July 15, 2026 • 38 mins
Hernias are one of the most common reasons people need surgery, but there are plenty of misconceptions about what causes them and when they’re actually dangerous. This week, Hari and Dr. Priyanka explain why hernias happen, the different types to know about, the symptoms that shouldn’t be ignored, and when it’s safe to monitor one versus when it’s time to head to the emergency room.
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Speaker 1 (00:00):
This podcast is for information purposes only and should not
be considered professional medical advice. For over six hundred years,
routine lead the herdi operations that they would do, they
would just take out your testicles.
Speaker 2 (00:14):
I have thought you need to be an athlete or
somebody who's so physically active that the parts get discombobulated.
Speaker 1 (00:20):
There's a hole and something sticking out of it, and
they push it back in.
Speaker 2 (00:27):
I'm hurry, condibolu.
Speaker 1 (00:29):
I'm doctor Preuncle Wally.
Speaker 2 (00:30):
And this is health stuff. Hello, Prianca, Well, hello there,
how are you. I'm doing okay?
Speaker 1 (00:40):
Yeah, I'm just had a busy morning, you know, just
the routine. Ye, gotta get up, get ready, get going,
show up on time.
Speaker 2 (00:50):
Like own it as a stand up comic, or perhaps
a recovering stand up comic. Yeah, those are very new ideas,
making up, getting ready, doing something fascinating.
Speaker 1 (01:05):
Yeah, you're like a comedian in rehabilitation and you're like
reaccustoming back to life. And yeah, I can't wait to
hear the impact it'll have on your circadian rhythm. Because
when I was performing comedy, I mean staying out late
under those bright lights. Yeah, I mean it would affect
(01:26):
my circadian rhythm for sure, and it definitely took a
while before.
Speaker 2 (01:29):
Things like stabilize, plus playing with your adrenaline like you're
like on stage if it goes well, if it doesn't
go well, like that all has an impact on how
you feel after and whether you can sleep after easily enough.
Speaker 1 (01:42):
Yeah, no, I would be so revved right after. It
takes so much time to settle your nervous system to
actually get sleepy after a show.
Speaker 2 (01:50):
So do you want to hear some news? I went
to the gym yesterday.
Speaker 1 (01:59):
Congratulations, tell me all about it.
Speaker 2 (02:01):
I am so sore. I am in pain when I walk.
My kid was so worried about me. Oh like he
was holding my hand tighter than usual when we were
walking from school, and I'm like, I can walk, It's
just very painful. Everything is sore. But it freaked me
out because it made me think about, like, what other
injuries could I get at the gym? And my first
(02:24):
thought was hernia's.
Speaker 1 (02:26):
Have you ever had a hernia?
Speaker 2 (02:28):
No? But the thing is I don't think I'm all
that physically active, And whenever I think of hernias, have
thought of like, oh, you need to be somebody like
an athlete or somebody who's so physically active that the
parts get discombobulated. I don't think that's particularly scientific. Is
that a scientific way of looking at it? Like, well,
you know, because then you'll get discombobulated if you try
(02:49):
to art.
Speaker 1 (02:50):
Yes, they definitely taught us discombobulated in medical school. That's
definitely a real medical term. No, it's not listeners, it's
really not. But yeah, let's talk about hernias. Let's get
into the gut of hernias. Okay, because it's actually very common.
They're about seven hundred thousand hernia repairs performed every year
(03:13):
in the United States alone.
Speaker 2 (03:15):
What is a hernia exactly?
Speaker 1 (03:16):
Okay, so hernia, It actually comes from the Latin word
for rupture. Hernia is when a part of your either
organs or tissues, they push through a weak spot in
the muscle or the connective tissue that normally should be
holding that organ in place. So when you look at
(03:39):
someone with a hernia, you'll see some kind of bulge
in their gut or they're groin, and it's usually easier
to see if they're standing up or if they're coughing
or lifting something or straining. If you're lying flat, it's
a little bit harder to see a hernia unless it's
like a mass of hernia, and then how do you
(04:02):
fix it? So it's surgical. It's surgical repair.
Speaker 2 (04:05):
Like what do they do, Like they just push the
stomach back into place or.
Speaker 1 (04:09):
Yeah, yeah, they push the organ back where it should be.
And then nowadays they use either some kind of mesh,
like a like a wired mesh or some sort of
synthetic mesh to kind of patch up the hole that
is allowing the tissue to bulge through. So it's like
(04:30):
pretty rudimentary. It's like there's a hole and something sticking
out of it and they push it back in.
Speaker 2 (04:38):
Is it like a really basic surgery or is.
Speaker 1 (04:41):
It it's definitely it's I mean, obviously every surgery has risk,
but it's definitely like if one goes to surgical residency training,
it's like surgery one oh one, like one of the
first things you learn kind of thing. And of course
people can then get really good at it and and
only do that all the time, and you know, get
(05:04):
the latest meshes and now they have robotic surgeries to
do it versus like just cutting someone open. And of course,
like every surgery has risk, but nowadays we're actually pretty
good at treating this.
Speaker 2 (05:18):
Why do they have such a reputation as being like
a dad injury or something that happens when you move
a couch? Like, is it just like I know, it
affects men at a slightly higher rate.
Speaker 1 (05:29):
Right, Yeah, yeah, So I think it's been associated with
dad injuries or moving couches number one, because you tend
to see hernias more if someone is lifting something or straining.
But it's also just more common in men. Like the
lifetime risk of developing a groin hernia, for example, is
twenty seven percent for men, but only three percent for women.
(05:51):
So it makes sense that it's associated more with dads
or dad bods.
Speaker 2 (05:57):
And there's a genetic component to it as well.
Speaker 1 (06:00):
Yeah. Yeah, And I didn't actually know this until we
started researching for this episode, but a family history of
a groin hernia increases the risk by up to eight times.
Speaker 2 (06:12):
Hernias are among the oldest documented surgical conditions in human history.
The earliest known reference appears in Ebers Papyrus. Ebbers Papyrus.
Speaker 1 (06:21):
Yeah, I think it's Ebers, But I don't think the
ancient Egyptians would like really be offended if we mispronounce it.
Speaker 2 (06:28):
Right Ebers, which is around fifteen fifty BC, which describes
a hernia as a quote, a swelling that comes out
when one coughs. So that's like kind of like the
pressure of potential. Is that a real thing, like when
one coughs, you could have a hernia?
Speaker 1 (06:45):
Oh? Absolutely. In fact, when medical training they teach us
one of the ways that you test to see if
something is a hernia is you ask the person to
cough while you're pushing on the spot, and if you
feel that it bulging out with the cough, that's a
clue that we're dealing with a hernia. Yeah.
Speaker 2 (07:05):
The mummy of Ramsey's the fifth exhibits evidence of a
scrotal hernia, making it one of the oldest physical specimens
of the condition. This is not a new thing. This
has happened, it's been documented, and it's been seen for
thousands of years.
Speaker 1 (07:19):
This is like probably one of the oldest medical things
we can think about. It's ancient. Hernias are old news.
It's like a basic medical thing. But I think every
now and then it's important to review this. Yeah, because
there's certain things about hernias that I definitely think the
listeners should be aware of. In terms of like taking
(07:41):
it seriously and not just ignoring it. And we'll get
to that in a minute.
Speaker 2 (07:46):
So, contrary to popular belief, it's not a pulled muscle,
though some people discover it after lifting, coughing, straining, or
working out, exercise doesn't really cause the hernia. If you
have an existing weakness, we are more likely to have
a hernia through exercise, but it doesn't cause it, is that.
Speaker 1 (08:03):
Right, Yeah, exactly, it's going to reveal the weakness rather
than creating one from scratch. But the key is if
you're exposing your abdomen to very high pressure. So let's
say you're lifting weights right like you were at the gym,
and you're doing it with poor form, so you're basically
exposing your abdomen to very high pressure. It can definitely
(08:26):
contribute to a hernia if the person is already susceptible. Okay,
So that's also a great point for like having a
personal trainer, someone who can monitor your form, make sure
you're doing things safely. Lifting weights safely is you know,
really important.
Speaker 2 (08:43):
So hernia has ordinarily involved two forces weakness in the
wall plus pressure pushing against it. Weakness can be something
you're born with something that develops with age, or something
caused by surgery, injury, pregnancy, or tissue strain. Pressure can
come from heavy lifting, as we discuss chronic coughing, constipation, straining, pregnancy,
(09:04):
fluid in the abdomen, or repetitive physical strain. I'm going
to back up just for a seconds. So constipation, yeah, yeah,
can cause a hernia.
Speaker 1 (09:13):
Yeah, because when you are constipated and you're straining on
the toilet, you're increasing your intra abdominal pressure more than
it should be. And anything that increases pressure could potentially
cause organs or tissues to push out through any kind
of susceptible weakness in the wall.
Speaker 2 (09:33):
So what does that look like? If you have a
hernia from your like, do you where's the bump?
Speaker 1 (09:38):
Oh? So the so any the hernia can appear anywhere
in your abdomen, in your groin, even your belly button.
There's there's several types of hernias, but anywhere there's a
physical bulge coming out the constipation. Listeners might be thinking, oh,
there's going to be a bulge coming out of your
butt or anything like that. No, it's not like that.
(10:00):
It's you're increasing pressure in your core and that's what's
going to cause bulges to come out in the form
of hernias? Okay, and of course, I mean, let's be honest,
consummation can also cause other issues like hemorrhoids. Right, Hemorrhoids
are engorged vessels because of increased pressure down there. So
that's not a hernia per se. That's a different thing.
(10:22):
But like, basically, consummation causes all sorts of bulges out
of you. And it's ironic because the only thing that's
not bulging out of you is the poop that you're trying.
Speaker 2 (10:32):
To get out, right, right, right, So this is another
call for fiber.
Speaker 1 (10:36):
Yes, And I mean I full disclosure here. I am
a huge squatty potty fan proponent, So I do feel
like squatty potties make a huge difference in terms of
decreasing the pressure, the introrectal pressure and the intra abdominal pressure,
so you're not straining as much.
Speaker 2 (10:57):
I haven't gotten there yet, but I've thought about it special.
We've discussed it before, and I've thought about it.
Speaker 1 (11:02):
So you don't use any kind of step stool or
anything when you use the bathroom, no oh wow? I mean,
I honestly, like Harry like, I'm sorry life has been so.
Speaker 2 (11:12):
Hard for you. Much like that much better.
Speaker 1 (11:14):
Yeah, Ever since I introduced the squatty potty into my life, like,
going to the bathroom has been an incredibly relaxing and
enjoyable experience. Like it's not stressful at all. And I
attribute it to the fact that any kind of step stool,
you don't need to buy a squatty potty, like anything
that brings your knees closer to your chest, Yeah, it
(11:36):
will relieve that pressure.
Speaker 2 (11:39):
Symptoms can range from painful, aching, pressure, and burning to
no pain at all. So that's that's interesting. So if
it's no pain at all, do you just know it
from the bulge exactly?
Speaker 1 (11:51):
Yeah, you might suddenly sort of notice, oh there's this
bulge here, and I'm not in pain, but maybe sometimes
it gets bigger when I cough or when I lift
something that can be a very common way things present.
Speaker 2 (12:07):
Common inguinal hernia symptoms are a groin area bulge, burning
or aching, pressure, and discomfort that worsens with bending, coughing,
or lifting. The degree of pain is mostly dependent on
the type of hernia and where material gets trapped. So
by material we're talking about what we're talking about the organ, organs,
tissue tishoes. Okay, So generally you'll see a bulge. But
(12:32):
if and this is like just a PSA out there.
Speaker 1 (12:36):
If someone sees a bulge in their belly or groin
and at any point the skin of that bulge starts
to change color, like it turns dark, that is a
medical emergency and you got to go to the er
(12:56):
because that could be a sign that this point that
the tissue or the organs that are coming out of
the hole are basically getting strangled and losing blood supply.
And that's called strangulation. That's the medical term for that,
where now the stuff that's come out of the hole
(13:18):
is getting basically strangled and the blood supply is coming
off and now it's turning blue or it's turning black,
that is a very serious thing, and that warrants going
to the er immediately, like, don't wait around for that.
Speaker 2 (13:32):
So the hernia itself is not an emergency condition. It's
only when it changes color like that.
Speaker 1 (13:38):
Yeah, But generally it depends on the type of hernia,
Like some hernias are more at risk of getting strangulated,
so they should probably be operated on sooner rather than later.
Whereas there are some other hernias depending on where it
is that you know, you can probably like take it
(13:59):
easy and wait a little, but.
Speaker 2 (14:04):
More to come on health stuff. So, I mean, hernia
surgery is one of the earliest surgeries. You were saying,
So what did people do before they just lived with hernias?
Speaker 1 (14:18):
I mean, I think there were more people dying of
herniash And to be clear, the hernia surgeries back in
the day, like you know, from pre seventh century, they
weren't that successful. You know, it was thanks to modern
medicine now, like most hernias have a zero recurrence rate,
(14:40):
but way back in the day, it was like they
would get operated on and there was like one hundred
percent recurrence rate.
Speaker 2 (14:45):
So plus the operation itself might kill you based.
Speaker 1 (14:49):
On I mean, yeah, you know, it was very barbaric.
Speaker 2 (14:52):
Germs and the rest of it. Yeah.
Speaker 1 (14:54):
Yeah. In fact, there was a documentation that for inguinal
hern which is when the tissue pushes through a weak
spot into the lower part of your abdomen, like often
into your groin. This is like way more common in men,
and it could even go into the scrotum and cause
(15:16):
testicular pain. For over six hundred years, routinely. The hernia
operations that they would do, they would just take out
your testicles with the her cheesez.
Speaker 2 (15:25):
Yeah, so was it necessary.
Speaker 1 (15:28):
I know, but that was sort of they didn't know
what else to do. And now, thankfully, thanks to modern medicine,
we know we can robotically push that tissue back in
and save the testicle. We don't have to do anything
with the testicle. We can Jesus separate it. But yeah,
like it was a really tough time to have hernias
back then.
Speaker 2 (15:47):
Yeah, my god, losing a testicle because people just didn't know.
Speaker 1 (15:51):
Yeah.
Speaker 2 (15:51):
Yeah, and guenal hernia has a come for seventy five
percent of all abdominal wall hernias and are ten times
more common in men than women. Yeah, and we talked
about this a little bit. So why are they more
common in men.
Speaker 1 (16:04):
It all comes down to anatomy. So before a man
is born, the testicles they're not actually in the scrotum,
They actually develop in the belly inside the abdomen, and
then they descend through the abdominal wall into the scrotum.
And so basically there's a passageway that is created from
(16:27):
this descent. The descent of the testicles and that passageway
can later become a vulnerability for hernias later in life.
The inguinol canal is part of that passageway, and if
there's tissue that bulges out through the inguinal canal, that's
how it can even descend into the scrotum. And so
(16:48):
women we have inguinol canals, but they're a lot lot
smaller than the male physique and so they're less vulnerable
to herniation. That's why inguinal hernias are ten times more
common in men.
Speaker 2 (17:05):
So there's femoral hernias and they're less common than nguinol hernias.
What are they about, right?
Speaker 1 (17:11):
So also these are near the groin, but they're a
little bit lower. They're kind of closer to the upper
part of the thigh, and these are more common in women.
Femoral hernias more likely because of where they're located. Generally
present more often with strangulation as the first sign of it,
(17:34):
so like you might not feel anything and then all
of a sudden, you have a bulge and it's really painful.
That generally happens with femoral hernias.
Speaker 2 (17:42):
And then there's umbilical hernias, which occur near the belly
button that are common in babies and adults can get
them as well. Definitely. How does that happen?
Speaker 1 (17:52):
Yeah, So, actually, umbilical hernias can be more common in
people who have had pregnancies because during pregnancy the belly
sort of expands and the tissue kind of stretches out,
so there's like more chances of potential holes arising. And
so after pregnancy, when the belly sort of closes up,
(18:15):
women can have trouble repairing that and then later develop
umbilical hernias. Sometimes you don't feel anything, you just see
the bulge, but sometimes they can be symptomatic.
Speaker 2 (18:27):
And then there's is this hiatel hernia's hiatl hernias? Tell
me about those?
Speaker 1 (18:33):
So, hyatel hernias are actually when your stomach pushes through
up the diaphragm and into your chest. Yeah, so it's
really different from other hernias because you don't see the bulge,
you can't see anything. What you do experience, though, is
(18:55):
actually reflux, like acid reflux can be caused by a
hyatel hernia, or you get a lot of regurg or heartburn,
or sometimes people with a hyadel hernia they have trouble
swallowing or they get full really quickly after they eat.
Speaker 2 (19:12):
So how would you know if you have it in
that heartburn, like you're taking heartburn medication, it's not working,
like something else is going on. You see a doctor
and that's when they let you know that, okay, this
is it's not just heartburn, you have.
Speaker 1 (19:24):
A hernia exactly. So this is also another PSA, Like
if someone has heartburn and you've been prescribed medication, let's
say like a PPI, like a map resol or Prilosec
that's one of the brand names. Like if you are
prescribed that for heartburn and then you take it for
whatever eight to twelve weeks and there's no improvement in
(19:46):
your heartburn, that would be a great opportunity to go
back to your provider and say this med didn't work
at all, Like should we do a workup for a
hyadel hernia? And sometimes it is the hyadel herne that
is the cause, and then there are options for that,
like you can surgically repair that and stuff.
Speaker 2 (20:06):
And then there's finally incisional or ventral hernias, which occur
in the area of the abdominal wall weakened by surgery.
Speaker 1 (20:13):
Yeah, yeah, and so this is visually when you see
someone with a ventral hernia it's sort of like a
hernia straight down the middle of their belly, and it's
usually caused by some sort of manipulation because maybe they
were operated on or something like that.
Speaker 2 (20:33):
So how do you I mean, we discussed this a
little bit already, but how do you know if you
have a hernia?
Speaker 1 (20:37):
Yeah, exactly, Okay. So it's usually like a visible bulge
or some sort of touchable bulge in either your groin
or your abdomen or your belly button, or maybe like
if you had surgery, it's along the site of the scar,
and it could be like a very subtle bulge. At first,
you might only notice it like if a person is
(21:00):
standing or coughing or straining, or like taking a really
close look in the mirror, and there's not so much
like a sharp pain. If there is a sensation, it's
more like a heaviness or a dragging or a sense
that something's pulling. And usually the discomfort is very mild.
(21:21):
Because that's a lot of the reason why hernias are ignored,
because the there's not really a lot of pain or discomfort,
and people don't really seek medical attention until they become
like more severe.
Speaker 2 (21:33):
What do people think it is? Normally like, oh, this
is a bug bite that's gotten out of control, or like.
Speaker 1 (21:38):
It's usually a little bit more. It's usually a little
bit bigger than just a bug bite. Sometimes they think
it's like, oh, you know, just gaining weight or something
like that, right, like, oh, it's just like a little
pouch thing. Sometimes, especially like with inguinal hernias or groin hernias,
if the pain goes into the testicle or the scrown,
(22:00):
they might think like, oh, I need to go see
a urologist. I'm having testical pain, but it's actually a hernia.
Speaker 2 (22:06):
Would a urologists be able to diagnose it as a hernia?
Speaker 1 (22:09):
Yes? Yes, any most actual medical professionals can diagnose hernia's.
Speaker 2 (22:15):
So hernia symptoms often get worse during activities that increase
pressure inside the abdomen, like coughing, lifting, bending, exercising, or
standing for long periods. You seem like some of these
things are things comedians have to deal with. I never
thought that hernias were a risk of standing on stage
(22:38):
for hours on end. A key clue is that the
discomfort or bulge may improve when lying down, because the
tissue can sometimes settle back into place exactly gravity.
Speaker 1 (22:48):
Right, Yeah, Yeah.
Speaker 2 (22:50):
There are significant and well documented racial and socioeconomic disparities
in hernia care across multiple dimensions, Like with everything, Yeah, I.
Speaker 1 (23:00):
Think it's important to name this. Yeah.
Speaker 2 (23:03):
Yeah, Black patients are disproportionately more likely to undergo hernia
repair in the emergence setting rather than electively, So meaning
that like black patients are more likely to be ignored
when they initially show hernia symptoms. Is that what it is?
Speaker 1 (23:19):
Yeah, So there's a difference in terms of outcomes, Like
when you do the hernia surgery emergently, there's more likely
that complications are going to arise. If you do it electively,
it means there was time you could plan it, you
could schedule it. You know, you could probably have a
conversation with a surgeon about what kind of surgical technique
(23:41):
we're going to use, what kind of mesh we're going
to use, whether we're going to use minimally invasive surgery
or robotic surgery. There's just a lot more mindfulness that
goes through in an elective planned surgery, and when you're
in an emergency it's like you use whatever mesh you have,
like you're under direct and so things are more likely
(24:02):
to have complications under an emergency.
Speaker 2 (24:06):
Is it that patients are being ignored or is it
that black patients have less access to medical care.
Speaker 1 (24:14):
I think it has a lot to do with both access,
taking their concerns seriously, education around like what they deserve.
I think the financial aspect of it as well getting
access to the right kind of treatment is So it's like,
really this sort of multifactorial approach in terms of like
(24:37):
what inequities are driving these these outcomes. We're going to
take a short break stay with us.
Speaker 2 (24:50):
African Americans had more than twice the odds of undergoing
emergent inguinill hernia repair compared to Caucasians, and significantly higher
odds of emerging ventral and umbilical hernia repair. This is
from a New York state analysis of over two hundred
and thirty eight thousand hernia repairs. Yeah.
Speaker 1 (25:10):
Yeah, And on top of that, another study published in
JAMA show that black patients are less likely to receive
minimally invasive surgery for hernia repair. The less you open
up the abdomen, the less complications that are going to arise.
It seems like even when you have access to advanced
(25:32):
surgical techniques and equitable access, the outcomes may not be
the same as well.
Speaker 2 (25:38):
A large study from the Abdominal Core health Quality Collaborative
found that while black patients actually had slightly higher rates
of robotic ventral hernia repair than white patients, they had
a higher reoperation rate and higher pain scores at two years,
suggesting that equitable access alone does not guarantee equitable outcomes.
(25:58):
Now explain that one to me.
Speaker 1 (26:00):
So basically, what this implies is that there is some
sort of inherent racial bias in terms of black patients
experience of going through surgery, even if it's minimally invasive,
in the sense that we are not listening to their concerns,
(26:22):
We're not guaranteeing that we are treating each patient the
same for whatever reason. There's actually research that shows in
medicine that there is a lot of unconscious race bias,
especially among surgeons. I think this study is direct evidence
(26:42):
of how that actually shows up clinically. That if you're
then operating on both black and white patients, but black
patients are having more complications or pain, they're in more pain.
I think this is evidence that there is some sort
of unconscious race or social class bias existing within medicine.
(27:05):
Which we know the research is showing.
Speaker 2 (27:07):
That when should you go to the doctor for hernia?
Speaker 1 (27:11):
Okay, so a lot of times if the hernia is
really small or you don't have symptoms, you can just watch.
But it's important to understand that a hernia can just
go away on its own. Like hernias don't heal themselves.
You can use temporary things like they make these hernia
belts or hernia binders that can kind of provide temporary
(27:35):
support in terms of supporting the tissue, but I want
to be super clear that they're not repairing the hernia right.
The hernia has to be repaired surgically and majority of time,
like if you take, for example, men who have inguinal
hernias that they're not really having symptoms, they can wait
(27:58):
on the surgery, but eventually, like seventy percent eventually develop
worsening symptoms and within five years need surgery. In general,
it's better like to plan to get the surgery when
you're ready, but it's not like an emergency thing that
you have to deal with, you know, tomorrow.
Speaker 2 (28:17):
Wait, so people are waiting five years before they get
the hernias taken care of.
Speaker 1 (28:21):
Well, I think it's like sometimes people just don't want
to be operated on, which is fair, right for whatever reason,
and they think like, oh, okay, I can just do
some other things or keep it under control. But the
research shows that eventually people do get symptoms and then
they need surgery.
Speaker 2 (28:41):
Right, is it also the people don't know that it
doesn't go away on its own? I think soon.
Speaker 1 (28:46):
Yeah, I think there's some Yeah, I think that that's
fair to say.
Speaker 2 (28:50):
Okay, before the modern era hernia repair had a one
hundred percent reoccurrence rate at four years. Thanks to modern
medical techniques, we now have close to a zero percent
recurrent rate. That's enormous, that's incredible.
Speaker 1 (29:04):
Yeah. No, I think as far as modern medicine is concerned,
hernia repairs are one of the things that modern medicine
does really well, or it can do really well with
the right planning and the right surgeon. I think one
thing to ask if you're like trying to decide who's
going to operate on you, it's always helpful to ask
(29:27):
your surgeon, number one, how many of these have you done?
How many of these specific types of repairs have you done?
And my favorite question is also to ask the provider
if you had to get operated on who would you
want operating on you? Ooh, and then see who they ask,
and then go to that person and see who they say,
(29:50):
and generally they say, then the right person will be like, well,
I wish I could operate on myself, but I can't.
And then you know you've got the right guy.
Speaker 2 (30:01):
And also dependent on insurance.
Speaker 1 (30:03):
Oh well that too. Yeah.
Speaker 2 (30:04):
Hernia becomes more dangerous when tissue gets trapped and cannot
be pushed back in. This phenomenon is known as incarceration,
and even bigger emergency is when blood supply to the
trapped tissue is cut off, which is known as we
discussed this before, strangulation. Yeah, about half of fhemoral hernias
eventually requires surgical resection due to incarceration, strangulation, bowel obstruction,
(30:28):
and ischemia. Is that right?
Speaker 1 (30:30):
Yep, yep, yep, yep. And the thing about femoral hernia
repair that's done as an emergency, it's associated with a
ten times risk of dying compared to elective surgery. If
you have a femoral hernia, you definitely don't want to
just like wait and watch. Because thirty five to forty
(30:53):
percent of femoral hernias usually present with strangulation or bowel
obstruction as the first manifestation, so they're more dangerous.
Speaker 2 (31:04):
The Cleveland Clinic advises going to the emergency room for
any of the following sudden severe pain, a bulge that
becomes firm and cannot be pushed back in, nausea, vomiting, fever,
skin color changes over the hernia, and an inability to
pass gas or stool.
Speaker 1 (31:22):
Yeah. I remember in medical school like seeing lots of hernias,
and definitely the ones where you couldn't push them back
in because they had progressed too far. Majority of the
hernias you just diagnosed by looking at the patient physical
exam and like I said earlier, when assessing the bulge,
(31:45):
and if you're going to see your doctor, they might
ask you to stand or cough or bear down, and
if the bulge becomes more obvious, then that's sort of
more diagnostic. Sometimes you're looking at a bulge and you're like,
is this a hernia? Is this on a hernia? I
can't really tell. That's when your doctor might order like
an ultrasound or a cat scanner, an MRI. Remember, like
(32:07):
that applies for all of the hernias that you can
see visibly, except for hyadel hernia, which you can't see.
So sometimes hyadel hernias are diagnosed because they take a
camera and they stick it down your throat and then
they see it, or they take an X ray and
if it's really big or like we discussed earlier, like
you have acid reflex and it's not going away, and
(32:29):
then it ends up like being discovered in that discovery process.
Speaker 2 (32:33):
What does that mean pushed back in? Because you said
it acquire surgery to push it back in, So what
does that mean, Like you know you can't push it
back in.
Speaker 1 (32:41):
Yeah, So let's say someone has a bulge right and
there's a hole let's say lower down, and let's say
it's your intestines that are bulging out through that hole.
But now so many of the organs have come out
through the hole that there's more outside than can be
pushed back in through that small hole because the hole's
(33:02):
the same. So if you try and push the organs
back through the hole into the abdomen and you can't
do it, that's what I mean, like, you can't push
that back in.
Speaker 2 (33:13):
Basically, wait, you can push it back in.
Speaker 1 (33:16):
If a herdia is what's called reducible, then you can
push it back.
Speaker 2 (33:20):
In without surgery.
Speaker 1 (33:23):
Well temporarily, not permanently. Yeah, okay, you can push it
back in momentarily and then maybe put like a binder
over it or something, but it's gonna pop back out.
Speaker 2 (33:35):
Yeah, okay, yeah, God, this is horrifying. I don't like
this at all.
Speaker 1 (33:41):
That's fair, that's fair. So surgery involves speaking of pushing
the tissue back in. So surgery involves pushing the tissue
back in, putting everything where it's supposed to be, and
then patching up that weak spot. And it's usually with
a mesh of some sort, and nowadays they have all
kinds of synthetic meshes made of all sorts of really
(34:03):
interesting things. But your surgeon would talk to you about
what kind of mesh they would want to use, what
are the risks of the mesh, and what type of
surgery they're going to do. A lot of times they'll
make that decision based off of where the hernia is,
how big it is, whether they have a mesh that
fits that size, and all sorts of things. But this
(34:27):
is generally like a pretty routine surgical procedure.
Speaker 2 (34:32):
So the mesh just stays in the body. Then yes, okay, yeah,
so most common hernia repairs a routine, but they still
require recovery time and lifting restrictions. Well, many are able
to walk around soon after the surgery, anything that involves
core strain generally has to wait. Recovery depends on the
type of hernia, the type of surgery, the patient's health,
(34:54):
and the physical demands of their life or job. It's
important to follow the surgeon's specific instructions. Reoccurrence can happen,
especially if someone returns too quickly to heavy strain or
has ongoing pressure risks like chronic cough or constipation.
Speaker 1 (35:10):
Yeah, I mean it's rare, but it does happen. Reoccurrence
can happen, but it's it's very rare. And if you
follow the postop instructions, like you should be good.
Speaker 2 (35:22):
How do you prevent to hernia? How do how do
we avoid this from happening? To begin with?
Speaker 1 (35:25):
Well, I think it's important to share that, like, you
can't truly prevent every hernia, especially if like maybe there's
a genetic component, or maybe you were born with some weakness,
or you had surgery that you couldn't control. And no
one should ever have any like shame around having a
hernia because like, it's not your fault. You can do
things to avoid them, Like if you lift things like
(35:48):
at the gym, do it with good form. So here's
where good trainers come in. If you have things that
increase the pressure of your abdomen, so like let's say
you're coughing a lot, you have this sort of chronic cough,
or let's say you're constipated all the time, get that
treated because you don't want to just have a cough
(36:13):
all the time or just be constipated that over time
could increase your risk of hernias. And then you know,
doing core exercises is obviously really important for your health,
but don't just like go gung ho like. You have
to build your core gradually because if you go really hard,
really strong, like you could strain yourself and then develop
(36:36):
a hernia. And then obviously, if you see a bulge
at any point in your belly, abdomen, groin and it
keeps coming back, definitely go get that checked out. Because
the earlier you get looked at, you can be sort
of watched carefully or you know, if it's confirmed that
(36:57):
is it a hernia, then you can sort of take
your time and play for correcting it.
Speaker 2 (37:02):
So here are ore takeaways. Hernia is tissue pushing through
a weak spot, usually in the abdominal wall or groin.
Hernias are common and they are not always emergencies. The
classic sign is a bulge that may worsen withithstanding, coughing,
lifting or straining, sudden severe pain, vomiting, fever, skin discoloration,
or a bulge that will not go back in should
(37:25):
be treated urgently.
Speaker 1 (37:27):
Yeah, some hernias can be watched, but most eventually needs
surgical repair. And I think it's important to remember this
will not heal on its own, but don't panic. It's
about knowing when to monitor it, the signs to look for,
and when to call the doctor, and then of course
when you should go to the er.
Speaker 2 (37:46):
Okay, everybody, that was another week of health Stuff. I
hope this helped you learn how not to have a hernia.
Speaker 1 (37:57):
Health Stuff is a production of iHeart podcast US. The
show is hosted by Me, doctor Prianko Wally and Harikonnebolu.
Producers are Rebecca Eisenberg, Jenna Cagel, Christina Loranger, Maya Howard,
and Katrina Norvel. Our researcher is Maria Tremarki and Our
intern is Katia Zobel Lejayala. To send us a question,
(38:18):
you can email us a voice memo at health Stuff
Podcast at gmail dot com. Thanks so much for listening.
This podcast is for information purposes only and should not
be considered professional medical advice. For over six hundred years,
routine lead the herdi operations that they would do, they
would just take out your testicles.
Speaker 2 (00:14):
I have thought you need to be an athlete or
somebody who's so physically active that the parts get discombobulated.
Speaker 1 (00:20):
There's a hole and something sticking out of it, and
they push it back in.
Speaker 2 (00:27):
I'm hurry, condibolu.
Speaker 1 (00:29):
I'm doctor Preuncle Wally.
Speaker 2 (00:30):
And this is health stuff. Hello, Prianca, Well, hello there,
how are you. I'm doing okay?
Speaker 1 (00:40):
Yeah, I'm just had a busy morning, you know, just
the routine. Ye, gotta get up, get ready, get going,
show up on time.
Speaker 2 (00:50):
Like own it as a stand up comic, or perhaps
a recovering stand up comic. Yeah, those are very new ideas,
making up, getting ready, doing something fascinating.
Speaker 1 (01:05):
Yeah, you're like a comedian in rehabilitation and you're like
reaccustoming back to life. And yeah, I can't wait to
hear the impact it'll have on your circadian rhythm. Because
when I was performing comedy, I mean staying out late
under those bright lights. Yeah, I mean it would affect
(01:26):
my circadian rhythm for sure, and it definitely took a
while before.
Speaker 2 (01:29):
Things like stabilize, plus playing with your adrenaline like you're
like on stage if it goes well, if it doesn't
go well, like that all has an impact on how
you feel after and whether you can sleep after easily enough.
Speaker 1 (01:42):
Yeah, no, I would be so revved right after. It
takes so much time to settle your nervous system to
actually get sleepy after a show.
Speaker 2 (01:50):
So do you want to hear some news? I went
to the gym yesterday.
Speaker 1 (01:59):
Congratulations, tell me all about it.
Speaker 2 (02:01):
I am so sore. I am in pain when I walk.
My kid was so worried about me. Oh like he
was holding my hand tighter than usual when we were
walking from school, and I'm like, I can walk, It's
just very painful. Everything is sore. But it freaked me
out because it made me think about, like, what other
injuries could I get at the gym? And my first
(02:24):
thought was hernia's.
Speaker 1 (02:26):
Have you ever had a hernia?
Speaker 2 (02:28):
No? But the thing is I don't think I'm all
that physically active, And whenever I think of hernias, have
thought of like, oh, you need to be somebody like
an athlete or somebody who's so physically active that the
parts get discombobulated. I don't think that's particularly scientific. Is
that a scientific way of looking at it? Like, well,
you know, because then you'll get discombobulated if you try
(02:49):
to art.
Speaker 1 (02:50):
Yes, they definitely taught us discombobulated in medical school. That's
definitely a real medical term. No, it's not listeners, it's
really not. But yeah, let's talk about hernias. Let's get
into the gut of hernias. Okay, because it's actually very common.
They're about seven hundred thousand hernia repairs performed every year
(03:13):
in the United States alone.
Speaker 2 (03:15):
What is a hernia exactly?
Speaker 1 (03:16):
Okay, so hernia, It actually comes from the Latin word
for rupture. Hernia is when a part of your either
organs or tissues, they push through a weak spot in
the muscle or the connective tissue that normally should be
holding that organ in place. So when you look at
(03:39):
someone with a hernia, you'll see some kind of bulge
in their gut or they're groin, and it's usually easier
to see if they're standing up or if they're coughing
or lifting something or straining. If you're lying flat, it's
a little bit harder to see a hernia unless it's
like a mass of hernia, and then how do you
(04:02):
fix it? So it's surgical. It's surgical repair.
Speaker 2 (04:05):
Like what do they do, Like they just push the
stomach back into place or.
Speaker 1 (04:09):
Yeah, yeah, they push the organ back where it should be.
And then nowadays they use either some kind of mesh,
like a like a wired mesh or some sort of
synthetic mesh to kind of patch up the hole that
is allowing the tissue to bulge through. So it's like
(04:30):
pretty rudimentary. It's like there's a hole and something sticking
out of it and they push it back in.
Speaker 2 (04:38):
Is it like a really basic surgery or is.
Speaker 1 (04:41):
It it's definitely it's I mean, obviously every surgery has risk,
but it's definitely like if one goes to surgical residency training,
it's like surgery one oh one, like one of the
first things you learn kind of thing. And of course
people can then get really good at it and and
only do that all the time, and you know, get
(05:04):
the latest meshes and now they have robotic surgeries to
do it versus like just cutting someone open. And of course,
like every surgery has risk, but nowadays we're actually pretty
good at treating this.
Speaker 2 (05:18):
Why do they have such a reputation as being like
a dad injury or something that happens when you move
a couch? Like, is it just like I know, it
affects men at a slightly higher rate.
Speaker 1 (05:29):
Right, Yeah, yeah, So I think it's been associated with
dad injuries or moving couches number one, because you tend
to see hernias more if someone is lifting something or straining.
But it's also just more common in men. Like the
lifetime risk of developing a groin hernia, for example, is
twenty seven percent for men, but only three percent for women.
(05:51):
So it makes sense that it's associated more with dads
or dad bods.
Speaker 2 (05:57):
And there's a genetic component to it as well.
Speaker 1 (06:00):
Yeah. Yeah, And I didn't actually know this until we
started researching for this episode, but a family history of
a groin hernia increases the risk by up to eight times.
Speaker 2 (06:12):
Hernias are among the oldest documented surgical conditions in human history.
The earliest known reference appears in Ebers Papyrus. Ebbers Papyrus.
Speaker 1 (06:21):
Yeah, I think it's Ebers, But I don't think the
ancient Egyptians would like really be offended if we mispronounce it.
Speaker 2 (06:28):
Right Ebers, which is around fifteen fifty BC, which describes
a hernia as a quote, a swelling that comes out
when one coughs. So that's like kind of like the
pressure of potential. Is that a real thing, like when
one coughs, you could have a hernia?
Speaker 1 (06:45):
Oh? Absolutely. In fact, when medical training they teach us
one of the ways that you test to see if
something is a hernia is you ask the person to
cough while you're pushing on the spot, and if you
feel that it bulging out with the cough, that's a
clue that we're dealing with a hernia. Yeah.
Speaker 2 (07:05):
The mummy of Ramsey's the fifth exhibits evidence of a
scrotal hernia, making it one of the oldest physical specimens
of the condition. This is not a new thing. This
has happened, it's been documented, and it's been seen for
thousands of years.
Speaker 1 (07:19):
This is like probably one of the oldest medical things
we can think about. It's ancient. Hernias are old news.
It's like a basic medical thing. But I think every
now and then it's important to review this. Yeah, because
there's certain things about hernias that I definitely think the
listeners should be aware of. In terms of like taking
(07:41):
it seriously and not just ignoring it. And we'll get
to that in a minute.
Speaker 2 (07:46):
So, contrary to popular belief, it's not a pulled muscle,
though some people discover it after lifting, coughing, straining, or
working out, exercise doesn't really cause the hernia. If you
have an existing weakness, we are more likely to have
a hernia through exercise, but it doesn't cause it, is that.
Speaker 1 (08:03):
Right, Yeah, exactly, it's going to reveal the weakness rather
than creating one from scratch. But the key is if
you're exposing your abdomen to very high pressure. So let's
say you're lifting weights right like you were at the gym,
and you're doing it with poor form, so you're basically
exposing your abdomen to very high pressure. It can definitely
(08:26):
contribute to a hernia if the person is already susceptible. Okay,
So that's also a great point for like having a
personal trainer, someone who can monitor your form, make sure
you're doing things safely. Lifting weights safely is you know,
really important.
Speaker 2 (08:43):
So hernia has ordinarily involved two forces weakness in the
wall plus pressure pushing against it. Weakness can be something
you're born with something that develops with age, or something
caused by surgery, injury, pregnancy, or tissue strain. Pressure can
come from heavy lifting, as we discuss chronic coughing, constipation, straining, pregnancy,
(09:04):
fluid in the abdomen, or repetitive physical strain. I'm going
to back up just for a seconds. So constipation, yeah, yeah,
can cause a hernia.
Speaker 1 (09:13):
Yeah, because when you are constipated and you're straining on
the toilet, you're increasing your intra abdominal pressure more than
it should be. And anything that increases pressure could potentially
cause organs or tissues to push out through any kind
of susceptible weakness in the wall.
Speaker 2 (09:33):
So what does that look like? If you have a
hernia from your like, do you where's the bump?
Speaker 1 (09:38):
Oh? So the so any the hernia can appear anywhere
in your abdomen, in your groin, even your belly button.
There's there's several types of hernias, but anywhere there's a
physical bulge coming out the constipation. Listeners might be thinking, oh,
there's going to be a bulge coming out of your
butt or anything like that. No, it's not like that.
(10:00):
It's you're increasing pressure in your core and that's what's
going to cause bulges to come out in the form
of hernias? Okay, and of course, I mean, let's be honest,
consummation can also cause other issues like hemorrhoids. Right, Hemorrhoids
are engorged vessels because of increased pressure down there. So
that's not a hernia per se. That's a different thing.
(10:22):
But like, basically, consummation causes all sorts of bulges out
of you. And it's ironic because the only thing that's
not bulging out of you is the poop that you're trying.
Speaker 2 (10:32):
To get out, right, right, right, So this is another
call for fiber.
Speaker 1 (10:36):
Yes, And I mean I full disclosure here. I am
a huge squatty potty fan proponent, So I do feel
like squatty potties make a huge difference in terms of
decreasing the pressure, the introrectal pressure and the intra abdominal pressure,
so you're not straining as much.
Speaker 2 (10:57):
I haven't gotten there yet, but I've thought about it special.
We've discussed it before, and I've thought about it.
Speaker 1 (11:02):
So you don't use any kind of step stool or
anything when you use the bathroom, no oh wow? I mean,
I honestly, like Harry like, I'm sorry life has been so.
Speaker 2 (11:12):
Hard for you. Much like that much better.
Speaker 1 (11:14):
Yeah, Ever since I introduced the squatty potty into my life, like,
going to the bathroom has been an incredibly relaxing and
enjoyable experience. Like it's not stressful at all. And I
attribute it to the fact that any kind of step stool,
you don't need to buy a squatty potty, like anything
that brings your knees closer to your chest, Yeah, it
(11:36):
will relieve that pressure.
Speaker 2 (11:39):
Symptoms can range from painful, aching, pressure, and burning to
no pain at all. So that's that's interesting. So if
it's no pain at all, do you just know it
from the bulge exactly?
Speaker 1 (11:51):
Yeah, you might suddenly sort of notice, oh there's this
bulge here, and I'm not in pain, but maybe sometimes
it gets bigger when I cough or when I lift
something that can be a very common way things present.
Speaker 2 (12:07):
Common inguinal hernia symptoms are a groin area bulge, burning
or aching, pressure, and discomfort that worsens with bending, coughing,
or lifting. The degree of pain is mostly dependent on
the type of hernia and where material gets trapped. So
by material we're talking about what we're talking about the organ, organs,
tissue tishoes. Okay, So generally you'll see a bulge. But
(12:32):
if and this is like just a PSA out there.
Speaker 1 (12:36):
If someone sees a bulge in their belly or groin
and at any point the skin of that bulge starts
to change color, like it turns dark, that is a
medical emergency and you got to go to the er
(12:56):
because that could be a sign that this point that
the tissue or the organs that are coming out of
the hole are basically getting strangled and losing blood supply.
And that's called strangulation. That's the medical term for that,
where now the stuff that's come out of the hole
(13:18):
is getting basically strangled and the blood supply is coming
off and now it's turning blue or it's turning black,
that is a very serious thing, and that warrants going
to the er immediately, like, don't wait around for that.
Speaker 2 (13:32):
So the hernia itself is not an emergency condition. It's
only when it changes color like that.
Speaker 1 (13:38):
Yeah, But generally it depends on the type of hernia,
Like some hernias are more at risk of getting strangulated,
so they should probably be operated on sooner rather than later.
Whereas there are some other hernias depending on where it
is that you know, you can probably like take it
(13:59):
easy and wait a little, but.
Speaker 2 (14:04):
More to come on health stuff. So, I mean, hernia
surgery is one of the earliest surgeries. You were saying,
So what did people do before they just lived with hernias?
Speaker 1 (14:18):
I mean, I think there were more people dying of
herniash And to be clear, the hernia surgeries back in
the day, like you know, from pre seventh century, they
weren't that successful. You know, it was thanks to modern
medicine now, like most hernias have a zero recurrence rate,
(14:40):
but way back in the day, it was like they
would get operated on and there was like one hundred
percent recurrence rate.
Speaker 2 (14:45):
So plus the operation itself might kill you based.
Speaker 1 (14:49):
On I mean, yeah, you know, it was very barbaric.
Speaker 2 (14:52):
Germs and the rest of it. Yeah.
Speaker 1 (14:54):
Yeah. In fact, there was a documentation that for inguinal
hern which is when the tissue pushes through a weak
spot into the lower part of your abdomen, like often
into your groin. This is like way more common in men,
and it could even go into the scrotum and cause
(15:16):
testicular pain. For over six hundred years, routinely. The hernia
operations that they would do, they would just take out
your testicles with the her cheesez.
Speaker 2 (15:25):
Yeah, so was it necessary.
Speaker 1 (15:28):
I know, but that was sort of they didn't know
what else to do. And now, thankfully, thanks to modern medicine,
we know we can robotically push that tissue back in
and save the testicle. We don't have to do anything
with the testicle. We can Jesus separate it. But yeah,
like it was a really tough time to have hernias
back then.
Speaker 2 (15:47):
Yeah, my god, losing a testicle because people just didn't know.
Speaker 1 (15:51):
Yeah.
Speaker 2 (15:51):
Yeah, and guenal hernia has a come for seventy five
percent of all abdominal wall hernias and are ten times
more common in men than women. Yeah, and we talked
about this a little bit. So why are they more
common in men.
Speaker 1 (16:04):
It all comes down to anatomy. So before a man
is born, the testicles they're not actually in the scrotum,
They actually develop in the belly inside the abdomen, and
then they descend through the abdominal wall into the scrotum.
And so basically there's a passageway that is created from
(16:27):
this descent. The descent of the testicles and that passageway
can later become a vulnerability for hernias later in life.
The inguinol canal is part of that passageway, and if
there's tissue that bulges out through the inguinal canal, that's
how it can even descend into the scrotum. And so
(16:48):
women we have inguinol canals, but they're a lot lot
smaller than the male physique and so they're less vulnerable
to herniation. That's why inguinal hernias are ten times more
common in men.
Speaker 2 (17:05):
So there's femoral hernias and they're less common than nguinol hernias.
What are they about, right?
Speaker 1 (17:11):
So also these are near the groin, but they're a
little bit lower. They're kind of closer to the upper
part of the thigh, and these are more common in women.
Femoral hernias more likely because of where they're located. Generally
present more often with strangulation as the first sign of it,
(17:34):
so like you might not feel anything and then all
of a sudden, you have a bulge and it's really painful.
That generally happens with femoral hernias.
Speaker 2 (17:42):
And then there's umbilical hernias, which occur near the belly
button that are common in babies and adults can get
them as well. Definitely. How does that happen?
Speaker 1 (17:52):
Yeah, So, actually, umbilical hernias can be more common in
people who have had pregnancies because during pregnancy the belly
sort of expands and the tissue kind of stretches out,
so there's like more chances of potential holes arising. And
so after pregnancy, when the belly sort of closes up,
(18:15):
women can have trouble repairing that and then later develop
umbilical hernias. Sometimes you don't feel anything, you just see
the bulge, but sometimes they can be symptomatic.
Speaker 2 (18:27):
And then there's is this hiatel hernia's hiatl hernias? Tell
me about those?
Speaker 1 (18:33):
So, hyatel hernias are actually when your stomach pushes through
up the diaphragm and into your chest. Yeah, so it's
really different from other hernias because you don't see the bulge,
you can't see anything. What you do experience, though, is
(18:55):
actually reflux, like acid reflux can be caused by a
hyatel hernia, or you get a lot of regurg or heartburn,
or sometimes people with a hyadel hernia they have trouble
swallowing or they get full really quickly after they eat.
Speaker 2 (19:12):
So how would you know if you have it in
that heartburn, like you're taking heartburn medication, it's not working,
like something else is going on. You see a doctor
and that's when they let you know that, okay, this
is it's not just heartburn, you have.
Speaker 1 (19:24):
A hernia exactly. So this is also another PSA, Like
if someone has heartburn and you've been prescribed medication, let's
say like a PPI, like a map resol or Prilosec
that's one of the brand names. Like if you are
prescribed that for heartburn and then you take it for
whatever eight to twelve weeks and there's no improvement in
(19:46):
your heartburn, that would be a great opportunity to go
back to your provider and say this med didn't work
at all, Like should we do a workup for a
hyadel hernia? And sometimes it is the hyadel herne that
is the cause, and then there are options for that,
like you can surgically repair that and stuff.
Speaker 2 (20:06):
And then there's finally incisional or ventral hernias, which occur
in the area of the abdominal wall weakened by surgery.
Speaker 1 (20:13):
Yeah, yeah, and so this is visually when you see
someone with a ventral hernia it's sort of like a
hernia straight down the middle of their belly, and it's
usually caused by some sort of manipulation because maybe they
were operated on or something like that.
Speaker 2 (20:33):
So how do you I mean, we discussed this a
little bit already, but how do you know if you
have a hernia?
Speaker 1 (20:37):
Yeah, exactly, Okay. So it's usually like a visible bulge
or some sort of touchable bulge in either your groin
or your abdomen or your belly button, or maybe like
if you had surgery, it's along the site of the scar,
and it could be like a very subtle bulge. At first,
you might only notice it like if a person is
(21:00):
standing or coughing or straining, or like taking a really
close look in the mirror, and there's not so much
like a sharp pain. If there is a sensation, it's
more like a heaviness or a dragging or a sense
that something's pulling. And usually the discomfort is very mild.
(21:21):
Because that's a lot of the reason why hernias are ignored,
because the there's not really a lot of pain or discomfort,
and people don't really seek medical attention until they become
like more severe.
Speaker 2 (21:33):
What do people think it is? Normally like, oh, this
is a bug bite that's gotten out of control, or like.
Speaker 1 (21:38):
It's usually a little bit more. It's usually a little
bit bigger than just a bug bite. Sometimes they think
it's like, oh, you know, just gaining weight or something
like that, right, like, oh, it's just like a little
pouch thing. Sometimes, especially like with inguinal hernias or groin hernias,
if the pain goes into the testicle or the scrown,
(22:00):
they might think like, oh, I need to go see
a urologist. I'm having testical pain, but it's actually a hernia.
Speaker 2 (22:06):
Would a urologists be able to diagnose it as a hernia?
Speaker 1 (22:09):
Yes? Yes, any most actual medical professionals can diagnose hernia's.
Speaker 2 (22:15):
So hernia symptoms often get worse during activities that increase
pressure inside the abdomen, like coughing, lifting, bending, exercising, or
standing for long periods. You seem like some of these
things are things comedians have to deal with. I never
thought that hernias were a risk of standing on stage
(22:38):
for hours on end. A key clue is that the
discomfort or bulge may improve when lying down, because the
tissue can sometimes settle back into place exactly gravity.
Speaker 1 (22:48):
Right, Yeah, Yeah.
Speaker 2 (22:50):
There are significant and well documented racial and socioeconomic disparities
in hernia care across multiple dimensions, Like with everything, Yeah, I.
Speaker 1 (23:00):
Think it's important to name this. Yeah.
Speaker 2 (23:03):
Yeah, Black patients are disproportionately more likely to undergo hernia
repair in the emergence setting rather than electively, So meaning
that like black patients are more likely to be ignored
when they initially show hernia symptoms. Is that what it is?
Speaker 1 (23:19):
Yeah, So there's a difference in terms of outcomes, Like
when you do the hernia surgery emergently, there's more likely
that complications are going to arise. If you do it electively,
it means there was time you could plan it, you
could schedule it. You know, you could probably have a
conversation with a surgeon about what kind of surgical technique
(23:41):
we're going to use, what kind of mesh we're going
to use, whether we're going to use minimally invasive surgery
or robotic surgery. There's just a lot more mindfulness that
goes through in an elective planned surgery, and when you're
in an emergency it's like you use whatever mesh you have,
like you're under direct and so things are more likely
(24:02):
to have complications under an emergency.
Speaker 2 (24:06):
Is it that patients are being ignored or is it
that black patients have less access to medical care.
Speaker 1 (24:14):
I think it has a lot to do with both access,
taking their concerns seriously, education around like what they deserve.
I think the financial aspect of it as well getting
access to the right kind of treatment is So it's like,
really this sort of multifactorial approach in terms of like
(24:37):
what inequities are driving these these outcomes. We're going to
take a short break stay with us.
Speaker 2 (24:50):
African Americans had more than twice the odds of undergoing
emergent inguinill hernia repair compared to Caucasians, and significantly higher
odds of emerging ventral and umbilical hernia repair. This is
from a New York state analysis of over two hundred
and thirty eight thousand hernia repairs. Yeah.
Speaker 1 (25:10):
Yeah, And on top of that, another study published in
JAMA show that black patients are less likely to receive
minimally invasive surgery for hernia repair. The less you open
up the abdomen, the less complications that are going to arise.
It seems like even when you have access to advanced
(25:32):
surgical techniques and equitable access, the outcomes may not be
the same as well.
Speaker 2 (25:38):
A large study from the Abdominal Core health Quality Collaborative
found that while black patients actually had slightly higher rates
of robotic ventral hernia repair than white patients, they had
a higher reoperation rate and higher pain scores at two years,
suggesting that equitable access alone does not guarantee equitable outcomes.
(25:58):
Now explain that one to me.
Speaker 1 (26:00):
So basically, what this implies is that there is some
sort of inherent racial bias in terms of black patients
experience of going through surgery, even if it's minimally invasive,
in the sense that we are not listening to their concerns,
(26:22):
We're not guaranteeing that we are treating each patient the
same for whatever reason. There's actually research that shows in
medicine that there is a lot of unconscious race bias,
especially among surgeons. I think this study is direct evidence
(26:42):
of how that actually shows up clinically. That if you're
then operating on both black and white patients, but black
patients are having more complications or pain, they're in more pain.
I think this is evidence that there is some sort
of unconscious race or social class bias existing within medicine.
(27:05):
Which we know the research is showing.
Speaker 2 (27:07):
That when should you go to the doctor for hernia?
Speaker 1 (27:11):
Okay, so a lot of times if the hernia is
really small or you don't have symptoms, you can just watch.
But it's important to understand that a hernia can just
go away on its own. Like hernias don't heal themselves.
You can use temporary things like they make these hernia
belts or hernia binders that can kind of provide temporary
(27:35):
support in terms of supporting the tissue, but I want
to be super clear that they're not repairing the hernia right.
The hernia has to be repaired surgically and majority of time,
like if you take, for example, men who have inguinal
hernias that they're not really having symptoms, they can wait
(27:58):
on the surgery, but eventually, like seventy percent eventually develop
worsening symptoms and within five years need surgery. In general,
it's better like to plan to get the surgery when
you're ready, but it's not like an emergency thing that
you have to deal with, you know, tomorrow.
Speaker 2 (28:17):
Wait, so people are waiting five years before they get
the hernias taken care of.
Speaker 1 (28:21):
Well, I think it's like sometimes people just don't want
to be operated on, which is fair, right for whatever reason,
and they think like, oh, okay, I can just do
some other things or keep it under control. But the
research shows that eventually people do get symptoms and then
they need surgery.
Speaker 2 (28:41):
Right, is it also the people don't know that it
doesn't go away on its own? I think soon.
Speaker 1 (28:46):
Yeah, I think there's some Yeah, I think that that's
fair to say.
Speaker 2 (28:50):
Okay, before the modern era hernia repair had a one
hundred percent reoccurrence rate at four years. Thanks to modern
medical techniques, we now have close to a zero percent
recurrent rate. That's enormous, that's incredible.
Speaker 1 (29:04):
Yeah. No, I think as far as modern medicine is concerned,
hernia repairs are one of the things that modern medicine
does really well, or it can do really well with
the right planning and the right surgeon. I think one
thing to ask if you're like trying to decide who's
going to operate on you, it's always helpful to ask
(29:27):
your surgeon, number one, how many of these have you done?
How many of these specific types of repairs have you done?
And my favorite question is also to ask the provider
if you had to get operated on who would you
want operating on you? Ooh, and then see who they ask,
and then go to that person and see who they say,
(29:50):
and generally they say, then the right person will be like, well,
I wish I could operate on myself, but I can't.
And then you know you've got the right guy.
Speaker 2 (30:01):
And also dependent on insurance.
Speaker 1 (30:03):
Oh well that too. Yeah.
Speaker 2 (30:04):
Hernia becomes more dangerous when tissue gets trapped and cannot
be pushed back in. This phenomenon is known as incarceration,
and even bigger emergency is when blood supply to the
trapped tissue is cut off, which is known as we
discussed this before, strangulation. Yeah, about half of fhemoral hernias
eventually requires surgical resection due to incarceration, strangulation, bowel obstruction,
(30:28):
and ischemia. Is that right?
Speaker 1 (30:30):
Yep, yep, yep, yep. And the thing about femoral hernia
repair that's done as an emergency, it's associated with a
ten times risk of dying compared to elective surgery. If
you have a femoral hernia, you definitely don't want to
just like wait and watch. Because thirty five to forty
(30:53):
percent of femoral hernias usually present with strangulation or bowel
obstruction as the first manifestation, so they're more dangerous.
Speaker 2 (31:04):
The Cleveland Clinic advises going to the emergency room for
any of the following sudden severe pain, a bulge that
becomes firm and cannot be pushed back in, nausea, vomiting, fever,
skin color changes over the hernia, and an inability to
pass gas or stool.
Speaker 1 (31:22):
Yeah. I remember in medical school like seeing lots of hernias,
and definitely the ones where you couldn't push them back
in because they had progressed too far. Majority of the
hernias you just diagnosed by looking at the patient physical
exam and like I said earlier, when assessing the bulge,
(31:45):
and if you're going to see your doctor, they might
ask you to stand or cough or bear down, and
if the bulge becomes more obvious, then that's sort of
more diagnostic. Sometimes you're looking at a bulge and you're like,
is this a hernia? Is this on a hernia? I
can't really tell. That's when your doctor might order like
an ultrasound or a cat scanner, an MRI. Remember, like
(32:07):
that applies for all of the hernias that you can
see visibly, except for hyadel hernia, which you can't see.
So sometimes hyadel hernias are diagnosed because they take a
camera and they stick it down your throat and then
they see it, or they take an X ray and
if it's really big or like we discussed earlier, like
you have acid reflex and it's not going away, and
(32:29):
then it ends up like being discovered in that discovery process.
Speaker 2 (32:33):
What does that mean pushed back in? Because you said
it acquire surgery to push it back in, So what
does that mean, Like you know you can't push it
back in.
Speaker 1 (32:41):
Yeah, So let's say someone has a bulge right and
there's a hole let's say lower down, and let's say
it's your intestines that are bulging out through that hole.
But now so many of the organs have come out
through the hole that there's more outside than can be
pushed back in through that small hole because the hole's
(33:02):
the same. So if you try and push the organs
back through the hole into the abdomen and you can't
do it, that's what I mean, like, you can't push
that back in.
Speaker 2 (33:13):
Basically, wait, you can push it back in.
Speaker 1 (33:16):
If a herdia is what's called reducible, then you can
push it back.
Speaker 2 (33:20):
In without surgery.
Speaker 1 (33:23):
Well temporarily, not permanently. Yeah, okay, you can push it
back in momentarily and then maybe put like a binder
over it or something, but it's gonna pop back out.
Speaker 2 (33:35):
Yeah, okay, yeah, God, this is horrifying. I don't like
this at all.
Speaker 1 (33:41):
That's fair, that's fair. So surgery involves speaking of pushing
the tissue back in. So surgery involves pushing the tissue
back in, putting everything where it's supposed to be, and
then patching up that weak spot. And it's usually with
a mesh of some sort, and nowadays they have all
kinds of synthetic meshes made of all sorts of really
(34:03):
interesting things. But your surgeon would talk to you about
what kind of mesh they would want to use, what
are the risks of the mesh, and what type of
surgery they're going to do. A lot of times they'll
make that decision based off of where the hernia is,
how big it is, whether they have a mesh that
fits that size, and all sorts of things. But this
(34:27):
is generally like a pretty routine surgical procedure.
Speaker 2 (34:32):
So the mesh just stays in the body. Then yes, okay, yeah,
so most common hernia repairs a routine, but they still
require recovery time and lifting restrictions. Well, many are able
to walk around soon after the surgery, anything that involves
core strain generally has to wait. Recovery depends on the
type of hernia, the type of surgery, the patient's health,
(34:54):
and the physical demands of their life or job. It's
important to follow the surgeon's specific instructions. Reoccurrence can happen,
especially if someone returns too quickly to heavy strain or
has ongoing pressure risks like chronic cough or constipation.
Speaker 1 (35:10):
Yeah, I mean it's rare, but it does happen. Reoccurrence
can happen, but it's it's very rare. And if you
follow the postop instructions, like you should be good.
Speaker 2 (35:22):
How do you prevent to hernia? How do how do
we avoid this from happening? To begin with?
Speaker 1 (35:25):
Well, I think it's important to share that, like, you
can't truly prevent every hernia, especially if like maybe there's
a genetic component, or maybe you were born with some weakness,
or you had surgery that you couldn't control. And no
one should ever have any like shame around having a
hernia because like, it's not your fault. You can do
things to avoid them, Like if you lift things like
(35:48):
at the gym, do it with good form. So here's
where good trainers come in. If you have things that
increase the pressure of your abdomen, so like let's say
you're coughing a lot, you have this sort of chronic cough,
or let's say you're constipated all the time, get that
treated because you don't want to just have a cough
(36:13):
all the time or just be constipated that over time
could increase your risk of hernias. And then you know,
doing core exercises is obviously really important for your health,
but don't just like go gung ho like. You have
to build your core gradually because if you go really hard,
really strong, like you could strain yourself and then develop
(36:36):
a hernia. And then obviously, if you see a bulge
at any point in your belly, abdomen, groin and it
keeps coming back, definitely go get that checked out. Because
the earlier you get looked at, you can be sort
of watched carefully or you know, if it's confirmed that
(36:57):
is it a hernia, then you can sort of take
your time and play for correcting it.
Speaker 2 (37:02):
So here are ore takeaways. Hernia is tissue pushing through
a weak spot, usually in the abdominal wall or groin.
Hernias are common and they are not always emergencies. The
classic sign is a bulge that may worsen withithstanding, coughing,
lifting or straining, sudden severe pain, vomiting, fever, skin discoloration,
or a bulge that will not go back in should
(37:25):
be treated urgently.
Speaker 1 (37:27):
Yeah, some hernias can be watched, but most eventually needs
surgical repair. And I think it's important to remember this
will not heal on its own, but don't panic. It's
about knowing when to monitor it, the signs to look for,
and when to call the doctor, and then of course
when you should go to the er.
Speaker 2 (37:46):
Okay, everybody, that was another week of health Stuff. I
hope this helped you learn how not to have a hernia.
Speaker 1 (37:57):
Health Stuff is a production of iHeart podcast US. The
show is hosted by Me, doctor Prianko Wally and Harikonnebolu.
Producers are Rebecca Eisenberg, Jenna Cagel, Christina Loranger, Maya Howard,
and Katrina Norvel. Our researcher is Maria Tremarki and Our
intern is Katia Zobel Lejayala. To send us a question,
(38:18):
you can email us a voice memo at health Stuff
Podcast at gmail dot com. Thanks so much for listening.
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