Epigastric Hernia: The Complete Guide
An epigastric hernia appears in the midline between the navel and the breastbone. It is usually small, but often painful because it contains trapped fat.
Contents
What is an epigastric hernia?
An epigastric hernia is a protrusion of fat (sometimes bowel) through a small defect in the linea alba — the fibrous band joining the two rectus muscles — between the navel and the lower breastbone. Like the umbilical hernia, it is a primary midline hernia. See the complete hernia guide.
Who gets it?
Most common in men aged 20–50; may be multiple; occasionally seen in children.
Causes
- Congenital weakness of the linea alba where small vessels pass through.
- Raised abdominal pressure: obesity, pregnancy, chronic cough, lifting, constipation.
- Diastasis recti weakening the linea alba.
Symptoms
- A small lump in the upper abdomen, noticed when standing or tensing.
- Localised pain often out of proportion to its size, due to trapped fat in a narrow defect.
- Pain worse with bending, after meals or exertion — often mistaken for stomach pain or ulcer.
- Some are irreducible (fat-filled) without being dangerous, but still need assessment.
Epigastric hernia vs diastasis recti
| Epigastric hernia | Diastasis recti |
|---|---|
| A true defect in the linea alba | Widening without a defect |
| Localised, sometimes painful lump | Ridge-like bulge when tensing |
| Low risk of incarceration | No incarceration risk |
| Treatment: surgery | Physiotherapy; surgery in selected cases |
Diagnosis
Clinical examination, ultrasound to confirm the defect(s), and CT in complex or multiple cases.
Treatment
Epigastric hernias do not close spontaneously; symptomatic hernias need surgery. Per the EHS/AHS 2020 guidelines: mesh is preferred for defects ≥1 cm; suture for very small defects; open repair for single small hernias; laparoscopy (eTEP or IPOM) for multiple defects, diastasis or obesity. The operation usually takes under an hour with return to activity within days. See hernia surgery and recovery.
Frequently asked questions
Is an epigastric hernia dangerous?
Can an epigastric hernia cause stomach pain?
Will exercises close an epigastric hernia?
Scientific references
⚠ This website is for health education and does not replace a medical examination. If you develop sudden severe pain at a hernia, vomiting, or the bulge changes colour, go to the emergency department immediately.