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Dr. Rodney Barker lives an active life, getting outdoors and hiking with his wife whenever he can, but it wasn't always that way. This surgeon had his own turning point story that came when he first started practicing medicine.

Dr. Barker had been in practice for about 5 years when he had his wake up call. Like many men as they get further along in their career, he began to get very busy. He wasn't working out or eating quite as well as he used to. He had put on some fat and had lost some muscle. He was feeling not as good as he used to.

As a surgeon, Dr. Barker does a lot of standing in his job. As he stopped working out, he soon found himself having trouble staying on his feet all day. He would come home after a day of surgery and feel worn out and sore. He'd lie on the couch in front of the TV until he fell asleep, just to find himself getting up and doing it all over again. He was in a cycle that was significantly impacting his health.

Dr. Barker woke up one of these mornings, took a hard look at himself in the mirror and decided he needed to make a change.

He gets outside whenever he can and tries to work up a sweat at least once a day for 30 minutes. This new focus on his daily activity level has lead to looking better, feeling better, and is helping him stay able-bodied enough to do what he loves as he ages.

Remember, 30 minutes of activity a day can lead to immense health benefits for anyone. "That's all it takes," Barker agrees. You don't need to spend two hours in the gym every day to be fit. What Is A Hernia?

A hernia is a defect in the muscle layer of the abdominal wall that causes the muscle lining to be thinner than usual. Eventually, that muscle wall weakness may form into a hole that allows organs and tissue inside the abdominal wall to poke out into places they shouldn't be.

Hernias can form anywhere along the abdominal wall, typically from the belly button down. A majority of cases are inguinal hernias that form at the very bottom of the abdomen, leading to a lump in the groin area.

The media will often portray a hernia being caused by someone lifting something heavy, then feeling a pop. That's not quite true. Hernias are caused by many factors. Remember, the hernia itself is a weak spot caused by your genetics. The contents of your abdomen can move through the hole by many means. The act of lifting something heavy, coughing or sneezing, or just going about your daily activities can cause the hernia to form. Some people have a hernia present at birth and don't even realize it until they're older and their muscle tissues begin to weaken. You Don't Need to Rush to the ER if You Find a Hernia

Troy will often have patients rushing into the ER when they discover a hernia. Patients will feel bump, get scared, and think it's an emergency.

Hernias do not typically a medical crisis. Unless the hernia is incarcerated - meaning the bowel is stuck in the hernia and kinked - there is no need to go to the ER. Incarceration is not subtle. People with an incarcerated hernia they will suffer extremely painful cramping and vomiting. You will know if you need immediate medical attention. Hernias Will Not Go Away On Their Own

You may have heard that hernias happen when a person is moving something and they hear a pop. While some patients do experience something along those lines, it's not the most common way people find a hernia.

A majority of people will first find their hernia while in the shower. A patient will be washing themselves when they feel a bump that wasn't there before. THe bump may go away when they lie down, then come back when they stand up.

While a hernia is not a condition that requires immediate medical attention, a hernia will never go away on its own. A hernia will need to be treated with surgery, but not immediately. A lot of hernias are asymptomatic, meaning there is no pain or other complications. It's just an annoying lump. These types of hernias can be monitored for a long time before surgical intervention. Dr. Barker has had patients that lived with hernias for ten years before seeking treatment.

When any hernia becomes symptomatic, it will need surgery. What to Expect with a Hernia Surgery

Hernia surgery is a very simple procedure with a great success rate. Barker does most hernia surgeries laparoscopically, using small tools through a small incision in the stomach..

The procedure itself starts with three small little incisions under the abdominal muscle layer. Dr. Barker will then separate the muscle layers without making any cuts. He then puts the displaced tissue back through the hernia, into the abdomen where it belongs. Finally he places a patch of surgical mesh over the hole to prevent anything from coming back through.

Most of Dr. Barker's patients will be able to go home the same day as the procedure. The recovery is relatively quick, with most people back to their regular activity within ten days to two weeks. In fact, some of Barker's patient heal up even faster. He has run into some of his patients on the slopes skiing less than a week after he's repaired their hernias. How Can a Person Prevent a Hernia?

Hernias are congenital. People are born with the likelihood of a weak abdominal wall and the potential for a hole to form. But is there anything a person can do to prevent them?

Dr. Barker says that hernias happen to everyone, but anecdotally, he has found that people that stay physically fit are less likely to form hernias. He emphasizes that there is no hard data to back that up, but with his long career of treating hernias he is confident in shape people are less likely to form them. A majority of hernia patients are getting older and forming hernias as they age.

A common misconception is that weightlifters are likely to form a hernia as they strain to lift heavy in the gym. Dr. Barker says this isn't the case. Lifting heavy objects doesn't cause hernias.

Additionally, a hernia is not a reason to stop exercising. Exercise will not make the hernia any worse. As long as the hernia isn't causing any pain or interfering with your daily activity, you can carry on with your life as normal. However, if you do experience any pain at any time with your hernia, you should seek treatment. Hernia Trusses, Belts, and Briefs: Do they Actually Work?

A hernia truss is a supportive undergarment that tries to keep the protruding tissue in place and relieve discomfort from a hernia. These devices can also be called hernia belts or briefs. If you have a hernia, should you consider using one of these devices?

Trusses were very common just a few decades ago. They could be bought at any drugstore to help men with hernias. Back then, hernia surgery was not as effective or simple as it is today, so patients would turn to whatever relief they could find.

Trusses do not treat the hernia. Only surgery can actually fix the condition. These devices do little more than hold the hernia in place. While these trusses may help some patients with asymptomatic hernias, the only solution available is surgery. Is Surgical Mesh Safe?

If you've recently stayed up late watching cable TV, you've probably seen an ad about patients experiencing complications from the surgical mesh used during hernia surgery and class action lawsuits against the mesh manufacturers. These ads can raise some serious concerns and may lead patients worry about the safety of using mesh during their hernia surgery.

Dr. Barker uses surgical mesh in his operations and vouches for the mesh's effectiveness. Surgical mesh significantly reduces the chance of the hernia reforming after surgery. According to Barker, there is no research based evidence that modern surgical mesh used in hernia surgery causes post-surgical complications.

Dr. Barker has been treating hernias since before mesh was regularly. He has found that the very low occurrence of patients suffering from chronic pain after surgery is the same now as it was back when hernias were treated without mesh.

If you find an unusual bump in the shower and believe it's a hernia, go get it looked at by a professional. Your physician should be able to diagnose what that lump is and prescribe what your next steps in treatment should be. Just Going to Leave This Here

On this episode's Just Going to Leave This Here, Scot learns that ER doctors will actually call poison control themselves, The first thing you should do is call poison control. And Troy second guesses himself after learning that an Apple Watch saved a man's life after it sensed a total heart block. On a previous episode he was concerned about the frequent false positives from the device. Talk to Us

If you have any questions, comments, or thoughts, email us at hello@thescoperadio.com.

Interviewer: Will a hernia go away on its own? Dr. Rodney Barker is a hernia expert. So do hernias eventually heal without surgery?

Dr. Barker: No, they don't. It's a defect in the abdominal wall. It's a mechanical issue, and it needs a mechanical fix. Physical therapy, medication won't do anything for it.

Interviewer: If a person has a hernia, should they go in and get it fixed right away?

Dr. Barker: Not necessarily right away. They should have it checked and make sure that's what it is and it's not some other diagnosis. The repair will be a discussion between them and the surgeon as to when it's most desirable to do it.

Interviewer: And sometimes, if somebody notices a small bump that's not giving them any problem that's a hernia, do you ever take a wait-and-see approach?

Dr. Barker: We do. Again, we want to confirm that small bump is a hernia and not an enlarged lymph node or something else. But watchful waiting is an appropriate response.

updated: October 28, 2021
originally published: August 21, 2019

Announcer: Health information from experts supported by research. From University of Utah Health, this is thescoperadio.com.

Interviewer: Hernias are extremely common and millions of people have them, and symptoms can vary from men to women. They also vary depending on the type of hernia you have. And if you have one, you should get it treated.

Dr. Rodney Barker is a surgeon and hernia specialist at University of Utah Health. And let's start out with a very basic thing here as we go through our journey. What is a hernia?

Dr. Barker: A hernia is a defect in the abdominal wall. Some people call it a hole in the muscle, but it's more complicated. There's muscle. There's connective tissue that holds muscles and tendons together. When we get a defect there, it allows something that normally belongs in the abdomen to protrude through that defect, and that is the process of herniation.

Interviewer: And is it a genetic reason that I would have this defect? Does everybody have the defect?

Dr. Barker: It's genetic to the human condition, but there are natural weak spots where they typically occur.

Interviewer: All right. So everybody has the possibility of getting a hernia?

Dr. Barker: Correct.

Interviewer: Nobody is completely immune.

Dr. Barker: That's correct.

Interviewer: All right. So you've mentioned one of the symptoms I think, is there is that weakness in the abdominal wall and all that tissue, the more complicated version, and something kind of pokes out. Is there a noticeable bump?

Dr. Barker: In most people, yes. That's what they first notice. But if someone has a very small hernia and they're large, they may not feel or notice the bump themselves.

Interviewer: Okay. I've heard kind of the classic way is you go to pick something up or you're lifting something or pushing some weight and you feel a pop. Is that kind of the traditional way most people would experience . . .

Dr. Barker:That's probably a minority of the patients that I see. It is still fairly common, but most people are in the shower or they're doing something and they incidentally find this bump.

Interviewer: Okay. And didn't even realize, at the time, that they did anything.

Dr. Barker: That's correct.

Interviewer: All right. So I was told that hernias are a little different in men than they are in women. How is that?

Dr. Barker: Most hernias are the same. Inguinal hernias, which are the commonest type that we fix, tend to be more noticeable in men and easier to diagnose because of the difference in anatomy. In women, they don't get the same degree of outward bulging. It's not often as easy to palpate or feel it.

Interviewer: And as a result, are there more women that are walking around with hernias that don't realize it than perhaps men?

Dr. Barker: No way to know that.

Interviewer: Okay, fair enough.

Dr. Barker: Probably not. Men are more prone to getting inguinal hernias than women.

Interviewer: All right. So you could have a hernia and not even know that you have a hernia.

Dr. Barker: That's correct.

Interviewer: Yeah. So then could it possibly heal on its own?

Dr. Barker: No, it won't heal on its own, but if it's there and it's not bothering you and you don't know about it, it's not a dangerous problem.

Interviewer: Okay.

Dr. Barker: It's not something you need to worry about or run and see your doctor and say, "Do I have a hernia?"

Interviewer: So if it's something that it's not giving you any sort of complications, you're not feeling any . . . like, what would be an indication that this is actually a hernia I should be concerned about?

Dr. Barker: So if you feel the bump or the bulge or you're having discomfort or you're questioning that, that's something to get checked, and you could see your doctor and check for that.

Interviewer: Are there any dangers of not treating after you realize that there's a bump there or you have some discomfort?

Dr. Barker: The danger of a hernia, and I use that word literally, danger, is that you can get bowels stuck in it. Incarceration is what we call it. That bowel can sit there long enough, swell up, and strangulate. It sounds terrible. It is terrible, but it's very rare. Most hernias will not go on to incarcerate.

In my training, when I first started years ago, we would tell people with a hernia, "Boy, you should get that fixed because, you know, it could strangulate on you sometime." These were hernias that were often found on routine physical exams in totally asymptomatic patients.

Since then, we've learned that the rate of incarceration in a totally asymptomatic small hernia is very, very low. And we don't rush all those people to surgery anymore.

Interviewer: So do you have a lot of patients that come in with kind of initial hernia symptoms and then you just kind of watch them?

Dr. Barker: Not too many, because most of the time by the time they're seeing me, they've made that decision. But I've seen patients who have had a hernia for 10 years and they've just been watching it and now it's growing and becoming symptomatic.

Interviewer: Got you. So let's talk about how you treat a hernia. I understand there are three different ways. Two of them you kind of use now. One of them not so much anymore. Explain what those are.

Dr. Barker: Correct. The first we've talked about. We call it watchful waiting. And I use those words carefully when I talk to patients. I don't tell them, "Hey, we're just going to ignore this. Go away. Don't worry about it." We're going to watch it and we're going to wait.

The majority of people that have hernias will eventually get them fixed. One study showed that within a year, 30 percent. By five years, 70 percent, 75 percent are going to have it repaired. And that's because the hernias get bigger and they become more symptomatic or the patient changes their mind to say, "Yeah, this really does bug me. I want to get it taken care of." So watchful waiting is most of the time a temporary treatment.

The second option, and the most common thing, is we operate on them. We repair them. That is the standard of care for symptomatic hernias.

The third option is not used much anymore. I see it more in elderly patients. But 30 years ago when I started, I saw it much more frequently, and that is to wear a truss. Trusses are like little belts with a pad or a ball on them that pushes in on the hernia. And the idea is that keeps it from coming out.

The problem with trusses is they don't work very well. They are uncomfortable for most patients, and we rarely see them anymore. And I don't ever prescribe them. If I have a patient who says, "I want a truss," they can Google it and find some vendor that sells it and buy it if they want to.

Interviewer: Sure.

Dr. Barker: It's pretty rare, though.

Interviewer: And as far as surgery is concerned, what type of procedure is this? Is it a laparoscopic, you know, that small incision surgery, or is it an open surgery?

Dr. Barker: It's both and it depends on the hernia type. It depends on is it a brand new hernia or a recurrent hernia? And it depends on the preference and skill of the surgeon that's doing it.

Most hernias are still repaired with an open approach, where they make a single incision, cut through the layers, sew it up usually with a patch, get out.

Laparoscopy is done frequently. I'm primarily a laparoscopic surgeon when it comes to hernias, especially inguinal hernias. In that, we make three little incisions and go in with a camera and long skinny instruments. There's less cutting and sewing of the natural tissues. It does require a patch to be put in there to block the hole, but it works very well and it has a very acceptable recurrence rate.

Interviewer: And after a hernia surgery procedure, what type of recovery would a person expect at that point?

Dr. Barker: So the average laparoscopic repair that I do, most people within a week are back to their regular activities or close to it.

Interviewer: Wow.

Dr. Barker: I don't put any restrictions on after that first week.

Interviewer: Got you.

Dr. Barker: It's either fixed or it's not, and the patch is well set up or it's not, so lifting is not going to make any difference.

Interviewer: What about the more open type of surgery? Does that take a little bit longer?

Dr. Barker: It does. And it depends, again, on how it's done. If you bring tissues together and put stitches in them, you need to wait for that to heal. And that can take up to six or eight weeks.

It also depends on whether mesh was used or if it's just a straight-up suturing. Without any reinforcement, if we just straight up suture, I tell people six weeks of limited activity so they don't pull that apart.

Interviewer: But they can go back to work if it's not an active job within a week, two weeks?

Dr. Barker: Yeah. It depends on the job and how they feel.

Interviewer: Got you.

Dr. Barker: I have, you know, experience over this with part of it is their job. If you're a guy who hates your job and it requires physical activity, I won't get you back for a month. If you're a self-employed accountant and it's tax time, you'll be in the office the next day.

Interviewer: Yeah, I bet. All right. What's the bottom line when it comes to hernias, in your mind?

Dr. Barker: Well, I've done a lot of them, so it's . . .

Interviewer: That's good.

Dr. Barker: You know, they're very common. It is one of the most common operations done in the United States. About a million of them a year are repaired here. It is the most common surgical procedure I've done over the years, thousands of them.

We've changed in 30-some-odd years from fixing every single one we see because, "Gosh, you know, you're going to get incarcerated," to, "Well, let's watch it if it's not bothering you." We still fix all the hernias that are bothering people or that are at risk for incarceration.

I think the biggest controversy now or the biggest question we have is, "What's the role of mesh?" When I started, we rarely put it in. We sutured tissue together. We then switched to mesh, and now, in the 80s and 90s, almost all hernias are repaired with mesh since then and people are starting to blame the mesh for various things.

A lot of these people don't remember what I do in the pre-mesh days when we were seeing people come back with their fourth hernia at the same spot and we had no idea how to fix it because the tissue was gone. There was just nothing you could do for these people.

So I think mesh has done a lot to reduce recurrence rates, but there are questions about it. You know, it's a foreign body. Is it causing more pain? Is it causing other issues? And I think those questions need to be studied and answered.

Interviewer: What's your take on that, then, if a patient came to you and said, "I would rather not use mesh"?

Dr. Barker: We have a very frank discussion. I say, "We can fix your hernia without mesh." If it's a small umbilical hernia, we'll do it anyway without mesh. If it's a groin hernia, it's a longer discussion.

The vast majority of patients, once they hear the science behind it and once they hear their options and why we do it, opt for mesh repairs. We can do repairs without mesh, but most of us nowadays aren't that good at it. I trained doing them. I still do occasional ones, but it's not what I would choose for myself. If I had to have a hernia fixed, I would have it done laparoscopically with a mesh patch.

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