All organs in the body have a designated space and are meant to stay within that space. When they move away from their spot, it creates problems within the body. When an organ pushes through a muscle opening and starts protruding from its space, it is known as a hernia. Hernia during pregnancy is not unheard of, but an Epigastric Hernia during pregnancy is rare.
Hernia is a medical condition where a part of the intestines pushes through the abdominal wall, stomach, or muscles. Hernias can affect different parts of the abdomen. Epigastric Hernia develops above the naval, unlike the regular abdominal hernia that develops in the lower belly.
Hernias are very common, especially among infants. Hernias after pregnancy are also common as the abdominal muscles tend to become weak after being stretched during pregnancy. Epigastric Hernia, however, is quite rare, especially during pregnancy.
Hernias can cause trouble from time to time, thus requiring medical intervention. Unlike body aches, one cannot self-medicate or treat hernias. Only a well-trained professional can assess and treat epigastric and other hernias. In many cases of adult hernia, surgery is the only option.
Epigastric hernia in pregnancy can be both symptomatic as well as asymptomatic. Some common symptoms of epigastric hernia to watch out for are:
● A bulge in the abdomen above the belly button or navel.
● Pain around the back and abdomen – it can be dull or severe – occurs when you stand, cough, sneeze or lift heavy objects.
● Constipation or bloating.
● Tenderness or soreness in the epigastric region.
Pregnancy can increase the strain on the abdominal wall. So, one of the possibilities for epigastric hernia is the increase in pressure on the abdominal wall around the area where it attaches to the diaphragm. The exact reasons for an epigastric hernia, especially during pregnancy are still unclear.
If you experience any hernia symptoms, your doctor will require both physical and imaging tests to confirm a diagnosis.
They will first perform a physical exam to check for protrusion, extent of protrusion, etc. The doctor will make note of your surgical and medical history before carefully examining the abdominal area. They may ask you to stand and cough to see and feel the hernia or bulge.
Next, the doctor will order imaging tests like ultrasounds, CT scans, or MRIs to get a better and closer look at the abdominal area. These imaging tests can not only confirm the size or location of the hernia but will also help know more about the muscles and abdominal wall surrounding the hernia. These details in turn help in determining the most feasible treatment.
If the hernia does not protrude any further or cause any pain, the doctor will wait till the delivery to get a better view of the hernia. In many cases, the hernia can repair itself after the baby’s delivery. If the hernia does not resolve on its own or worsens post-delivery, surgery can help.
Surgical options for epigastric hernia or any hernia include laparoscopic surgery, open surgery, or robotic hernia repair surgery. While laparoscopy and robotic surgeries are minimally invasive, open surgery involves incision, plastic mesh, and sutures. An open surgery enables the surgeon to physically push the organ back into position.
In very rare cases, if there are indications of strangulation (where the organ or tissue gets trapped and can’t be pushed back), an emergency herniorrhaphy (a hernia surgery) may be required to save the tissues from further damage. If there are severe symptoms like vomiting, nausea, or pain that do not resolve within 4 or 5 hours, the doctor will not wait any longer. The strangulated hernia needs to be repaired before it can lose blood supply or get infected.
Herniorrhaphy is a hernia surgery. A hernia surgery during pregnancy can be very risky. If the surgery is done in the first trimester, it can increase the risk of a miscarriage. If done in the last trimester, it can increase the risk of preterm delivery.
Though the hernia surgery can be done using laparoscopy where only 3 tiny incisions are made, the growing baby’s weight can put pressure on the repaired hernia. Also, in a laparoscopy, a mesh is used to hold the organ in place. The mesh does not expand and, hence, is not generally recommended during pregnancy.
If the hernia occurs towards the end of the pregnancy, the doctor may suggest doing an elective cesarean delivery and then repairing the hernia.
Pregnancy limits the number or extent of treatments the expecting mother can get. An epigastric hernia in pregnancy is not dangerous as long as it does not hurt the mother or if it resolves on its own. In most cases, the growing uterus tends to block the opening or hole in the muscular wall and prevents the organ from protruding any further.
If the hernia is not very painful or does not protrude any further as the pregnancy progresses, it will most likely resolve on its own after the delivery. Your doctor might opt to wait and see how the hernia and pregnancy progresses without any interference.
An epigastric hernia does not affect all pregnant women. You are at a higher risk of an umbilical or epigastric hernia in the following:
● You smoke regularly
● Have diabetes
● Use steroids and other medications that can compromise the immune system
● Do strenuous activities or lift heavy weights that put a strain on the abdominal wall.
If the hernia starts protruding or causes a lot of pain and discomfort, it could mean the organ is trapped within the abdominal wall. It is important to consult a doctor right away to ensure there are no complications.
In case of sudden pain, vomiting, or nausea, it is advisable to get to the hospital without any delay. It is important to get the hernia checked immediately.
An epigastric hernia during pregnancy is rare and may not require any surgical intervention. While a little pain and discomfort during pregnancy is normal, excess pain is not. Anytime you feel an extra bulge, intense pain, or discomfort that doesn’t feel like a part of the pregnancy, consult your doctor. Let them perform the required tests and rule out complications.
No. Epigastric hernia during pregnancy is very rare. While all pregnant women will experience the displacement of their organs in the abdominal area, only a few may experience a hernia.
In many cases, after the baby’s delivery, when the pressure on the abdominal wall decreases, the hernia might self-resolve. Sometimes, the growing baby can block the opening in the muscles and prevent the hernia from worsening. Some cases may require medical or surgical intervention to protect and heal the mother.
