A hernia occurs when an organ or tissue pushes through a weak spot in the muscle or connective tissue that normally holds it in place. While many people associate hernias with the groin or naval area, they can occur in various parts of the abdominal wall. The location of the hernia determines its specific name. Yes, a hernia can absolutely occur in the region above the belly button. This condition is a common form of abdominal wall weakness that presents unique symptoms and requires specific medical attention.
The Answer: Understanding Epigastric Hernias
The type of hernia that appears above the umbilicus is called an epigastric hernia. This name is derived from the epigastrium, the upper central region of the abdomen located between the breastbone and the navel. Epigastric hernias develop along the linea alba, a thin, fibrous band of tissue that runs down the midline of the abdomen where the right and left abdominal muscles meet.
The mechanism involves a defect or small gap forming in the linea alba, allowing internal contents to push through. Typically, the protruding material is pre-peritoneal fatty tissue, but sometimes a portion of the intestine or peritoneum can be involved. This protrusion creates the characteristic soft lump or bulge that is often the first noticeable sign of the condition.
The size of the defect can vary significantly, ranging from less than half an inch to several centimeters. It is possible to have more than one epigastric hernia at the same time. Because the opening is located precisely in the midline where the connective tissue is naturally thinner, it represents a common site for this type of weakness to develop.
What Causes Epigastric Hernias
Epigastric hernias arise from either congenital factors, where a weakness exists from birth, or acquired factors that develop later in life. Some individuals are born with a naturally weaker fascia or with tissues in the abdominal wall that did not completely close during development. However, most epigastric hernias in adults are acquired, resulting from chronic or sudden increases in pressure within the abdominal cavity.
Any activity that strains the abdominal wall can contribute to the formation or enlargement of this type of hernia. Common acquired causes include frequent heavy lifting, which dramatically increases intra-abdominal pressure. Other factors are chronic coughing, persistent sneezing, or straining during bowel movements due to constipation.
Health conditions like obesity and pregnancy also place continuous pressure on the abdominal muscles, thinning the linea alba over time and increasing the risk. As the body ages, abdominal wall tissues naturally become less elastic and weaker, making the fascia more susceptible to defects. These combined forces of inherent weakness and external strain create the conditions necessary for the contents of the abdomen to protrude.
Recognizing Symptoms and Urgent Warning Signs
Many small epigastric hernias, especially those containing only fat, may not cause any symptoms and are sometimes discovered incidentally during an examination. When symptoms do occur, the most common is a visible lump or bulge in the upper abdomen that may become more pronounced when standing, coughing, or straining. The area around the defect may be tender to the touch, and some people experience a dull ache or a sharp pain, particularly during physical activity.
It is important to monitor the hernia for signs of a serious complication known as incarceration or strangulation. An incarcerated hernia occurs when the protruding tissue becomes trapped and cannot be pushed back into the abdomen, leading to a fixed, sometimes tender, bulge.
This state can quickly progress to strangulation, which is a medical emergency where the blood supply to the trapped tissue, often a loop of bowel, is cut off. Urgent warning signs of strangulation include sudden, rapidly worsening, severe pain at the hernia site. The skin over the lump may become red, purple, or dark in color, indicating tissue damage. Other signs are nausea, vomiting, fever, and the inability to pass gas or have a bowel movement, which suggests a bowel obstruction.
Diagnosis and Repair Options
A healthcare provider can typically diagnose an epigastric hernia through a physical examination, inspecting and gently feeling the abdomen for a bulge or tenderness. The doctor may ask the patient to cough or strain, which often makes the protrusion more apparent. In cases where the diagnosis is unclear or to determine the exact contents of the hernia sac, imaging tests like an ultrasound are commonly used.
Since an epigastric hernia will not heal on its own and carries the risk of complications, surgical repair is the standard treatment. The primary goal of surgery is to return the protruding tissue back into the abdominal cavity and close the defect in the linea alba.
Small defects, especially first-time hernias, may be repaired using only strong sutures to close the opening. For larger defects or in patients with a higher risk of recurrence, a synthetic surgical mesh is often used to reinforce the repaired area. The repair can be performed using an open technique, which involves a single incision directly over the hernia, or a minimally invasive approach like laparoscopic surgery, which uses several small incisions. Surgery is generally recommended to prevent the hernia from enlarging and causing serious issues like strangulation.