Symptoms of Abdominal Wall Hernias and Options for Treatment

We're talking wellness at MemorialCare Health System. It's time for Weekly Dose of Wellness. Here's Deborah Howell.

Deborah Howell (Host): Hello and welcome to our program. You're listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell. Today our guest is Todd S. Harris. Dr. Harris is board certified in general surgery, as well as highly experienced in hernia surgery. He is a fellow of the American College of Surgeons and medical director of California Hernia Specialists. He's currently a general surgeon at Orange Coast Memorial Medical Center. We'll be talking to him today about the key things to know to help identify a hernia and which options are available for treatment. Welcome, Dr. Harris.

Todd Harris, MD: Good morning.

Deborah Howell (Host): Let's jump right in. What is an abdominal wall hernia?

Todd Harris, MD: A hernia in general of the abdominal wall is where there's a small hole or a small defect or weakness in the abdominal muscles. And when patients get a small hole or a small defect, internal organs can push through that hole and create what we call a hernia. That can happen in a number of different areas. It can happen in the groin area, it can happen in the belly button, or it could happen in an area where a patient has had a previous surgery. So basically it's either fat or sometimes intestines sticking out through that weakened muscle that patients can see and feel.

Deborah Howell (Host): Wow, I've already learned a lot. What are the symptoms of a hernia?

Todd Harris, MD: Sure, so when that hole forms, patients can actually feel often the fat or the intestine bulging through the muscle. So a patient may come in to me and say, "Dr. Harris, I feel this walnut or this tennis ball, this golf ball underneath my skin, what is that? And we're actually feeling often the fat of the intestine underneath the skin. So we can reduce that hernia and push it back in, but most of the time it will just pop back out. So a bulge under the skin is a common symptom. One of the other common symptoms is pain. Obviously when the muscles are being pulled open and internal organs are pushing through, it can cause pain in the muscles or the nerves around the hernia itself.

Deborah Howell (Host): But you could actually have a hernia and not feel the pain? You can just have the bulge?

Todd Harris, MD: Sure, absolutely. You know, if a hernia's been there for many years, sometimes, you know, patients didn't realize that they had developed a hernia, and the muscles are so used to having that hole that they don't feel any discomfort. Often what we find, and some patients come in to see us, and they say, "I've had this for 10, 15 years, but now just recently it started to cause symptoms, and that's when we discussed treatment with them.

Deborah Howell (Host): Okay. Are hernias more common in men or in women?

Todd Harris, MD: In general, they're more common in men, mainly because men in the groin areas or the inguinal region tend to develop hernias quite often. It's mainly because of development. And in men, obviously there are arteries and veins that travel through the abdominal wall and the groin that go down to the testicle. and that creates an inherent weakness in the groin. So men most commonly get inguinal hernias. Women can also get them, certainly in the groin area. And then umbilical hernias or belly button hernias are common in both men and women. And as we mentioned a minute ago, anybody that's had a previous surgery or has an incision from, let's say, a gallbladder surgery or from a woman that had a hysterectomy or any sort of laparoscopic tubal procedure, whenever the muscle is open, surgeons have to reclose it after surgery, and that can lead to some weakness and can cause a hernia. So we see certainly more men in our practice with hernias, but we definitely see women as well.

Deborah Howell (Host): Okay. So what should I do about my symptoms if I think that I might have a hernia?

Todd Harris, MD: That's a good question. So, you know, we often, as I mentioned just a minute ago, we see patients that come in and say, "Dr. Harris, I've had this for 10 years. What should I do about it?"

Deborah Howell (Host): Yeah.

Todd Harris, MD: And if it's not causing any symptoms and it's not causing any pain at all, and it hasn't changed the size, maybe it's always been a small little marble underneath the belly button and it doesn't bother you, a lot of times I tell patients, you can watch it. There really isn't an emergency that you have to come in and have it done. Now, there is always a small chance of there being an emergency, but we do say that you can just watch the hernia without surgery if it's not causing any symptoms. Now, if patients do have symptoms and it's causing pain, then we obviously want to treat that because it's a sign that the hernia's either getting bigger or it's pinching the nerves and whatnot in that area. So we would say time for surgery in those patients.

Deborah Howell (Host): Right, there's no huge danger in watching it. I mean, what would be the worst case scenario in watching a hernia?

Todd Harris, MD: Sure, so there is a 1 to 2% chance per year on average and when they looked at big medical studies, that hernia can what we call strangulate and what that means is that small hole in the muscle usually has some fat pushing through it but a piece of intestine could actually get trapped in that small hernia and when that happens sometimes we can't get the intestine back in. Someone wouldn't, a patient wouldn't be able to push the intestine in. That strangulation can become an emergency and the patient would have to go to the emergency room and have emergency hernia surgery in the operating room where the intestine is then pushed back inside and then the hernia repaired. So that is a risk of any hernia, but when you look at the statistics of 1 to 2% chance of that happening per year, you know, patients can live 50 years and may not have that ever happen to them. So, you know, patients that, you know, aren't very active, you know, maybe they're a little older, we would say you certainly can just watch it, but I always give the disclaimer that tomorrow you could have a strangulation, but obviously the odds are against that.

Deborah Howell (Host): One to two percent. Okay. Let's talk a little bit about the surgery. What should I expect if my doctor says, "Okay, it's time for the surgery"?

Todd Harris, MD: Great question. There are some advancements in hernia surgeries that a lot of the advanced hernia surgeons use these days, and one of those is laparoscopic surgery. You know, obviously everything in medicine, for a good reason, is going towards minimally invasive treatments. And the less trauma we can do to the body, the better. At California Hernia Specialists, we do a lot of laparoscopic hernia repairs. And laparoscopic's good because we minimize the trauma to the muscles and the patient. So I think one of the upsides of laparoscopic surgery is quicker recovery, easier post-operative, less pain medicines usually are required. So that can be an excellent option for some patients. That doesn't work for every patient, and some patients have either advanced hernias or they've been there a long time, or sometimes maybe they're even really, really small, and we say doing laparoscopic surgery might be even too much. We can do just a very small incision and minimize the trauma even more by doing open surgery. So almost all hernia surgeries, I would say 99% of the surgeries that we do are outpatient surgery, which is good for patients of all ages. They can get in in the morning, have the surgery, then they're home, you know, an hour or two after surgery. We tell patients the first three or four days after a hernia surgery, plan on taking it easy, you know, stay home, don't have, you know, any big family event planned, don't plan on a big family reunion, don't go to Disneyland, Disney World, you know, just stay at home and rest and let your body heal for a few days. Whether you had open or laparoscopic surgery, it's important to let your body heal. And then, you know, after three or four days, most patients are feeling, you know, fairly back to normal and can get back to light duty. Now, as we've just learned, you know, that hole in the muscle needs to heal after the surgery. And when we repair that hole, we have to give the muscles, you know, two to three weeks to really regenerate the heal, just like if you had cut yourself on your skin. So we tell patients no heavy lifting, no real heavy activity for about three weeks after the surgery to let the hernia really heal.

Deborah Howell (Host): That's not the time to go to Best Buy and pick up a huge flat screen TV and carry it home yourself.

Todd Harris, MD: Exactly. That's exactly right. And we tell patients that are working at Best Buy, you have to be on light duty. You know, when we see a lot of our firemen and police officers and public safety and anyone at the, you know, the machine shops and whatnot, you know, we really have to tell them, "Look, you've got to give yourself those three weeks to heal, otherwise you'll be right back to see us and then they'll be mad at us, you know, and we don't want that."

Deborah Howell (Host): Right, but in terms of driving, maybe within a week?

Todd Harris, MD: Sure, absolutely, even after a couple of days. What we tell patients, as long as you can, you know, comfortably press the brake in the car without any pain in the groin or the hernia area and you're not taking any of those narcotic pain medicines, absolutely driving would be okay after sometimes two or three days. Obviously if patients are taking pain medicines, we don't want them out there on the road. We wouldn't want that. But yeah, driving, getting around, and even on the day of surgery, we have patients ask commonly, "My bedroom's on the second floor. What should I do?" And we say, "Stairs are fine. You know, you're not going to disrupt the surgery going up and down stairs, getting up off the couch, you know, in and out of bed. It's just that TV from Best Buy that we don't want that, we don't want them lifting, but driving, absolutely. Now the day of surgery, because of the anesthetic, they do have to have somebody with them to go home after the surgery. So just like with any major surgery or you know, moderate to major surgery, somebody has to be with them to drive them home and usually stay with them for a few hours and even a day or so after surgery to make sure that they're doing okay.

Deborah Howell (Host): Right, after all it is surgery. What about exercising? A lot of people are into Pilates and yoga and of course weightlifting. So what are your paradigms?

Todd Harris, MD: Yeah, great question. In, you know, Southern California here we get a lot of golfers and a lot of tennis players. So we get asked that all the time. You know, we talked about, you know, during that first week really minimizing, you know, any exercise. But after that first week things have really started to heal. By that second week and even the third week after surgery, we encourage some light cardio. If you want to get on a beach cruiser just go out you want to take walks around the neighborhood with the dog. Those things are okay. You know we tell golfers to go work on the putting and the chipping, that's okay with us. Yoga and Pilates obviously there's a lot of stress and strain that puts you know it's put on the core when patients are doing those activities and it's great obviously for all the health benefits associated with that but not immediately after hernia surgery so again that would probably be closer to that three-week mark. A little bit might be okay, you know, in that third week if you're doing some light Pilates or light yoga. Stretching would be okay, which obviously yoga is a lot of, but some of those, you know, level two, level three yoga classes really puts a lot of strain on patients. And the same thing with golfers. We say, "Don't go carrying your bag, you know, during that second or third week when you're out on the golf course."

Deborah Howell (Host): Definitely no double-bagging.

Todd Harris, MD: Exactly right. Exactly.

Deborah Howell (Host): Unfortunately, we're out of time. I have a lot more questions for you, so we'll have to have you back, Dr. Harris. All right?

Todd Harris, MD: That sounds great.

Deborah Howell (Host): Okay. We want to thank Dr. Harris for spending time with us this afternoon. It's been great to have him on the program today to talk to us about options for hernia treatment and recovery. To listen to the podcast or for more info, please visit MemorialCare.org. That's MemorialCare.org. I'm Deborah Howell. Join us again next time as we explore another weekly dose of wellness brought to you by MemorialCare Health System. Have yourself a fantastic day!