Epigastric hernias occur due to a small tear in the linea alba. Most epigastric hernias occur in conjunction with rectus diastasis or diastasis recti — the movement of the rectus muscles away from each other. In women, this is typically due to pregnancy, while in men this typically occurs due to heaviness. Epigastric hernias can be painful. Most epigastric hernias only contain fat and not bowel, and so there is less associated risk of a bowel obstruction.
Treatment of epigastric hernias can be with an incision directly over the painful area. An alternative is to have a full abdominoplasty, with an incision near the underwear line and a complete tightening of the linea alba. Some regard a full abdominoplasty as a more definitive repair of epigastric hernias, because the entire problem of rectus diastasis is corrected, rather than patching the weakest area. However, a full abdominoplasty is a larger surgery, has longer recovery, and would have additional out of pocket costs.