It's the one where Friends character, Joey Tribbiani, loses his health insurance and starts lifting weights to avoid the doctor. After one curl too many, a flash of blinding pain knocks Joey out. He ends up in the fetal position on the floor, unable to move with a bulge coming out of his stomach.
That's right—Joey has a hernia. It's hilarious on screen, but it's also a serious medical problem. Joey's fictional pain could be real for you.
If you've never had a hernia, dealing with one may sound intimidating. But handling these painful spots isn't as bad as it seems, says Mo S. Gerdvisheh, MD, a surgeon at The Christ Hospital.
What's that bulge?
Look at your abs and groin. If there's a bulge that's new, it could be a hernia. It may appear when you're bending over, squatting, or straining your muscles.
Hernias are pockets that develop when part of your insides—fat, intestines, or stomach—push through a weak spot in your muscles. They resemble bubbles, and they cause pressure, a dull ache, or pain.
You can push in (reduce) minor hernias. But if your insides get trapped (incarcerated) in the pocket, the tissue may lose blood flow (strangulation) and start to die off. That can be life-threatening.
Anyone can develop a hernia. But you're more at risk as a guy. You're also more vulnerable if you smoke, have diabetes, or are overweight.
Can you wait it out?
Hernias aren't like strained muscles. They won't improve even with heat or ice. But they can grow and cause other health problems. In fact, the incarceration risk for untreated hernias rises 1% every year, Dr. Gerdvisheh says.
Plus, strangulated hernias that prevent blood flow can get infected, landing you in the hospital. Severe damage to the intestines could lead to needing a colostomy. So, the longer you wait to get that hernia pain checked could lead to a lot more complicated surgeries down the road.
Are all hernias the same?
Hernias can be large or small. The most common types are:
- Hiatal: Your diaphragm (the muscle that helps you breathe) relaxes around your esophagus. This allows part of your stomach to squeeze into your chest.
- Incisional: Tissue comes through an incision from a previous abdominal surgery.
- Inguinal: This is the most common hernia. Your bowels push into your groin through weak points in the lower abs.
- Umbilical: Part of your intestines pokes through your abs and resembles an “outie" belly button.
Diagnosing a hernia
Nervous to see your doctor? Don't worry—most hernia exams are painless, and you don't even need to undress.
“Most times, we diagnose hernias with your medical history and a physical exam," Dr. Gerdvisheh says. “If we can't see or feel it, we do little tests that increase pressure in your abdomen to make the hernia bulge."
These tests are simple:
- Do a small crunch on the exam table.
- Turn your head and cough while your doctor's hand is over the possible hernia.
If your hernia doesn't pop out, your doctor may order a CT scan to get a better look at your abdomen or pelvis.
What does hernia treatment look like?
Dr. Gerdvisheh says delaying treatment is OK if your hernia is small and painless, and you can push it in. But follow up with your doctor to make sure before pursuing non-operative management.
If your hernia is large and stuck, you need surgery. To find the right surgeon, ask your doctor for a referral or talk to a friend who's had hernia surgery.
“Word of mouth will help make your choice," Dr. Gerdvisheh says. “Meet with your surgeon, get a sense of who they are, and ask questions about which surgeries they perform and how many they've completed."
Then, work together to select a procedure:
- Laparoscopic surgery where your surgeon makes a smaller incision and uses a laparoscope (a long, thin tube with a small camera at the end) and small tools to fix your hernia.
- Robotic surgery—like laparoscopic surgery—where your surgeon uses a computer console and robotic arms to repair your hernia.
- Open surgery where your surgeon makes an incision over your hernia, pushes the fat or tissue back in place, and closes the hole in your abdominal wall.
According to Dr. Gerdvisheh, it's becoming more common for surgeons to use minimally invasive robotic and laparoscopic surgeries for hernia repair. Dr. Gerdvisheh himself has completed hundreds of robotic hernia repairs.
The minimally invasive hernia repairs have several advantages over open surgery – like lower risk for infection, less blood loss, and shorter hospital stays.
With each procedure, your surgeon uses mesh to cover the hernia and reduce your risk of another one.
Can you lift?
It's tough to skip weight training or ignore yardwork. But put the heavy stuff aside until your hernia is fixed.
“Before surgery, don't lift anything over 15 pounds. It increases the pressure in your abdomen," Dr. Gerdvisheh says. “That can cause the hernia to bulge, dilate, and grow."
Avoid lifting until your doctor gives you the green light after surgery, too. Until then, walking, light jogging, and climbing stairs are safe activities.
Getting back into action
Small hernia repairs are outpatient procedures. If you feel well, you'll go home within a few hours with pain medication and a wrap to support your abs. If your hernia is larger or more complex, you could stay in the hospital for a couple of days.
Dr. Gerdvisheh says a full recovery takes between four to six weeks, but you'll start feeling better within a month. Please remember—heavy lifting is still a no-no.
“You'll feel completely back to normal within a few weeks, but that's the danger zone. Your muscle fibers haven't fully recovered," he says. “They won't be at full strength until about six weeks after surgery. So, take it easy."
“Ultimately, don't wait to deal with a hernia," Dr. Gerdvisheh says. “Being proactive could lead to easier treatment."
“Once you have problems, contact your surgeon," he says. “It's better to get it repaired sooner rather than later."