458 | Hernias Explained: Understanding the Treatment Options for Inguinal, Umbilical, and Sports Hernias

[00:00:05] Welcome to the Optimal Body Podcast. I'm Dr. Jen and I'm Dr. Dom and we are doctors of physical therapy bringing you the body tips and physical therapy pearls of wisdom to help you begin to understand your body, relieve your pains and restrictions, and answer your questions. Along with expert guests, our goal of the Optimal Body Podcast is really to help you discover what optimal means within your own body. Let's dive in. Before hopping into the episode, I just have to let you all know that the Jen Health annual membership is on a massive sale right now.

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[00:01:23] We are talking about hernias. Now, this is a topic that was requested from our podcast listeners. And really, we want to explain the anatomy, the treatment, the recovery behind, you know, different types of hernias as well, because they are extremely common. Over 20 million hernia repairs are performed worldwide each year, which is a wild number to kind of think about.

[00:01:47] And, you know, most people associate hernias with lifting something heavy, but many are due to anatomical weaknesses. Yeah. And what is a hernia? I think we should, I mean, I think when you hear hernia, people are always like, okay, is that a herniated disc? Is that a sports hernia, which is another common injury that has hernia in the name? In the ground.

[00:02:39] Umbilical hernias in our umbilical area, right around our belly button. So a herniated disc, different, but it is a herniation of the tissue through the disc. So similar type of thought process there. Right. And I think what we want to, you know, also define that it's not just like a muscle tear. It is a defect of the fascia. So that's that connective tissue layer, which doesn't regenerate well.

[00:03:07] And that's why we want to talk about not only what the research recommends and what we see, but also is there options that you can do, even though it's fascia related, are there things that we can do to function better? Yeah. And this can be due to like what caused this defect, you know, we can have congenital effects. A lot of the inguinal hernias happen around this, where the spermatic cord comes through the inguinal canal.

[00:03:33] And there could just be an increased opening there or, you know, due to pressure management, weightlifting, things like that, where I am somebody who had bilateral inguinal hernias. I kind of want to talk about it because I think it's relevant to even the research I was seeing, um, incomplete closure at the umbilical area and just anatomical weak points, weak points, kind of like I mentioned with that spermatic cord.

[00:03:56] So these are all sorts of reasons, um, we could develop this defect. What a hernia is not the things that we might think are hernias or hernia related. Because when we talk about umbilical hernias, people might think of diastasis recti. Right. And we've talked about this before. Everyone who is pregnant, basically everyone I think is showing in the research will have diastasis recti because it's a stretching of the tissue.

[00:04:22] It's an anatomical normality that happens in order for us to grow a baby. Right. But that stretching of the tissue, which is fascia, is not the same as the protrusion that we see in a hernia. Because even though we might see changes to that tissue, the abdominal tissue, where now we're seeing pressure going out, that does not mean that there is like our organs actually pushing and protruding through.

[00:04:51] So there's not an actual defect in the tissue. It's a stretching of the tissue. Right. Which is due to that change in intra-abdominal pressure, but it's different. And a similar thing that we could put in this bucket is many prolapses. You did mention when we were talking about this before, like, yes, a diastasis recti could develop into an umbilical hernia. Which I had. I have, I guess I should say.

[00:05:19] Yeah. And so there's like, it creates an anatomical weak point that could end up causing a development of a defect in that tissue. So different, but on the same spectrum, we would say. It is on the same spectrum. And same thing with different prolapses, rectal vaginal prolapses to, you know, as the disease progresses, again, it could develop into some sort of actual hernia or defect in the tissue.

[00:05:47] But for the majority of those, it is a stretching of the tissues and structures that then allows the, I don't want to say protrusion, because again, we're kind of blurring the lines, but that tissue to bulge out. Right. Which then can create some organs to start to peek through, especially when we're talking about prolapse. So this is where, you know, those become so muddied in terms of. We kind of are talking about this. The umbrella of what happens.

[00:06:14] Umbrella of pressure related. Yes. Abdominal canister issues. Yes, exactly. If we just had this whole umbrella of pressure related abdominal canister problems and diagnoses that we develop because of pressure management issues. Again, there's a lot that can go into it congenitally. Our own personal anatomy. Pregnancy. And birth. Things that, you know. Constipation. Different trauma. Hernias.

[00:06:44] Just quickly. There are the progression of hernias. Reducible. So this is what I had when I had my inguinal hernia. I would kind of bear down or flex my abdomen and see the little protrusion. And then I would let it go and that would go back. Reducible. It essentially means that anything that comes through can be pushed back or reduces back in. Incarcerated means it's not reducible. It has poked out and now it stays there.

[00:07:10] And then the last stage is strangulated, which essentially is kind of what it sounds like. You are cutting off blood supply to whatever tissue has poked through. This is an emergency. We don't want to cut off blood supply, especially if it's having to do with our bowels or intestines. Absolutely an emergency in those types of situations. So we quickly just want to touch on the different types of hernias because especially when you're hearing different classifications, we want you to understand where that is, what that means.

[00:07:40] And then we'll get into really the meat of it. Like what can we be doing about it? I think that's what people really want to know. Right. So when we talk about the most common one, which is what you had, inguinal hernia. Right. We see this account for about 75% of all abdominal wall hernias and they occur in that inguinal canal. So that's that narrow passage in that groin area where we're going to kind of see that protrusion. Yeah.

[00:08:07] And again, very common, especially in young men where that spermatic cord comes through the inguinal canal. It does say typically in older adults due to weakness that has started to develop in that abdomen. Again, we're not using it as much. It might be easier to cause a defect in this area. The other only specific type of hernia that accounts for a semi-large percentage is the umbilical hernia that we talked about.

[00:08:35] And really, when we look through all of the research, it basically says the only way to completely fix this is through surgery. I put that in quotes. But again, if you're actually talking about fixing the defect, again, we're talking about fascia here. It's not a highly doesn't have a high blood supply. It's not going to heal on its own quickly or potentially at all. So I can agree with if you're actually talking about closing the defect.

[00:09:06] Surgery is one of the only options. And that's what I had. And we'll talk about recurrence rates. So there's a couple different types of surgery. One of the most common is mesh. It has the lowest reoccurrence rates of one to four percent when we're talking about inguinal hernias. And five to ten percent of people might develop chronic groin pain after having that mesh repair.

[00:09:33] Which is what I want to talk about now with you, because that is so how old were you when you got the repair? Seventeen. I was yeah, seventeen. I was a junior in high school. Yeah. And you were you were doing football at the time? Basketball at the time. Basketball. Yeah. I only remember this because we're going on a winter break trip, go to a family friend's wedding. And I got the surgery like right the day before we left. Went.

[00:10:03] The doctors did the surgery. They're like. And it was so interesting because even in what we saw in the research for like what you should do exercise wise after hernia, it was kind of like they did the repair and they're just like, great. Slowly work back to your activity. Which your activity at the time. Hernia is closing. I was playing basketball. But you also did heavy strength training, didn't you? Yeah. As a part of basketball. I guess maybe for football most of them. Yeah. As a part of basketball, we would definitely be lifting weights still. So. Yeah.

[00:10:32] And I was a heavy weight lifter since I was in seventh grade. So. Yeah. I mean, I've heard some of your numbers before. Right. You were back squatting like 400 pounds, weren't you? Probably at that point. Which again, that's where this all developed from. Mm-hmm. And I landed in that category of people who started to develop chronic pain, even to the point that when I was playing football in college, I think I was a freshman in college.

[00:11:01] I was still having so much groin pain. That I was like, I'm having a hernia again. It was the same pain that I was getting when the hernia was developing in the first place. And I, so I went back in for a second exploratory surgery because I was like, I'm still having pain. What's going on here? Like, why is this happening? And this is where, again, it didn't, I don't, I'm just shocked that it didn't ping for anybody. Like, why did this develop?

[00:11:32] I clearly had imbalances in my core. Knowing what I know now, I clearly had dysfunction in my pelvic floor. I was putting way too much pressure in that area. That's why it developed for me. You know, that's why I ended up developing this protrusion. And to have nobody along the line of going into surgery postoperatively, coming back to them and telling them, I need to have another something, surgery of some sorts, because I'm still having pretty significant groin pain.

[00:12:02] No one along that line told me that I should be doing any sort of rehab, doing any sort of core training. You would never refer to physical therapy. Not for my hernia, no. This podcast is supported by MidiHealth. Are you in midlife feeling dismissed, unheard, or just plain tired of the old health care system? You're not alone. For too long, women's serious midlife health issues have been trivialized, ignored, and met with a just deal with it attitude.

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[00:14:22] I was dumping into anterior pelvic tilt. I was putting way too much pressure still forward into my abdomen. I had clear pelvic floor dysfunction. Like, I was a mess. And this is- As a doctor of physical therapy, I want to point out. And this is 10 years later. 10 years later. I met you when I was 27. I met you at 26. 26. Yeah. Yeah.

[00:14:44] So it's like, I'm 9-10 years later, still have all of these abdominal and core related pressure management issues. And nobody along any of those points had said anything to me like, maybe you should go to physical therapy and train your core or look into pelvic floor. Still, I mean, at that point, it was probably very taboo to be talking about anything pelvic floor related. Especially for men. Especially with a young man who's like- Exactly.

[00:15:13] I know, it's pretty wild. And then you met our friends and everyone was like, move like this, do this. Why are you doing that? The first time I hung out with Venus, frickin' A, she'd spent like 20 minutes. I was getting so mad at her. You were. Like, just let me swing the kettlebell. Stop. Stop doing this to me. I'm not having fun. I'm not having fun. But listen, we helped to point some things out that you've now learned. Yeah. And now I move a lot better. Thanks, Venus.

[00:15:44] And now you're not having pain? No. I don't have any abdominal or groin related pain. So it's like, this is all to point out. Because also in the research, there are research studies that compare watchful waiting, which I don't even like that term. And I'm like, okay, watchful waiting. If you just watch and wait and look and you don't change anything. The defect developed for a reason. The protrusion started happening for a reason. If you don't change anything. Yeah, it's probably going to progress and you'll need surgery anyway.

[00:16:14] There were also research studies that compared just exercise and doing core related exercises. And there were some case studies showing. Okay. Okay. Okay. Core related exercises can significantly reduce symptoms and significantly reduce the amount people see protrusion happening. It doesn't heal the defect. In fact, might be able to delay the operation.

[00:16:41] There was also research studies that showed it was great paraoperatively. So it's kind of like prehab going into the operation, which of course, if you train your core prior to having a core related surgery, you're going to be able to rehab your core better. So, um, again, those studies to me don't like exclude. Oh, exercise like that does nothing for hernias.

[00:17:06] It shows me exercise absolutely should be a part of prehab, rehab and beyond. And some people with very minimal symptoms and very minimal protrusion could be something to do for symptom management prior to the surgery. Again, we're not saying this to tell you don't get a hernia surgery. I very well likely would have had a surgery anyway, but I would have done it very differently knowing what I know now.

[00:17:33] Well, and this is where it comes to the point of what are we really trying to fix here, right? Are we trying to fix the way it looks or are we trying to fix the way it functions? And for it, and sometimes it could be both, right? I, I don't want it to, to continue to pop up. It's interrupting my daily activity, my life, my, my pain levels, my symptoms that I'm feeling. But also if we know that maybe we won't change the way something looks, but we can change the way that we function and we feel.

[00:18:00] And I think that's what's so important. And that's, that's the same thing with diastasis recti. And we've had Anthony Lowe on the podcast where he's really talked about diastasis recti. He works with a lot of women who have diastasis recti. And the number one thing that he points out is that he can get someone who has a five finger gap. So imagine a whole hand that can go into the stomach tissue or into the abdominal wall, right?

[00:18:28] Right. However, and so they'll, they'll still have those tummy looking symptoms that where, you know, you're getting that tummy to kind of overhang, you're getting a lot of loose skin. However, they can function to the level of CrossFit, TOTO bars, heavy strength training, power training, you know, all these exercises that you're told you should never do if you have diastasis recti.

[00:18:52] However, if you understand how to properly manage your abdominal pressure, you can get back to function in all activities and all exercise. There's no one exercise that we shouldn't be doing if we have diastasis recti. It just depends on how we are functioning and controlling our own intra-abdominal pressure. And so it's the same thing with any kind of hernia. And that's what I think about. If I can control the way that I'm managing the symptoms and the pressure that I'm putting,

[00:19:18] if I can disperse the pressures better through my core canister, so it's not all coming through the umbilical region or the inguinal hernia region. If I can control the pressures that are coming out there, then I can function better. I can feel better. And maybe I don't have to have the surgery, especially if it's early on, right? It's early minimal symptoms. Yeah. Yes. And again, this is similar to what we see in so many things, whether it's knee replacements,

[00:19:46] whether it's shoulder surgery for a labrum, like doing proper prehab could get you to the point where you're like, Hey, I don't think I need this procedure yet. There were the case studies that showed people were getting back to their normal exercise without doing surgery. They would maybe wear, still wear a pelvic belt or a belt for heavier weightlifting, but they were able to return to most of their activities. So again, it depends on the stage of life, what your goals are, what you want to be able to do.

[00:20:15] And like I said, if I know knew what I know now, I would do this very differently that, you know, there was a whole section on what to expect as far as exercise after the procedure, which I'm glad that they had because I don't. And again, maybe I'm just not remembering it because I was 17 years old, but I don't remember being consulted on what I should do for exercise. It even in what we looked up, it says two to four weeks for a laparoscopic mesh repair, which is what I had. You could be returning to heavy lifting.

[00:20:45] Okay. How much have you trained your core? How much have you done the prehab? If you are very regimented and very systematic in how you do things, maybe two to four weeks back to heavy resistance training. But again, we're talking about pressure management issues. And so how do we resolve and solve that underlying... The underlying root issue here. Underlying root issue. Yes. Without just jumping to the surgery because that's what will fix us.

[00:21:11] And yes, the research shows that's going to fix the defect, but what's going to long-term help us, help prevent us from developing similar symptoms due to the same root issue. Exactly. Which is what you were experiencing, that pain that was continuing to come back. And so again, we want to, you know, continue to highlight. But yeah, there's no strong evidence that it's going to repair on its own. The fascia is not going to spontaneously heal, right?

[00:21:40] And that again is the same as when we think about diastasis recti. If you want an aesthetic look that is different, especially if you have such a large gap, you will need surgery. That is going to be the quote unquote fix for that aesthetic appearance. But if you want to be able to function and feel better, you can do it. And going even back, thinking of the prolapse, I know people who have grade two, grade three prolapse and are running marathons.

[00:22:08] So it's possible to function at a level that you want to be at and be able to manage these symptoms without surgery. And I think that's what's most important, even though our evidence is saying there's no evidence that, you know, we can really heal this with exercise. Well, because we're not talking about healing, necessarily healing the tissue. We're talking about improving our function in our day-to-day life. Yeah. Function and symptom management.

[00:22:36] And again, like, yes, there's risks that come with that. And we're not saying all of this to tell anyone out there what they should do medically. No. This is just information there. We're pointing out case reports. The case reports of, oh, my uncle, my aunt's husband, Rick, came to me and said, yeah, I had this little hernia. The doc told me I could have surgery or I could, you know, do some core exercises and wait and see what happens. And he's like, so I trained my core and about a month later went away and I haven't seen it since.

[00:23:06] I'm like, yeah. And he, the age that he's at, that's probably totally fine for him, but he lifts weights a lot. He's very strong. And so, like, knowing that he did that, he never had the procedure and he continues to lift weights. There are the case reports out there saying, like, it can be an option and it's something that you should talk to with whoever you're working with. Exactly. I even had a little bit of right above the belly button umbilical hornia when I was going through my second pregnancy.

[00:23:36] He was a big baby. Big guy. I stretch a lot. Still a big guy. He's still a big guy. I stretch a lot with that pregnancy. So, it was no surprise for me that beyond just diastasis recti, I did have that protrusion happening right above the belly button. But now, I don't see that at all. Now, can I still increase my pressure to a point that it's not ideal and start to see that protrusion?

[00:24:03] I can, but I make sure that when I'm exercising, I'm progressing things the way that my core responds best to so that I'm not increasing unnecessary pressure. And I don't feel any symptoms. I don't have any pains. And I'm able to continue progressing in my strength training and power training, which I just, I hope that the message overall that we're, you know, providing is one of empowerment and understanding that there are tools available.

[00:24:31] Typically, we recommend going to see a pelvic floor physical therapist in person. They are really understanding that core canister and observing everything within that core canister to the best of their abilities to understand how you can progress more functionally to get to where you want to. We also have a core and pelvic floor plan on GenHealth that takes you through kind of that basic understanding of the breath, the pelvic floor, the core, how this all works together. And how you can kind of progress it through different types of exercises.

[00:25:01] It's not the purpose, but the amount of people that reached out, that have reached out saying, oh, I've had this previous issue, whether it's leaking, diastasis recti, different pressure management issues saying like that is completely resolved just from doing the core plan is pretty remarkable. I know. So again, there are tools and ways out there that we can function better within our bodies. And hopefully we catch it soon enough that we can start to make those improvements.

[00:25:30] Thanks for joining us for another podcast. I love being able to share my own hernia story and going through almost 10 years of these abdominal and pelvic floor related symptoms. Our goal is really to help people manage these pressure related issues that they're having a little bit better. So please pass it along to somebody, you know, who might be going through this. If you resonated with the episode, please consider leaving a rating and review on your favorite podcasting platform.

[00:25:58] We have that core and pelvic floor plan on Gen Health. You could try a week of that for free. Grab an extra discount with code optimal at checkout on your month. You'll get your first full month for just $20. And of course, we'll see you next time on the optimal body podcast.