes no discomfort or pain. Nevertheless, it is advisable to consult a doctor for further clarification. Typical complaints of an abdominal wall hernia are usually chronic pressure discomfort in the upper abdomen or a burning, pain or pulling sensation. The discomfort often intensifies when sitting up, sneezing or having a bowel movement.
A major abdominal wall hernia is often clearly visible and often psychologically stressful for those affected.
Symptoms such as sudden pain in the area of the hernia indicate that abdominal organs are trapped in the hernia sac. It is possible that the blood supply to the organ is interrupted – which may be life-threatening. In this case, see a doctor urgently. Nausea and vomiting are other typical symptoms.
In case of sudden severe pain in the abdomen with nausea and vomiting, do not let any time pass and, in case of doubt, notify the emergency medical services. Apart from a hernia of the abdominal wall, these symptoms may conceal other serious or life-threatening illnesses.
With an epigastric hernia, there is only a low overall risk of entrapment of abdominal organs. Smaller upper abdominal hernias, which make up the majority of cases, usually remain without symptoms. The doctor usually recommends treatment only if there are symptoms and if organs become trapped in a larger hernia, which is a medical emergency.
In this case, the surgeon removes the hernia sac during surgery and relocates the hernia sac contents back into the abdomen. The surgeon often uses plastic mesh to reinforce the abdominal wall to prevent another hernia sac. Often, the suture is enough to close the hernia in the long term.
An incarcerated hernia is usually an emergency, and emergency medical services should be called.
Causes and risk factors
Although some children are born with a diagnosis of epigastric hernia, it actually tends to occur in older people. This is because the increasing weakness of the connective tissue in old age favors hernia conditions. Also in overweight people, the connective tissue is often weakened, so that there is an increased incidence of tearing and hernias.
Tumors or water accumulation in the abdominal cavity in some diseases (a “fat” or “distended abdomen”) also promote abdominal wall hernias and other hernias. Pregnant women are also more often affected. Heavy lifting, heavy coughing or pushing are factors that often enlarge an existing small hernia.
Examinations and diagnosis
If you suspect you are suffering from an epigastric hernia, it is best to see your family doctor or a gastroenterologist. He or she will first try to talk to you (anamnesis). This is followed by a physical examination. The doctor will ask the patient to cough or to tense the abdomen in order to feel for changes. Increased abdominal pressure usually allows a bulge to be felt. This bulging hernia sac under pressure confirms to the physician the diagnosis of abdominal wall hernia.
An ultrasound examination is additionally necessary in only a few cases.
Epigastric hernia: course of the disease and prognosis
Behavior after abdominal wall hernia surgery
Abdominal wall hernia surgery (abdominal wall hernia surgery) is usually not a major procedure. However, after the surgery, the wound must have time to heal in peace so that new hernias do not occur.
Depending on the size of the hernia operated on, doctors usually recommend avoiding physical activity for two to three weeks. For up to three months after surgery, doctors advise against heavy lifting.
Sick leave is usually given for a period of between seven and 14 days, depending on the size of the operation and how it progresses. How long you are actually out of work after abdominal wall hernia surgery depends, of course, on the type of activity. Heavy physical work is not possible for up to three months afterwards.
Prevention
Basically, for prevention, it makes sense to avoid risk factors such as being very overweight or heavy lifting. Appropriate lifting techniques (“from a squatting position instead of a standing position”) or abdominal belts for lifting heavy loads also help.
