Scott Webb (Host): Hernias are common and may need to be treated surgically, but what exactly is a hernia and how do we get them? General Surgeon, Dr. Jason Miller, is here today to answer these questions and a whole bunch more.

 This is Putting Your Health First, the podcast from Health First. I'm Scott Webb. Doctor, thanks so much for joining me today. We're going to talk about hernias, which I think are things that we think we know about, but it's good to have an expert on and tell us what is a hernia, that kind of thing. But before we get there, just a little bit about yourself.

Dr. Jason Miller: My name is Jason Miller. I'm a general surgeon at Palm Bay Hospital. I did my training at Orlando Health in Orlando. And then, I've been over here in Brevard County for about a year with Health First System in my general surgery practice.

Host: Yeah, that's awesome. And it's great to have you here. You know, hernias are one of those things, again, like I said, I think most of us think we know what they are, but we probably don't, or we don't know how we got them in the first place. And it's just great to have your expertise and kind of pick your brain a little bit today. So, let's start with the most obvious one. What is a hernia?

Dr. Jason Miller: A hernia really is a protrusion, a bulge, or a projection of tissue from one body cavity through the wall of that cavity into another. That defect can be caused by a multitude of different things, but it's really that abnormal location of things that's supposed to be contained in one cavity into another.

Host: All right. So yeah, good to lay the foundation there. And I'm assuming that there's different types of hernias, hernias that may be a result of exertion and then other things. But from your perspective as someone who is a doctor and performs surgery and all that good stuff, are there different types and is there one that's more common?

Dr. Jason Miller: Yes, absolutely. So, there's a multitude of different types of hernias. The most common are abdominal wall hernias. So, that's anything in the abdomen and the belly, but they also can occur in the groin. So, abdominal wall hernias are either umbilical, which is through the belly button, incisional, which can come through a prior incision from a prior surgery or parastomal, which is next to an ostomy or a stoma. Groin hernias are in the inguinal region down in the groin. And those are more common in men. And then also, pelvic hernias, which can go through certain smaller spaces into the pelvis.

Host: Yeah. And I've self-diagnosed that I have more of a groinal sort of hernia over the years that seems to be exacerbated by, you know, doing stuff, lifting stuff, whatever it might be. And the symptom that I associate with that, for me anyways, is sort of this dull, achy kind of pain in that one spot there. I'm pointing, but no one can see me, of course, doctor. But generally speaking, what are the symptoms of a hernia?

Dr. Jason Miller: So, the most common symptom of a hernia is the presence of a bulge. It may or may not be able to be pushed back in. It can be brought out by coughing, straining, or lifting. Anything that increases pressure in the abdominal cavity. That can make the bulge more prominent. You can also have symptoms of pain, swelling, or even constipation.

Host: Okay. Yeah. And it makes me wonder if there are some other conditions, like so many things in medicine. You know, I'll speak with experts and they'll, you know, run off a list of signs and symptoms. And I'm like, "Yeah, but couldn't that be like a hundred different things?" So, I'm wondering about hernias, some of these conditions or signs or symptoms, can they be mistaken for other things? Could it be something else? Or is it pretty much when you do patient history, you're like, "Yep, that's a hernia"?

Dr. Jason Miller: Oh, absolutely. So, there are other conditions that mimic hernias. Our most common that we see is something called rectus diastasis. That's a very common condition that occurs in the abdomen with the ab muscles, which are your six-pack muscles. Over time, they can flatten out and kind of migrate towards the sides of the abdomen rather than near the belly button. And so, when they contract, such as when you sit up from laying down, it can cause a bulge and protrusion in the middle of the abdomen, which is often shaped kind of like a football. And surgery for rectus diastasis is not considered a hernia surgery because there's no actual defect, nothing actually pushing through to another cavity.

Also, lipomas, which are benign fatty tumors, they can present as a lump or a bulge. They may mimic a hernia as well, but they just are a mass rather than an actual protrusion. And then, another thing we see is something called a sports hernia, which is a strain or tear of a muscle, tendon, or ligament in the lower abdomen or the groin area.

Usually, in younger athletic folks who have been to the gym, it's like, "Oh man, just really not feeling it right. There's no bulge there, but it is tender." And so, those are not treated with surgery, mainly rest, ice, and anti-inflammatory medications.

Host: Okay. So, assuming that it actually is a hernia and not something else mimicking a hernia, how serious are they? Like, do we need to see a physician? Do we need to see someone like yourself? Do they need to be treated? You know, I guess simply put, you know, how serious is a hernia?

Dr. Jason Miller: Yeah. So, hernias can be very serious and, if they get to a certain point, can require emergency surgery. So, anytime you have a hernia, it does warrant at least initial evaluation by a healthcare provider. So, they can develop into very serious conditions depending on what is actually herniated out, and if it can be pushed back in.

Host: Yeah, that's the part I'm stuck on, you know, the pushback in part. Do you find, doctor, that patients try to self-medicate a little bit? They try to self-diagnose and they're like, "Oh, this thing feels like it's popping out here. I wonder if I can just push it back in"? And if so, if people are doing that themselves, is that effective in any way?

Dr. Jason Miller: So, we do see that a lot, and that's usually what we call a reducible hernia. And that can sometimes lead to a delay in seeking treatment. It's like, "Oh, I can get it back in. It's not a problem." But it becomes a more serious problem when it becomes stuck out, unable to be pushed back in. And when that happens, there's a risk of even the intestines getting stuck out and then getting kinked off. That then becomes a surgical emergency, so we prefer to fix these hernias before they get to that point.

Host: Yeah, that all sounds unpleasant, what you're describing there. So, good to seek the help of medical professionals, of course. So, let's do that. Let's talk about the treatment options, other than folks trying to push these things back in themselves. What are the options available, you know, maybe before surgery?

Dr. Jason Miller: As far as before surgery, we want to optimize things as best we can for a surgery to have its best success. So, doing things like stopping smoking. If someone is overweight or obese, we try to reduce that weight so that the hernia repair when it's done has the best chance of success. Because when you fix these hernias, you want it done right the first time rather than having to come back over and over again because then your chances of success go down with each subsequent attempt.

Host: Okay. Yeah. And as far as the surgery goes, I mean, it seems obvious from what you're describing what you need to do, but take us through that generally, broadly anyway. What are the options for surgery?

Dr. Jason Miller: Surgery can be either an open surgery, which is kind of considered the quote "old-fashioned way," of surgery where the incision is made directly over the hernia. It's dissected out and pushed back down to where it's supposed to be. And then, the defect is closed, and sometimes a mesh is placed, I would say usually a mesh is placed there. So, that's kind of the more traditional approach. The approach that I prefer is laparoscopically or robotically. So, that's an approach with small incisions and a camera where the hernia is reduced or brought back in from the inside. And then, the defect closed, and then a mesh placed from the inside. Patients often report a faster recovery. And also, this has a lower infection rate as well.

Host: Yeah, it does seem, doctor, that minimally invasive robotic surgery. So, how about the recovery time from a hernia? It seems like it shouldn't take too long, especially in the hands of an expert surgeon like yourself, but what's the recovery like?

Dr. Jason Miller: Yeah. So, I usually tell my patients that it's one to two weeks to recover from a surgery. But during that time, you're back to your normal day to day activities. As you might guess, groin hernias are much more painful due to the amount of nerves in that area. So, they take a little bit longer to recover from for surgery. I also give lifting restrictions during the first four weeks after surgery while these areas heal.

Host: Okay. You know, I think the $64,000 question for anyone who's old enough to get that reference doctor is, will hernias go away on their own? As prospective patients, we were like, "Yeah, but maybe if I just don't do anything, maybe this will just resolve itself." Does that ever happen? Does it ever just sort of go back in and they're just sort of fine after that?

Dr. Jason Miller: So, the hernia may reduce or push back in on its own or with a little bit of help, but the hernia defect is still there, so the danger is still present. A hernia belt or a truss can minimize your symptoms of the hernia by sometimes helping to keep it from pushing back out, but that does not fix the actual defect.

Host: Yeah. And I think that's what we're really getting at here is that left untreated probably won't resolve on its own and could end up really bad. Some of the things you described earlier. , let's finish up there. If a hernia is left untreated, what's the worst case scenario? Is it like going to burst and how do we encourage folks to really seek medical treatment?

Dr. Jason Miller: Yeah. So, I tell my patients that hernias don't get any smaller with time, and we usually don't get any healthier with time. So, over time, these hernias get larger and eventually may not be able to be pushed back in. So if a portion of the intestine herniates out into that space, there's a risk of it becoming kinked off and even losing its blood supply and dying. In that case, you need an emergency surgery to fix the hernia, untwist the intestines, or even to take out part of the intestines. And when hernias are fixed in an emergency operation, they're at a much higher risk of recurring in the future.

Host: Yeah, it totally makes sense. It's been great to have you on. You're an awesome guest and, you know, I love hearing that you're sort of on the cutting edge using the da Vinci, minimally invasive, laparoscopic. It seems to be that that's where a lot of surgeries are headed. But as you say, some may still perform old school open surgery and maybe that's fine too for now. But just great to understand what hernias are, how we get them, how you help us fix them and all that good stuff. So, thanks so much.

Dr. Jason Miller: Thank you so much for having me on, and I appreciate the time.

Host: And if you are experiencing symptoms of a hernia, schedule an appointment with your primary care provider or general surgeon at hf.org/findadoc or call 321-434-3131.

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