What is an umbilical or epigastric hernia?

Umbilical or epigastric hernias occur when a part of the intestine pushes through an opening in the abdominal, or stomach, muscles.

• Umbilical hernias develop at the belly button
• Epigastric hernias develop in the upper abdomen

These types of hernias are most common in infants and will typically resolve on their own within the first five years. (Although if you suspect your child has one, you should consult with your pediatrician.)

Sometimes, however, umbilical and epigastric hernias are diagnosed or develop later in childhood or in adulthood. While they usually do not cause major complications when developing later, they still must be surgically repaired — especially in adults.

What are the risk factors for umbilical and epigastric hernias in adults?

In most cases, it is not known why an umbilical or epigastric hernia develops in adults. The primary risk factors are being overweight or having prior pregnancy, either of which can cause an opening in the abdominal muscles to expand over time.

Conditions, behaviors and activities that put strain on or weaken the abdominal wall can also cause umbilical or epigastric hernias. These include:

• Smoking
• Diabetes
• Using steroids or other medications that can compromise the immune system
• Heavy lifting or other strenuous activities

What are the signs and symptoms of umbilical and epigastric hernias?

Signs and symptoms include:

• A bulge in the affected area
• Pain — which can range from a dull ache to severe pain — especially when coughing, sneezing or lifting heavy objects
• Bloating or constipation

How are umbilical and epigastric hernias diagnosed?

Your doctor will review your medical and surgical history and then carefully examine your abdominal area. You will likely be asked to stand and cough so the doctor can see or feel a bulge that indicates a hernia.

If you have an umbilical or epigastric hernia, your doctor will often order imaging tests, such as:

• Ultrasounds
• Computed tomography (CT) scans
• Magnetic resonance imaging (MRI) scans

These scans will help your doctor determine your hernia's location and help determine the surgical strategy.

What are treatment options for umbilical and epigastric hernias?

There are three primary treatment options for umbilical and epigastric hernias. The method used to treat your hernia will depend on your hernia's size and location, your general health and your expected level of physical activity in the future.

• Observation: For less severe hernias, your doctor will recommend observing its progress over time before taking further action.
• Elective surgical repair: Some umbilical and epigastric hernias cause excessive pain or discomfort, which may lead your surgeon to recommend elective (non-emergency) surgical repair.
• Emergency surgical repair: If the umbilical or epigastric hernia threatens to strangle a portion of your intestine, your doctor will recommend urgent or emergency surgery.

Surgical repair of an umbilical or epigastric hernia involves closing the weakness in the abdominal wall and reinforcing it, sometimes with synthetic mesh material.

What are the different types of surgery for umbilical and epigastric hernias?

The surgeons at the Brigham and Women's Hospital Hernia Program are highly experienced in the full range of surgeries for umbilical and epigastric hernias, including:

• Open hernia repair: This involves making an incision over the hernia site and pushing the bulging tissue or organ back in place. The surgeon then closes the hole with sutures or with a combination of sutures and plastic mesh.
• Laparoscopic hernia repair: This is a minimally invasive procedure in which small incisions, a tiny video camera, special surgical tools and a piece of plastic mesh are used to repair the hernia.
• Robotic hernia repair: This procedure is similar to laparoscopic repair. In this case, however, your surgeon uses robot-assisted technology to guide the movements of the surgical tools precisely.

As part of their role at a major academic medical center, our surgeons keep up-to-date on and incorporate into their practice the latest advancements in hernia surgery. In some instances, our surgeons are performing research that guides hernia care across the country and the world.

How do you make an appointment?

To learn more about the Hernia Program’s multidisciplinary approach to patient care or to schedule an appointment with one of our specialists, please call 617-525-9726. Our providers see patients at the following locations:

• Brigham and Women's Hospital, Boston
• Brigham and Women's Faulkner Hospital, Jamaica Plain
• Brigham and Women's/Massachusetts General Health Care, Foxborough
• Brigham and Women's Health Care Center, Westwood

What other resources are available on umbilical and epigastric hernias?

TBD: patient resources to be listed here (e.g. PDFs on preparing for surgery, plastic surgery, recovery post-surgery).