Epigastric Hernia A Hernia of the Upper Midline
Your comprehensive guide to epigastric hernia: why it appears between the breastbone and navel, how to recognise its early symptoms, and why it may need surgical repair even when small.
In this article
Epigastric hernia is a type of hernia that appears in the area between the breastbone (just below the chest) and the navel, resulting from a localised weakness in the linea alba, the fibrous band connecting the two rectus abdominis muscles along the body's midline. It affects adults more than children, is often small at the outset, and tends to contain fatty tissue more than a portion of the intestine.
To understand epigastric hernia within the broader context of different hernia types, you can first review our comprehensive guide on hernia types, then return to learn the details of this type, which can go unnoticed for a long time.
What Is an Epigastric Hernia?
An epigastric hernia is the protrusion of part of the fatty tissue surrounding the intestines, or less commonly a portion of the intestine itself, through a small opening in the linea alba of the upper abdomen. Unlike an umbilical hernia, which appears right at the navel, an epigastric hernia can appear anywhere between the breastbone and the navel, and may involve one opening or several adjacent ones in more complex cases.
Why Can It Be Hard to Notice Early?
Because it's often small, an epigastric hernia can go unnoticed by the patient for a long time, or be mistaken for simple bloating or ordinary fat accumulation. Some patients also feel recurring localised pain without seeing a clear bulge, which can sometimes delay the correct diagnosis until the hernia enlarges.
Single Small Defect
The most common form: a single small opening that usually contains only fatty tissue, without intestine.
Multiple Defects
Several small adjacent weak points along the linea alba, requiring a more precise assessment of their number before surgery.
In Athletes
Repeated abdominal strain, especially high-resistance exercise without adequate muscular preparation, can reveal it.
In Pregnant Women
Increased abdominal pressure during pregnancy can expose an underlying weakness in the linea alba that wasn't previously apparent.
What Causes an Epigastric Hernia?
The main cause is a congenital or acquired weak point in the linea alba tissue, where small blood vessels pass through this fibrous band, leaving natural weak spots that can widen over time. The likelihood of developing the hernia rises with factors such as obesity and increased abdominal pressure, repeated pregnancies, heavy lifting or intense abdominal exercise without adequate muscular preparation, and chronic cough.
For those wishing a deeper understanding of these factors, we cover them in detail in our separate articles on genetic factors in hernia and weak abdominal muscles and hernia.
Symptoms of Epigastric Hernia
Symptoms range from being completely unnoticeable to clear pain warranting prompt attention:
Symptoms to Watch For
- A small, firm bulge above the navel and below the breastbone that's sometimes hard to push back in.
- Sharp localised pain when bending or exercising.
- Tenderness or pain on direct pressure over the hernia area.
- Gradual, noticeable enlargement of the bulge over time.
- Mild nausea accompanying episodes of pain in some cases.
When Symptoms Are Relatively Reassuring
- The bulge, if present, can easily be pushed back in with the fingers.
- Pain is mild, intermittent, and linked only to exertion.
- The bulge size is stable without noticeable change over time.
- No change in skin colour over the hernia area.
- Daily activities are not noticeably affected.
How Is Epigastric Hernia Diagnosed?
Diagnosis mostly relies on clinical examination, where the doctor palpates the upper abdomen while the patient stands and strains, to precisely locate the opening and assess its size. Because some epigastric hernias are very small or multiple, the doctor may request an ultrasound to accurately determine the number of openings before planning surgery, especially if the patient has obesity that makes manual examination harder.
If you notice any bulge or symptoms mentioned above, don't delay booking an appointment for early hernia diagnosis, as early diagnosis makes treatment options simpler and safer.
Treating Epigastric Hernia: Is Surgery Always Necessary?
Like most types of hernia, an epigastric hernia does not heal on its own and is not closed by any medication. Its risk, however, lies in the fact that the opening is often small relative to the tissue pushing through it, which relatively raises the risk of strangulation even in small hernias. For this reason, most surgeons recommend repairing an epigastric hernia surgically even when symptoms are not obvious.
| Surgical Method | What It Involves | Key Advantages |
|---|---|---|
| Open Surgery | A small incision directly over the hernia site | Suited to a single small defect and lower cost |
| Laparoscopic Surgery | Multiple fine incisions with an internal camera | Ideal for multiple defects along the linea alba |
| Use of Surgical Mesh | Often used even in small hernias | Significantly reduces the risk of recurrence or a new adjacent defect |
Choosing the most suitable method depends on the number and size of the defects, patient age, and overall health, and is determined by the surgeon after a complete evaluation. Learn more about the stages of hernia surgery and recovery in detail.
If the bulge becomes hard, suddenly very painful, changes colour, and doesn't reduce, especially with nausea or vomiting, these are signs of a possible strangulated hernia requiring immediate emergency care without delay, as small openings are most prone to this risk.
"Many patients ignore an epigastric hernia because of its small size, assuming a small bulge means low risk. The truth is the opposite: small openings are the most prone to strangulating the tissue pushing through them. My constant advice to my patients: don't judge a hernia's risk by its apparent size."
Dr. Mohamed EsmatFrequently Asked Questions
What's the difference between an epigastric and an umbilical hernia?
An umbilical hernia appears right at the navel and often starts from birth, while an epigastric hernia appears anywhere between the breastbone and the navel and usually develops in adulthood.
Can I have more than one epigastric hernia at the same time?
Yes, it's relatively common to have multiple openings along the linea alba, so a careful pre-surgical examination is important to accurately determine their number.
Does exercise cause an epigastric hernia?
Exercise itself doesn't directly cause the hernia, but repeated strain on the abdominal muscles can reveal a pre-existing underlying weakness in the linea alba.
Does a small epigastric hernia need immediate surgery?
Not necessarily immediately, but most surgeons advise against long delays, given the relatively elevated strangulation risk compared with the opening's small size.
Have You Noticed a Small Bulge in Your Upper Abdomen?
Book your consultation with Dr. Mohamed Esmat for an accurate assessment and a treatment plan suited to you.
Dr. Mohamed Esmat
Consultant hernia and abdominal wall surgeon, PhD in General Surgery and founder of Hernia Core — the first Arab clinics dedicated to hernia surgery. 15+ years of experience and over 5,000 successful cases.
This article is for general medical awareness only and does not replace a consultation with a specialist. To assess your case, please book with Dr. Mohamed Esmat. Last reviewed: June 19, 2026.
