When you do a sit-up and/or contract your abdominal muscles do you have a bulge above your belly button? It can even be present just standing or sitting.

And this is not the belly fat I am talking about. Of course you should always have a doctor diagnose your issues, but there are two common possibilities for that bulge.

It could be an epigastric hernia. An epigastric hernia can develop in the mid/upper abdomen in a part that’s called the linea alba. This is the fascia or tendon between the two rectus abdominal muscles commonly called the “six pack.”

Believe it or not, everyone has a “six pack” and  linea alba, even if it might be covered up with extra padding!

This particular hernia is not uncommon. It arises in a defect of the linea alba. They are generally small in size and localized, rarely larger than the size of a golf ball. Due to the fact that it is small, the contents are easily pinched and can cause a great deal of pain.

This particular hernia is also well suited for repair.

It could also be diastsis recti. This is not a hernia. Although often confused and at times misdiagnosed as an epigastric hernia, these abdominal wall protrusions happen to the widening of the linea alba. There is no defect or true hernia present in normal diastsis recti. The linea alba does not contract like the muscles do.

When people with diastsis recti do a situp, a bulge in the upper abdomen will appear. This non-tender bulge extends from just below the breast bone down to the navel. I remember when I was pregnant and would do a sit-up I would have a slight bulge come up too due to the pregnancy and the linea alba separating when my belly was growing. There is no pain associated with this and when standing, the bulge is not noticeable. Surgery is not recommended for this condition.

So your doctor made a proper diagnosis and wants you to start exercising. At any time when performing a crunch or sit-up, your belly should stay down. Bring the belly button down to the inner spine while contracting. Your doctor might have told you to try to put on a back brace backwards. That would be one possibility. Another one is to hold your hand over your “bulge.” When doing any kind of abdominal exercise press hard enough that the bulge stays down. This way you can still do the exercises.

If you are carrying exra weight in your midsection, you have pressure pushing your bulge out. Try to lose weight and get a flat stomach (easier said than done, but doable!). I had an inguinal hernia with my first pregnancy. They actually fixed it after my first delivery. With each pregnancy (two more) it would open up again,  leaving the bulge in the groin area while pregnant. After each pregnancy, I would get back in pre-pregnancy shape and it would disappear. I know it is still there, however by keeping in shape I have not had the need to do additional surgery for this hernia or have a bulging groin area.

Not only for belly health but also back health, be aware of your posture, keep your stomach tight, talk to your doctor and if it hurts don’t do it!

Ester H Marsh is  Health & Fitness Director at  JF Hurley Family YMCA