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Health condition · Clinically reviewed

Epigastric hernia, a midline lump above the belly button, and when it needs fixing.

A small defect in the linea alba, common in adults. Many are watched safely - others benefit from a well-planned repair.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against Royal College of Surgeons, European Hernia Society and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including watch-and-wait, mesh repair and laparoscopic and robotic techniques.

Key facts

Epigastric hernia at a glance.

The essentials, in plain English - what it is, who gets one, and how it is managed in the UK today.

  • What it is

    A protrusion of preperitoneal fat, and sometimes abdominal contents, through a defect in the linea alba between the xiphoid and the umbilicus.

  • How common

    Common in adults - prevalence up to 5 per cent. More common in men than women, roughly 2 to 3 times, and typically first noticed between the 20s and 50s.

  • Size of defect

    Most defects are small, under 2 cm, and often only trap fat or omentum rather than bowel.

  • What drives it

    A congenital weakness of the linea alba plus chronic rises in intra-abdominal pressure - obesity, chronic cough, constipation, pregnancy or heavy lifting.

  • The main risk

    Incarceration and, rarely, strangulation of trapped contents - an acute painful, tender, non-reducible lump is a surgical emergency.

  • How it is fixed

    Small, asymptomatic hernias can often be watched. Symptomatic or enlarging hernias are usually repaired - mesh is preferred for anything but the smallest defects.

Why this guide matters

A clear plan, not a scary lump.

Most epigastric hernias behave predictably. The three points below shape everything else on this page.

  • Small and quiet can be watched

    Small, asymptomatic hernias found by chance often do not need surgery - the risk of a serious complication is generally low.

  • Symptoms and size drive repair

    Pain, enlargement, incarceration or patient preference all justify surgery, usually with mesh to reduce the chance of recurrence.

  • Sudden pain is different

    A tender, red, non-reducible lump with severe pain is a strangulation risk - a same-day emergency, not a wait-and-see problem.

How the diagnosis is made

From a new lump to a clear plan.

The steps a UK GP or general surgeon will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and lump timeline

    When was the lump first noticed, is it there all the time or only on straining, and does anything reduce it or bring it back.

  2. 02

    Assessing

    Symptom review

    Pain and discomfort at the site, any change in size with cough or standing, and any nausea or vomiting - the latter is uncommon.

  3. 03

    Assessing

    Pressure-raising factors

    Weight, chronic cough, constipation, pregnancy history, occupation and lifting - each shapes both diagnosis and later management.

  4. 04

    Confirming

    Inspection and palpation

    A focused abdominal exam in the midline above the umbilicus, with the patient lying and then standing, feeling for a defect and its edges.

  5. 05

    Confirming

    Valsalva manoeuvre

    Asking the patient to cough or bear down often makes a small hernia appear or enlarge - a simple and reliable bedside test.

  6. 06

    Imaging

    Ultrasound if uncertain

    Confirms the defect, measures its size and shows the contents - useful when the lump is small, intermittent or hard to feel.

  7. 07

    Imaging

    CT in selected cases

    Reserved for large, complex or recurrent hernias, preoperative planning, or when a complication such as strangulation is suspected.

Typical timeline: a first visit to a plan in a single appointment, imaging within days if needed.

Symptoms

What an epigastric hernia feels like.

A small midline lump, worse on straining, sometimes uncomfortable - and the features that mean it is time to act.

  • Midline upper-abdominal lump

    A bulge in the midline between the breastbone and the belly button - the classic finding.

  • Bulge worse with straining

    Larger with coughing, standing or lifting, and often smaller or gone when lying flat.

  • Reducible lump

    Many small hernias push back in with gentle pressure - a reassuring sign, though not a reason to ignore it.

  • Local pain or discomfort

    Aching or a dragging feeling at the site, especially after activity, meals or a long day.

  • Nausea or vomiting

    Uncommon in a simple epigastric hernia - if present, think about incarceration or another cause.

  • Often asymptomatic

    Many are picked up incidentally on examination or a scan for something else.

  • Non-reducible lump

    A hernia that will not push back in has become incarcerated - review the same day.

  • Red flag - strangulation

    Sudden severe pain with a tender, red, tense, irreducible lump - an emergency needing urgent surgery.

Treatment

How epigastric hernias are treated in the UK.

Watchful waiting for small, quiet hernias - mesh repair, laparoscopic or open, for anything symptomatic or enlarging.

  • Watch and wait

    For small, asymptomatic, incidental hernias - the risk of complications is generally low and observation is reasonable.

  • Lifestyle measures

    Weight loss, treating a chronic cough or constipation, avoiding heavy lifting and building core strength - they do not resolve the hernia but ease symptoms and support any repair.

  • Primary suture repair

    For very small defects, generally under 1 to 2 cm, in fit patients. A specialist general surgery decision made case by case.

  • Open mesh repair

    The preferred approach for anything but the smallest defects - reinforces the linea alba and reduces recurrence.

  • Laparoscopic or robotic repair

    Keyhole and robotic techniques, including eTEP, are options for larger or complex hernias in appropriately trained hands.

  • Transversus abdominis release

    A specialist commissioned technique for large or complex abdominal wall defects - offered by high-volume hernia units.

  • Emergency surgery

    For a strangulated hernia - urgent operation with assessment of trapped tissue and bowel resection if the blood supply is compromised.

  • Rehabilitation and follow-up

    Post-op advice to avoid heavy lifting for 4 to 6 weeks and specialist general surgery follow-up to check healing and prevent recurrence.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or general surgeon knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • Royal College of Surgeons of England. Commissioning guide - groin and abdominal wall hernias.

  • European Hernia Society. Guidelines on the treatment of ventral and epigastric hernias.

  • NICE Clinical Knowledge Summaries. Hernias - abdominal wall.

  • British Hernia Society. Position statements on mesh use and complex abdominal wall reconstruction.

Red flags

When an epigastric hernia needs urgent attention.

Most are manageable in a planned way. These are the situations that are not - and where same-day care matters.

  • Strangulation

    Sudden severe pain with a tender, red, tense and irreducible lump - a surgical emergency needing same-day hospital assessment.

  • Incarceration

    A hernia that will not push back in, even without severe pain, needs urgent review as it can progress to strangulation.

  • Nausea and vomiting

    Unusual in simple epigastric hernia - suggests obstruction of trapped bowel or another intra-abdominal cause.

  • Rapid enlargement

    A hernia that is growing quickly, or a new bulge nearby, deserves prompt surgical review.

  • Overlying skin changes

    Redness, thinning or ulceration over a hernia is uncommon and needs same-day assessment.

  • Signs of bowel obstruction

    Distension, absolute constipation, bilious vomiting or severe colicky pain - go to A&E.

  • Recurrence after previous repair

    A new or returning lump at or near a previous scar needs specialist re-assessment, not another cycle of watch and wait.

  • Uncertain diagnosis

    A midline lump that does not behave like a simple hernia - lipoma, diastasis, umbilical or incisional hernia - deserves imaging and a specialist view.

  • Pregnancy planning

    Discuss timing of any repair before or after pregnancy, as intra-abdominal pressure changes affect outcomes.

Living with it

A common problem, with a clear ladder.

Four things that make the biggest difference day to day - manage weight, treat pressure-raising triggers, lift sensibly and know when to be seen urgently.

A quiet reminder

Small, steady changes protect the repair.

None of these steps close the defect on their own - but together they lower pressure on the abdominal wall and make any repair last.

  1. 01 Weight

    Lose weight if you can

    Even a modest reduction lowers intra-abdominal pressure, eases symptoms and improves the durability of any repair.

  2. 02 Triggers

    Treat cough and constipation

    Chronic pressure keeps a hernia coming back - a good asthma or reflux plan and enough fibre and fluid genuinely help.

  3. 03 Lifting

    Lift smart, not heavy

    Avoid single heavy lifts and Valsalva-style straining. Keep a core-strength routine within comfort - it does not close the defect but supports the wall.

  4. 04 Escalate

    Know when to be seen

    A sudden painful, tender, non-reducible lump is not a wait-and-see problem - contact NHS 111 or A&E the same day.

Frequently asked

Everything we get asked about epigastric hernia.

Quick answers on watch-and-wait, mesh, keyhole repair and emergency signs.

  • What is an epigastric hernia?

    It is a protrusion of preperitoneal fat, and sometimes abdominal contents, through a defect in the linea alba - the fibrous midline of the abdominal wall between the breastbone and the belly button. Most defects are small, under 2 cm, so what usually pushes through is fat rather than bowel.

  • How common is it and who gets one?

    Prevalence in adults is up to around 5 per cent. It is 2 to 3 times more common in men than in women and is typically first noticed between the 20s and 50s. A congenital weakness in the linea alba plus chronic rises in intra-abdominal pressure - obesity, cough, constipation, pregnancy or heavy lifting - are the usual drivers.

  • How is it different from diastasis recti or an umbilical hernia?

    Diastasis recti is a widening of the linea alba without a true defect, is often seen after pregnancy and is usually benign. An umbilical hernia sits at the belly button rather than above it, and an incisional or ventral hernia occurs through a previous surgical scar. Examination and ultrasound reliably tell them apart.

  • Do I need surgery for a small epigastric hernia?

    Not always. Small, asymptomatic, incidental hernias can be watched, as the risk of serious complications is generally low. Symptomatic, enlarging, incarcerated or strangulated hernias need repair, and patient preference is also a valid reason to opt for surgery.

  • What does the repair involve?

    Very small defects can be closed with sutures alone in the right patient. For anything but the smallest defects, mesh repair - open, laparoscopic or robotic - is preferred to reduce recurrence. Large or complex defects may need a specialist technique such as transversus abdominis release in a high-volume hernia unit.

  • When is an epigastric hernia an emergency?

    Sudden severe pain with a tender, red or tense lump that will not push back in suggests strangulation - the blood supply to the trapped tissue is compromised. This needs same-day hospital assessment and usually urgent surgery, with bowel resection if the tissue is not viable.

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