Epigastric hernia: symptoms, causes and treatment

The NHS says symptoms of a hernia depend on where it is and how long you have had it. For a hernia in the tummy, the common features are a bulge or lump, which may get bigger when you cough, sneeze or cry and get smaller when you lie down. It says the skin over the lump may seem tight and stretched.

The Wrightington, Wigan and Leigh leaflet says an epigastric hernia results in a bulge in the abdominal wall which may cause pain or discomfort. Cambridge University Hospitals says the lump in children is usually between 1 and 5cm, and although the hernia is always present, the lump may not always be visible and may only appear when the child cries, strains to poo or is active. The NHS adds that a large hernia may not be painful because the weak area has stretched, allowing the hernia to pass through it easily.

The NHS says to get help from NHS 111 if you have a hernia and any of the following. The NHS says pain in or around the hernia, usually with smaller hernias, can be a sign of strangulation, when the muscle tightens around the tissue.

The Wrightington, Wigan and Leigh leaflet says the most serious complication of a hernia is strangulation, where part of the intestine becomes trapped within it, causing severe pain and vomiting, and that if you have these symptoms you should go to your local accident and emergency department as soon as possible.

• Pain in or around the hernia.

• A bloated tummy.

• Feeling sick or being sick.

• Vomiting blood, or vomit that looks like coffee grounds.

• Constipation.

• A high temperature, or feeling hot, cold or shivery.

• Suddenly becoming confused.

The NHS says the treatment you are offered for a hernia depends on the type, what caused it, and whether it is new or has come back after treatment. For hernias in general, treatment includes losing weight if you are overweight and surgery to repair the hernia.

The Wrightington, Wigan and Leigh leaflet says the benefits of repair are that it can stop the hernia becoming any bigger, because the bigger it becomes the more likely complications are, and that it improves quality of life. It says there are no alternatives to a hernia operation, only surgery can repair a hernia. The European Hernia Society stresses that treatment should always be a joint decision between you and your surgeon.

In children, Cambridge University Hospitals says it is not essential to repair an epigastric hernia, but some children find it uncomfortable and older children may be unhappy with its appearance, so a small operation may be offered.

The Wrightington, Wigan and Leigh leaflet describes surgery as repair of the area of weakness and return of the abdominal contents to their normal position. Mesh repairs place a piece of mesh over the repaired hernia to give added strength. The operation is carried out under a general anaesthetic as a day case, so you go home the same day, and the surgeon marks the site beforehand.

The risks listed are scarring, infection, bleeding, a collection of blood (haematoma), bruising, recurrence of the hernia, numbness and chronic pain at the incision. After the operation, the leaflet advises supporting the wound with the flat of your hand when you cough, keeping the wound clean and dry, and not disturbing the dressing for at least 48 hours.

For children, Cambridge says the surgeon makes a small cut of roughly 2 to 4cm above the hernia, pushes the fatty tissue back and closes the opening with dissolvable stitches, and most children go home the same day.

The European Hernia Society defines an abdominal wall hernia as a protrusion of the contents of the abdomen through a defect in its wall, in other words part of your insides sticking out through a hole in the tummy muscles. Primary ventral hernias are commonest in the midline of the abdomen and are called umbilical or epigastric hernias depending on their location. An epigastric hernia is any midline hernia other than at the tummy button.

The NHS says some hernias improve on their own but others may need surgery.

In adults, the sources describe an epigastric hernia as a weakness, gap or opening in the muscles of the upper abdominal wall rather than giving one single cause. In children, Cambridge says epigastric hernias are congenital: they form when the tissues joining the muscles in the upper abdomen have not formed properly, and it is not related to anything that happened during pregnancy.

The NHS lists measures that reduce the chance of some types of hernia, which suggests which pressures matter: keeping to a healthy weight, being physically active (at least 150 minutes of moderate activity a week), quitting smoking and seeing a GP about a cough that does not get better or keeps coming back.

The NHS says to see a GP if you think you have a hernia, and they may refer you for tests or treatment if needed. Cambridge says in children the abdomen is examined externally by a doctor and usually no other tests are needed. The Wrightington, Wigan and Leigh leaflet says that before surgery a pre-operative assessment clinic nurse takes a nursing and anaesthetic history and organises investigations such as blood tests and ECGs as necessary.

Several hernias can look similar. The NHS and European Hernia Society describe where each occurs.

On the NHS, you see a GP, who may refer you for tests or treatment if needed. The adult leaflet describes repair as a day-case operation, and waiting times vary by area.

Some people choose a private surgeon for faster access to repair. The operation and the risks are the same. Ask what type of repair is planned, whether mesh will be used and what recovery involves, and make sure your GP receives the discharge letter.