Episode Transcript
[00:00:00] Speaker A: From Riverside Health System. This is the Healthy youy Podcast where we talk about a range of health related topics focused on improving your physical and mental health. We chat with our providers, team members, patients and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So let's dive in to learn more about becoming a healthier you.
Welcome to the Healthy youy the Podcast where we break down everyday topics and introduce you to the experts helping keep our communities well. I'm your host, Frankie Myers. Today's topic is one many people have heard about but not fully understand.
Hernias. What are they, why do they happen, and what should you be concerned about?
Joining me today is Dr.
Mark Moniz. I got it right with riverside surgical specialist. Dr. Moniz is a board certified surgeon who helps patients navigate diagnosis, treatment, and recovery from hernias every day.
Dr. Moniz, welcome to the show.
[00:01:07] Speaker B: Thank you very much.
[00:01:09] Speaker A: To get us started, tell our listeners a little bit about your role at Riverside, a surgical specialist and the types of conditions you most commonly treat. And then before we get started, how did you end up in medicine and then specifically this, this, this specialty?
[00:01:28] Speaker B: I wanted to be a doctor from a very young age.
I will date myself by saying that the show, Quincy. Oh, kind of inspired me to go into medicine. And so that was my inspiration and that's kind of always what I wanted to do. I, I did not know I wanted to be a surgeon until my last rotation as a third year medical student. And then it kind of just fell in love with the specialty and the immediate gratification of helping people.
So, yeah, so that's, that's a little bit about how I got into medicine.
[00:02:10] Speaker A: Interesting.
[00:02:11] Speaker B: Yep. So I've been a General Surgeon since 1998.
[00:02:16] Speaker A: Okay.
[00:02:17] Speaker B: Originally from Texas, went to medical school in Texas, trained in Tennessee, and then moved to Virginia and have been in Virginia since 98.
[00:02:25] Speaker A: All right, would that be Vanderbilt?
[00:02:27] Speaker B: No, I went to the University of Tennessee.
[00:02:30] Speaker A: University of Tennessee. Okay.
[00:02:34] Speaker B: And so as a general surgeon with Riverside, I see all kinds of surgical problems ranging from hernias to gallbladder issues to issues with diverticulitis or colon cancer or any intra abdominal pathology that we can correct with an operation.
[00:02:59] Speaker A: Okay. Well, thank you for what you do.
[00:03:01] Speaker B: Sure.
[00:03:02] Speaker A: Let's start with the basics because the word hernia gets used a lot in simple terms. What exactly is a hernia?
[00:03:14] Speaker B: A hernia is a weakness in the abdominal wall and it can be anywhere from the front of the abdominal wall or in the groin or pelvis.
You can have a hernia through the diaphragm, which is the muscle that helps you breathe, that marks the upper portion of the abdominal cavity.
But that's basically what a hernia is. It's a weakness in the wall, not so much through a muscle, but where the strong tissues surrounding the muscles connect or come into contact. And so that's basically what a hernia is.
[00:03:56] Speaker A: Okay, are hernias something people are born with, or do they develop over time?
[00:04:04] Speaker B: There are some hernias that people are born with.
Some boys are born with an inguinal hernia or a hernia down in the groin.
There are congenital hernias of the abdominal wall that are called omphaloceles or a gastroschisis, which is congenital hernia that's usually repaired by pediatric surgeons. But those are big hernias that you're usually aware of before they're born.
Umbilical hernias, or a hernia at the belly button is also a congenital hernia, but those are the more common, most common ones.
[00:04:54] Speaker A: Okay, good information.
So now that we know what a hernia is, talk about the different types people might hear their doctor mention. And you did just mention some of those. I don't know if there's any additional ones.
Are some hernias more common in men or women or at certain stages in life?
[00:05:17] Speaker B: The basic types of hernias are ventral hernias, which are on the front of the belly wall, Groin hernias, which can include. Or pelvic hernias, which can include inguinal hernias or femoral hernias.
Some less common hernias occur through some of the openings in the pelvis where blood vessels or nerves penetrate or travel down into the extremities. Yes, diaphragmatic hernias or hernias that involve the diaphragm.
Some people have heard of hiatal hernias, where the.
The junction of the stomach and the esophagus, or the tube that takes food from your mouth to your stomach join. Sometimes that will slide up into the chest, or there will be a hernia through the diaphragm where that.
Where the esophagus passes through.
So those are different types of hernias.
Inguinal hernias are probably the most common type of hernia. That and umbilical hernias are probably the most common type of hernias that we see.
Inguinal hernias are the most common type.
A little bit more common in men than in women.
But the most common type of hernia in either sex.
[00:06:39] Speaker A: That's good. That's good information.
When people hear they have a hernia, they often worry right away, are all hernias dangerous?
[00:06:49] Speaker B: So hernias can be dangerous if.
If it's not evaluated.
So some people think that the larger the hernia is, the more dangerous it can be. But it's usually the opposite, really.
A smaller hernia.
Try and explain it to patients. Like the rungs on a banister.
[00:07:14] Speaker A: Okay.
[00:07:16] Speaker B: If the rungs are close together, your kid could fit his head through, but couldn't get his head back out.
[00:07:21] Speaker A: Right.
[00:07:22] Speaker B: But if the rungs in the banister are wide, then he could get his head through the banister very easily. In and out. So the bigger the hernia, the easier it is for things to kind of move easily in and out.
[00:07:35] Speaker A: Okay.
[00:07:35] Speaker B: The smaller the hernia, the smaller the defect. It's easier for something to kind of slip through and swell on the other side and then obstruction not be able to reduce. Right. And so a hernia only becomes dangerous when whatever is herniating through there gets stuck and is not able to be pushed back in or reduced.
[00:07:56] Speaker A: Okay, great information. Let's talk about symptoms, because not everyone feels pain right away.
[00:08:03] Speaker B: Right.
[00:08:05] Speaker A: What are some early signs that someone might have a hernia?
[00:08:08] Speaker B: So usually pain is not the first symptom. Most people think or feel or see a bulge either in the groin or on their belly wall at their belly button.
Some people may experience some discomfort when whatever herniates through or whatever is pushing through there does push through. Or they may feel a strange sensation when it pushes back in.
And then, of course, as symptoms progress, or maybe the hernia becomes a little bit larger, something more or less larger can push through that defect. Then sometimes they will have some discomfort or pain either in their groin or at that site. So pain is not always.
Not usually the first thing that people notice.
[00:09:01] Speaker A: Okay, great, great, great information. Are there warning signs that may come. Come up?
[00:09:09] Speaker B: Sure. So pain is a warning sign.
Much like any type of pain, it usually indicates that something's wrong, especially if you don't see a bulge or feel a bulge.
People who are a little more overweight, you may not be able to feel that. So pain may be a little more of an indicator that something's amiss and it may not be easy to feel all the time. And so that may lead to some.
Some other studies. But that's always.
Pain, of course, is always a good indicator. Some people who have may have pain and also changes in their bowel habits, whether it's constipation or obstipation, where they feel like they have to go but they can't go, or nausea and vomiting sometimes can occur with pain.
Those are all kind of warning signs that something may be going on.
[00:10:15] Speaker A: Okay, is it common for people to ignore symptoms? And do you find that people wait too late, and when they present, it's very late stage.
[00:10:26] Speaker B: So that's not typical. But some people do.
There are some symptoms that are kind of vague, and you wouldn't expect it to be associated with a hernia, especially if you don't know what a hernia is or don't suspect that that may be happening. Some people have some chronic aches and pains that you just kind of deal with and keep going. Typically, I would say the most. The more common types of hernias are things that we see in the office as opposed to in the emergency room, in the emergency.
[00:10:57] Speaker A: Gotcha.
So once someone comes in with symptoms, how is a hernia diagnosed?
[00:11:06] Speaker B: Usually by physical examination and by history. A lot of people will explain that I can see this bulge when I stand, or it hurts when I walk for a long period of time, but when I sit down, I'm better.
Or the bulge goes away when I lie down. I don't see it in the morning, but in the afternoon it's there.
And then, of course, a history of surgery in the past maybe lead you to suspicion that there may be a hernia in the belly wall somewhere.
And then, of course, your physical examination, depending on where they see the bulge, where they feel the pain, will direct you a little bit.
But, yeah, usually on a physical examination, you can make the diagnosis.
[00:11:52] Speaker A: Okay, good, Good. Let's talk treatment. Do all hernias require surgery?
[00:11:57] Speaker B: No.
There are plenty of people who have hernias who don't want to have any surgery. And as long as they're not causing any symptoms, there's nothing that says that you absolutely have to have your hernia repaired.
There are plenty of men who have found hernia belts on the Internet, which kind of give some support to the area and will keep everything reduced or pushed in and they're able to function very well without any issues.
There are belly button hernias or umbilical hernias that don't cause any issues.
And people will delay surgery for as long as possible, mainly because it's not causing any issues.
But people who do have symptoms, whether they're minor or major, the main treatment for hernias is going to be surgical.
[00:12:55] Speaker A: Going to be surgical surgery.
When surgery is needed or required. What does that look like today compared to the past? Is it more minimally invasive?
[00:13:08] Speaker B: So it can be. It just depends on the type of hernia and the size of the hernia and the urgency for the operation. Sometimes emergent types of situations necessitate an open operation. Sometimes with emergencies, it's easier to do laparoscopically.
Every situation is a little bit different.
But of course, I guess the biggest difference from when I started to now is that a lot of hernias are fixed with more minimal invasion than what we used to do.
And so laparoscopic or robotic repairs are, are very common now.
[00:13:55] Speaker A: Okay. Okay. Now let's talk about recovery and getting back to normal.
Recovery is often one of the biggest concerns for patients. What does that time frame look like in process?
[00:14:07] Speaker B: Again, it depends on the type of hernia and the size of the hernia and the extent of repair that's required.
Larger ventral hernias will of course take longer than smaller inguinal hernias or an umbilical hernia.
But the typical outpatient type of surgery for an umbilical hernia or an inguinal hernia, usually I tell patients that by two weeks they're close to back to 70 to 80%.
Usually by four weeks, you're back to 100%.
[00:14:45] Speaker A: Okay.
If it's 100% exercise, you can get back to normal activities.
[00:14:51] Speaker B: My general rule of thumb is if it hurts, then you don't do it, and if it doesn't, then you're okay.
And usually by the time patients come back to see me in two weeks, most of the soreness is gone. And then I'll start to liberate their activities a little bit, guiding them that in another two weeks that they should be able to do whatever they want to do.
[00:15:11] Speaker A: Very good.
And finally, what role does following recovery guidelines play in?
What role does that play in long term success?
[00:15:19] Speaker B: I'm sure there are a lot of things that play into long term success, but following the guidelines as far as lifting and overall healthy lifestyle and avoiding submerging your incisions in water and things like that will minimize your chances of complications, especially infections that you're incest and things like that?
[00:15:46] Speaker A: Yes. Before we wrap up, let's touch on prevention.
Are there steps people can take to reduce the risks of developing a hernia?
[00:15:57] Speaker B: There are things that you can do to strengthen your core muscles.
A lot of the hernias, even inguinal hernias, are usually secondary to a structure that hasn't closed completely during development, during embryology.
And so I'm not sure that you could ever prevent a hernia. Most people, if they're going to get a hernia, they will get a hernia regardless.
But there are things that you can do to certainly minimize your chances, especially if you've had surgery in the past and things like that, such as, you know, maintaining your weight, healthy diets, if you are diabetic, making sure that you're.
Your diabetes is well controlled, avoiding smoking, Things like that will help minimize your chances of weakening your tissues at all, improving your health overall, improving your healing abilities, and things like that.
[00:17:08] Speaker A: Okay.
All right. What's one common myth about hernias that you'd like to clear up? I know several.
[00:17:17] Speaker B: I guess the biggest. Two of the biggest things that I hear are one, that you're.
They're concerned that their guts are going to pop out.
[00:17:26] Speaker A: Right.
[00:17:27] Speaker B: And that is not true.
Not all hernias contain intestine or guts.
Most hernias contain fat, whether it's from within the belly or just outside of the belly.
And then I guess the second myth is about mesh.
Most, if not all of the mesh is very safe and is not.
And there are always advances and improvements in the technology and the materials that we use, but those are two of the biggest myths.
[00:18:02] Speaker A: You hit it on the head.
For someone listening who suspects that they may have a hernia but feel nervous, what would you want them to know?
[00:18:14] Speaker B: Having a hernia does not.
Will not permanently alter your lifestyle, or having a hernia repair will not permanently alter your lifestyle.
Being seen for a hernia does not automatically mean surgery.
And so it's a decision. You know, surgery is always a decision that you make together with your physician. It's not usually an order given by a physician. So that would be.
It never hurts to talk to somebody.
[00:18:49] Speaker A: Right.
[00:18:50] Speaker B: You shouldn't be nervous coming in because we're not going to do anything that day.
But gathering information may help you with your.
With your nervousness and may make you feel better about the situation, and then you're able to make a. A better informed decision.
[00:19:08] Speaker A: That's good stuff. That's good stuff. Thank you for breaking this down.
[00:19:12] Speaker B: Sure.
[00:19:13] Speaker A: My pleasure. In such a clear and reassuring way, hernias can feel intimidating.
[00:19:18] Speaker B: Absolutely.
[00:19:19] Speaker A: But today's conversation really helps take the fear out of the unknown. So thank you so much for taking time out of your busy schedule. Well, thank you for having me. And you're welcome to come back anytime.
[00:19:29] Speaker B: Anytime.
[00:19:30] Speaker A: Yes. Thank you so much to our listeners. If you learned something new today, share this episode with someone who might be dealing with similar symptoms or questions. And as always, remember, being informed is one of the most powerful steps you can take for your health. Until next time, stay healthy.
Thank you for listening to this episode of Healthy youy. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riversideonline.com SAM.
