Is there a small lump in your upper abdomen? Let's talk about an epigastric hernia!

Have you ever seen, or experienced, a small swelling or lump in the upper abdomen, specifically below the breastbone, above the navel? Sometimes it can even hurt a little. Many people get a little scared when they see something like this. So today we are going to talk about one possible cause of this, which is an epigastric hernia. Don't worry, let's talk about this simply.

So what is this epigastric hernia?

Simply put, an epigastric hernia is a type of hernia that occurs in the upper, middle part of your abdomen. Specifically, it occurs in the area below your breastbone and above your belly button. This is also a common type of hernia that falls under the category of ventral hernias, which occur in the front wall of the abdomen. Sometimes, a person can have more than one epigastric hernia.

These hernias are often very small . Some are about half an inch (about 1 centimeter) or the length of a stapler. A slightly larger hernia can be about an inch and a half (about 4 centimeters) or the size of a walnut. If the hernia is small, you may not notice any symptoms. However, as the hernia gets larger, it can appear as a visible, palpable lump.

Epigastric hernias are usually not a serious health condition. However, large hernias can sometimes lead to life-threatening complications , so it is important to be aware of this.

What are the symptoms of this, doctor?

Sometimes you may not have any symptoms if you have an epigastric hernia. Or you may experience symptoms like these:

• A lump under the skin: A small lump or swelling may appear under the skin in the middle of your abdomen, just above your breastbone and below your breastbone. This is often more noticeable when you are standing, but it may also feel like it is slightly indented when you sit or lie down, or it may disappear.
• Cramp-like pain in the upper abdomen: You may feel a nauseous , or dull ache in the upper middle of your abdomen. This pain may seem to get worse as the day goes on.
• Sharp pain: You may experience a sudden, sharp pain, like a stab wound, when you cough, lift something heavy, or go to the bathroom.

Imagine, when you wake up in the morning, there's nothing wrong with you, but during the day, you notice a slight swelling in your upper abdomen, and by the evening, that area seems to be a little sore. That's what could happen.

Why do we get hernias like this?

This condition occurs when a piece of fatty tissue in your stomach, or sometimes part of your large intestine, pushes through your ``Linea Alba''. What is the ``Linea Alba''? It is a thin band of connective tissue that runs down the front, middle, and bottom of your stomach. If there is a weakness or defect in this ``Linea Alba'', that fatty tissue or part of your intestine can push through. If your abdominal muscles are weak, you are more likely to develop an Epigastric Hernia.

Some people can be born with an epigastric hernia. This means that this hernia is formed during fetal development. However, most often this hernia develops over time (acquired epigastric hernia). It can happen as you get older. Or, it can also develop due to other problems that put pressure on your ``Linea Alba'' or abdominal muscles. This hernia is usually most common in people between the ages of 30 and 50.

There are many reasons why an epigastric hernia can develop. Here are some of the main ones:

• Thinning of the ``Linea Alba'' with age: Over time, this band of connective tissue weakens and thins.
• Chronic cough: If you have a persistent cough, every time you cough, there is a lot of pressure in your abdomen.
• Constipation: The stomach becomes dry and the pressure inside the stomach increases even when you try to go to the toilet.
• Obesity: As body fat increases, pressure inside the abdomen automatically increases.
• Weight lifting: Lifting heavy objects incorrectly, without proper breathing control.
• Pregnancy: During pregnancy, as the baby grows, there is a lot of pressure on the mother's abdominal cavity.

Can this be dangerous? What are the possible complications?

Although a small epigastric hernia is usually not a big deal, there are two complications that can sometimes be dangerous. These are an incarcerated hernia and a strangulated hernia. Both of these are considered very serious medical emergencies . They can be life-threatening.

• Incarcerated Hernia: This is when the hernia becomes trapped between your abdominal muscles. When this happens, it will not go back in on its own, nor will it go back in even if you push. This can cause severe pain.
• Strangulated Hernia: This is even more dangerous. If blood flow to a part of a strangulated hernia is cut off, that part begins to die. This can cause severe pain, fever, nausea, and vomiting. This is a condition that needs to be corrected immediately with surgery.

The most important thing is, if you find out you have a hernia, to pay attention to whether there are any signs of it becoming incarcerated or strangulated.

How does a doctor detect this?

If you have any of the symptoms mentioned above, it's best to see a doctor. The doctor will first do a physical examination. This means they will feel the lump in your abdomen, ask you to cough, and have you lie down.

In addition, imaging tests such as these may sometimes be performed to determine the exact size, location, and contents of the hernia:

• CT scan (Computed Tomography - CT scan): This can provide detailed images of the hernia.
• MRI scan (Magnetic Resonance Imaging - MRI scan): This is similar to a CT scan, but uses a different technology.
• Ultrasound: A test that uses sound waves to create images of the inside of the body. This is often the first test done.

After these tests, the doctor can tell you exactly whether you have an epigastric hernia and what its condition is.

What are the treatments for this? How is it managed?

The only permanent treatment for an epigastric hernia is to have it repaired by surgery (hernia repair surgery) . This means that the protruding part is put back in, the weak spot or hole in the ``Linea Alba`` is sewn up, and sometimes something like mesh is used to reinforce the area.

However, not all epigastric hernias require immediate surgery. Your doctor may decide to perform watchful waiting rather than surgery in the following cases:

• If the hernia is very small (less than an inch, about 1 centimeter).
• If you don't have any pain or nausea from the hernia.
• If you don't have a big problem with that lump,
• If the doctor thinks that the risk of complications from the hernia is low .

In that case, your doctor will tell you to come back for checkups at specific intervals . That means checking to see if the hernia is getting bigger or if new symptoms are appearing.

How long does it take to recover after an operation?

This is hard to say exactly, because it varies from person to person. Many things affect this, such as your age, the size of the hernia, the nature of the surgery performed, and your general health.

Typically, you can resume your daily activities about two weeks after surgery. However, if you do strenuous work, such as lifting weights, it may take four weeks or longer to return to work. The most important thing is to follow your doctor's instructions exactly.He will tell you how long you need to rest, when you can start normal activities, and when you can start lifting weights.

Can this come back after surgery? (Outlook)

The good news is that an epigastric hernia can be completely cured with surgery. That means the lump will go away.

However, sometimes a hernia can recur, or a new one can form. The main reason for this is that your abdominal muscles or the ``Linea Alba`` are put under pressure again, or they become weak again. You can talk to your doctor about your chances of getting a hernia again after surgery. He or she can also tell you what you can do to prevent it from coming back.

Is there anything we can do to prevent this from happening?

Although it cannot be completely prevented, there are several things you can do to reduce your risk of developing an epigastric hernia:

• Maintain a healthy weight that suits you: It is very important to control your body weight, as obesity is a major cause of hernia formation.
• Treat conditions that put pressure on your stomach muscles: If you have a persistent cough or constipation, get them treated properly and get them under control.
• Be careful when lifting: Don't try to lift heavy weights all at once. If you do, maintain proper posture, control your breathing, and ask for help if possible.

When should we definitely see a doctor?

If you have a lump like the one I mentioned above in your upper abdomen and it feels like it's getting bigger, you should definitely see a doctor. Because an epigastric hernia that gets bigger has a higher chance of becoming an ``Incarcerated Hernia`` or ``Strangulated Hernia`` due to the blood supply being cut off.

If you experience any of the following symptoms, it should be considered a medical emergency. Go to the nearest hospital immediately, or if in Sri Lanka, call the 1990 Suwaseriya Ambulance Service:

• New, severe, rapidly increasing pain in the upper abdomen.
• Nausea and vomiting.
• The skin where the hernia is located becomes discolored (for example, it may be red, purple, blue, or black).

If you experience these symptoms, don't delay even a minute . Seeking medical attention immediately can save a life.

What questions should you ask the doctor?

When you go to see a doctor, it's a good idea to ask these questions:

• Doctor, why do I have this hernia?
• Will this get bigger?
• What kind of things could happen if this gets bigger?
• Do I really need surgery? Are there no other options?
• If I have surgery, what should I be careful of after it?

It is very important to ask questions like these and gain a clear understanding of your situation.

Can an epigastric hernia cause acid reflux?

No. Symptoms such as heartburn and acid reflux are usually caused by another type of hernia called a hiatal hernia. An epigastric hernia causes a dull, sharp pain in the upper abdomen. It does not cause symptoms of acid reflux.

So, if you have a lump in your upper abdomen, below your breastbone and above your ribcage, it could be an epigastric hernia. However, there could be other causes for such a lump. Therefore, it is best to see a doctor to find out the exact cause and get the treatment that is right for you.

So what are the most important things we need to remember? (Take-Home Message)

Okay, so, from what we've talked about Epigastric Hernia, here are the most important things you need to remember:

• An epigastric hernia is a small bulge in the upper, middle part of the stomach.
• Most of the time, this is not dangerous, but if it gets large, it can cause complications such as blockage and loss of blood supply.
• Symptoms may include a lump, swelling, and sharp pain. Some people may have no symptoms at all.
• This can be caused by things like obesity, chronic cough, constipation, heavy lifting, and pregnancy.
• Surgery is the only permanent treatment for this, but not everyone needs surgery right away.
• Maintaining a healthy weight and reducing things that put pressure on the stomach can help prevent this from happening.
• If the lump gets bigger, or if you experience symptoms such as severe pain, nausea, vomiting, or skin discoloration, see a doctor immediately.

I hope this information is helpful to you. If you have any concerns, don't hesitate to talk to a doctor. Stay healthy!

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