Epigastric Hernia during Pregnancy: Safety Tips and Precautions

Author :-

Dr.Sreejaya

General Medicine & Diabetology

Introduction to Epigastric Hernia in Pregnancy

Pregnancy is a transformative journey, bringing joy and challenges alike. Amidst the physiological changes, certain medical conditions may arise or exacerbate, such as an epigastric hernia. This blog delves into understanding epigastric hernias in the context of pregnancy, exploring symptoms, risks, management strategies, and when to seek medical help. Initially, it is crucial to understand the underlying factors. Most often, the problem arises with the patient or the patient's parties, who take actions without understanding any of the factors. This is called thoughtless action, and a thoughtless action cannot be a rational way to heal any problem or issue in terms of health.

What is an epigastric hernia?

An epigastric hernia is a protrusion of tissue or part of an organ through a weakened area in the abdominal wall, typically occurring in the upper abdomen, between the navel and the lower part of the ribcage. This condition results from weakened or stretched connective tissues, often exacerbated by increased intra-abdominal pressure.

While epigastric hernias can occur in both men and women, pregnancy is a unique period where the risks can increase due to the added strain on the abdominal wall. As a result, the abdominal wall experiences an internal pressure, which may cause pain or acute internal disorders.

How Pregnancy Can Influence Hernia Development

Pregnancy introduces hormonal and physical changes that may predispose an individual to an epigastric hernia. Key factors include:

Hormonal shifts: Relaxin and progesterone soften connective tissues, increasing susceptibility to hernias.

Increased intra-abdominal pressure: The growing uterus, weight gain, and heightened pressure on the abdominal wall contribute significantly.

Pre-existing conditions: Weakness in the abdominal muscles from previous pregnancies, surgeries, or conditions like diastasis recti heightens the risk.

Pregnancy may promote abdominal hernia recurrence by raising intraabdominal pressure. Current data are from small studies; therefore, the effect of pregnancy on recurrence is uncertain.

We estimated the hernia recurrence rate (reoperation). We used logistic regression to assess the relationship between pregnancy and hernia recurrence, both unadjusted and adjusted for diabetes, obesity (BMI > 30 kg/m(2)), tobacco abuse, and wound complication at the time of the first repair.

Common Symptoms of Epigastric Hernia

Recognising Epigastric Hernia Symptoms During Pregnancy

Identifying an epigastric hernia in pregnancy can be challenging, as its symptoms often overlap with common pregnancy discomforts. However, hallmark signs include:

A noticeable bulge: A visible lump in the upper abdomen, which may become more prominent when coughing, laughing, or lifting.

Pain or tenderness: Localised discomfort around the bulge, often exacerbated by physical activity or prolonged standing.

Nausea or vomiting: Especially if the hernia impedes normal bowel function.

A sense of fullness: Pressure or heaviness in the affected area.

Nausea, vomiting, epigastric discomfort, and post-meal stress are abdominal symptoms. Thoracic symptoms include dyspnoea, dysphagia, and left shoulder, chest, and back discomfort. In pregnancy, maternal diaphragmatic hernia was most associated with vomiting (60%), stomach discomfort (57%), and dyspnoea (57%). This review noted vomiting (56%), nausea (44%), dyspnoea (33%), epigastric (37%), abdominal (33%), chest (23%), shoulder (9%), and back discomfort (7%).

People often misinterpret upper-abdominal discomfort, nausea, and vomiting during pregnancy and postpartum as moderate and non-specific. The disease entity and pregnancy symptoms make maternal BH difficult to detect in pregnant women.

Investigate maternal BH when dyspepsia, postprandial vomiting, epigastric discomfort, and haematemesis persist late in pregnancy.

Herniated organs in this analysis include the colon (70%: transverse (37%), ascending (7%), and undesignated (26%)), stomach (63%), small intestine (33%), spleen (21%), pancreas (9%), appendix (7%), cecum (7%), kidney (2%), liver (2%), and omentum (26%). The analysis identified one herniated organ (21%), two or three (42%), more than three (33%), and undesignated (4%). The stomach has the most single-organ cases.

Differentiating Hernia Symptoms from Common Pregnancy Discomforts

Discerning hernia symptoms from typical pregnancy-related aches is crucial. For instance:

Round ligament pain tends to occur in the lower abdomen or groin, unlike the upper abdominal discomfort of an epigastric hernia.

Braxton Hicks contractions involve uterine tightening and resolve without producing a persistent abdominal bulge.

Heartburn or indigestion, while common, lack the localised lump and tenderness seen with hernias.

Having said that If the hernia is minor and asymptomatic throughout the pregnancy, it may be appropriate to wait for the surgery until after birth or the last pregnancy. If the hernia is large and symptomatic, one may postpone correction until the second trimester or, if stable, after delivery. This combination is not suggested consistently, although one research study found that it is an accepted practice. Hernia repair and a caesarean section (CS) require a complex decision-making process that varies from case to case. The groin hernia during pregnancy does not need regular correction. Round ligament varicosities (RLV) are a common groin hernia differential diagnosis and normally vanish two to four weeks following birth. Female reproductive-age ventral hernias recur 12% of the time. Pregnancy after ventral hernia surgery increases recurrence. Thus, pregnancy may increase hernia recurrence risk.

Potential Complications of an Epigastric Hernia During Pregnancy

Risks of Untreated Hernias for Expecting Mothers

An untreated epigastric hernia may lead to complications, including:

Incarceration: The hernia becomes trapped, causing severe pain and potential intestinal blockage.

Strangulation: Reduced blood flow to the herniated tissue, a medical emergency requiring immediate intervention.

An epigastric hernia happens in the front wall of the abdomen, halfway between the umbilicus and the xiphisternum, when there is a lack of the linea alba. Since most hernias are asymptomatic, many individuals do not seek medical counsel; hence the real rate may be greater than 1%.

Possible Effects on Pregnancy and Foetal Health

While most epigastric hernias do not directly harm the foetus, complications such as strangulation can pose risks to maternal and foetal well-being. Serious pain or stress from untreated hernias may indirectly affect fetal development by reducing maternal mobility or complicating delivery plans. Once the hernia gets complicated, this has a high chance of becoming lethal. Therefore, monitoring the progress of these tests is crucial. Primarily, the likelihood of the hernia rupture is a major concern. The moment the hernia ruptures, the patient's life is at risk. So, keeping a watchful eye would ensure sustainable fetal health.

Understanding Epigastric Hernia Side Effects in Pregnancy

Pain and Discomfort Management

Pain from an epigastric hernia can vary from mild to debilitating. Effective management is key to minimizing its impact in daily life.

Depending on the degree and kind of hernia, you can manage the discomfort at home until you see a surgeon. We offer these tips:

Stay away from heavy lifting and hard activity: Activities that cause pressure and strain may aggravate your hernia. Practice low-impact activities like walking or swimming. Follow your body and avoid exercise or anything that hurts until you get treatment.

Healthy weight: Weight might worsen hernia pain. Overweight hernia patients may benefit from losing weight to avoid strangulation.

Alter your diet: Hernia symptoms can be managed by diet. A gap in the diaphragm allows a portion of the stomach to protrude upward, notably in hiatal hernias. Avoiding acidic and heartburn-causing meals can also help. Hernia relief can also come from smaller meals and avoiding constipating foods.

Ice pack: Ice packs can relieve discomfort and inflammation from abdominal or groin hernias.

Over-the-counter drugs may help: Tylenol and ibuprofen can reduce hernia pain if prescribed by a doctor.

Postponing emergency surgery for certain hernias is not advisable. Physicians can assist in selecting the optimal treatment approach for you.

Impact on Daily Activities and Mobility

Activities like bending, lifting, or even walking can exacerbate hernia-related discomfort, impacting the mother’s quality of life. Limitations may require adjustments to routine tasks and lifestyle habits. Live a quality life without overstressing health. Owing to the stress, the hernia condition might differ. Furthermore, adopting a healthy lifestyle, which includes avoiding tobacco, smoking, alcohol, and other drug substances, would be beneficial.

Treatment Options and Safety Considerations

Non-Surgical Management During Pregnancy

For most pregnant individuals, non-surgical interventions are the preferred approach unless complications arise. These include:

Support garments: Abdominal binders or maternity belts can help alleviate pressure and support weakened tissues.

Pain management: Using pregnancy-safe analgesics under medical supervision.

Lifestyle adjustments involve incorporating modifications such as avoiding heavy lifting and adopting a low-impact exercise regimen.

The size and location of your hernia will determine whether your doctor recommends mesh or not. We repair only minor hernias without mesh.

Your doctor may propose a mesh that stays in your body permanently to support the repair. Others are natural and absorb with time, leaving just your tissue. Discuss these alternatives with your doctor to choose the best one.

While these treatments may alleviate hernia symptoms without surgery, they do not serve as a substitute for surgery. Luckily, hernia repair surgery is routine and typically effective, but choosing a specialist can help prevent recurrence and other issues.

Selecting an experienced hernia surgeon with advanced technical skills can greatly reduce recurrence and other problems. Ovum Hospitals' hernia repair surgeons are proficient in open, laparoscopic, and robotic procedures. Our surgeons successfully treat patients who underwent hernia repair elsewhere but need revision surgery because it resurfaced.

Overview of Herniorrhaphy Surgery: Is It Safe for Pregnant Women?

Herniorrhaphy, the surgical repair of a hernia, is typically postponed until after delivery unless the hernia becomes life-threatening (e.g., strangulation). If surgery is necessary during pregnancy, the second trimester is considered safest, as it avoids early organogenesis and the challenges of late pregnancy. Herniorrhaphy fixes a hernia by repairing the abdominal wall. A hernia arises when a weak abdominal wall muscle lets an internal organ pass through.

If you have a direct hernia, which bulges from your abdominal wall, the surgeon will press it back and suture the healthy muscle tissue together to restore the muscle wall weakness. Surgeons may augment major muscle repairs using synthetic mesh. The operation is called hernioplasty.

Hernias seldom return after surgery. Recurrence depends on the type of hernia and surgery. Hernias recurred in 15% of surgical patients prior to mesh. Mesh reduces this number.

Safety Tips and Precautions for Managing an Epigastric Hernia

Tips for Reducing Pain and Pressure

Elevate the head during sleep to reduce abdominal pressure.

Avoid straining during bowel movements by consuming a high-fibre diet and staying hydrated.

Use cold or warm compresses for localised pain relief.

An abdominal wall weakening causes a hernia. When problems begin, a lump or protrusion may appear in the central, upper abdomen, between the breastbone and the stomach button. This is known as the 'epigastrium,' hence the term 'epigastric hernia.' The bulge primarily consists of fatty tissue, but it can also contain the intestine when it becomes large. Initial discomfort may worsen while lifting heavy goods or coughing. Unlike a significant protrusion from the breastbone to the navel caused by weight gain, surgery is rarely suggested for this hernia.

Lifestyle and Dietary Changes to Minimise Symptoms

Small, frequent meals can reduce gastrointestinal pressure.

Avoid foods that trigger bloating or gas, such as carbonated drinks and beans.

Maintain a healthy weight gain trajectory to minimise strain on the abdomen.

Exercises and Posture Adjustments for Comfort

Prenatal yoga, pelvic tilts, and breathing exercises can strengthen core muscles without straining. Additionally, maintaining proper posture reduces undue pressure on the abdominal wall.

When to Seek Medical Help

Warning Signs of Complications

If you experience any of the following symptoms, contact a healthcare provider.

Persistent or worsening abdominal pain.

The hernia site may experience redness, swelling, or tenderness.

You may experience symptoms such as nausea, vomiting, or difficulty passing gas or stool.

Fever alongside hernia-related symptoms.

Preparing for a Medical Consultation During Pregnancy

When consulting a doctor:

Document symptoms: Note their duration, triggers, and severity.

Share pregnancy history, including prior abdominal surgeries or conditions.

Ask about tailored management plans to ensure foetal and maternal safety.

Conclusion

Navigating an epigastric hernia during pregnancy requires vigilance and proactive care. By recognising symptoms, adopting non-surgical management strategies, and seeking timely medical advice, expectant mothers can mitigate risks and ensure a safer pregnancy journey. For more information or a better healthcare experience, visit Ovum Hospitals.

FAQs

1. Can an epigastric hernia heal on its own during pregnancy?

No, hernias do not heal spontaneously. Management focuses on symptom relief and monitoring until surgical repair is viable, typically postpartum.

2. Is it safe to exercise with an epigastric hernia while pregnant?

Yes, but exercises should be low-impact and focus on core stability. Consult a healthcare provider for a tailored exercise plan.

3. How do doctors diagnose an epigastric hernia during pregnancy?

Diagnosis involves a physical exam and, if needed, imaging studies like ultrasound, which are safe during pregnancy.

4. Does an untreated hernia affect labor and delivery?

Yes, severe complications like strangulation can complicate delivery plans and may necessitate a caesarean section.

5. What should I do if my hernia pain worsens suddenly?

Seek immediate medical attention as this could indicate imprisonment or strangulation, requiring urgent intervention.