Sep 8, 2017

Announcer: Is it bad enough to go to the emergency room, or isn't it? You're listening to ER or Not on The Scope.

Interviewer: All right, let's see you how you do today. ER or Not with emergency room physician Dr. Troy Madsen. I'm going to give you the scenario. You decide whether it's worth going to the ER or not. Here is the situation, Dr. Madsen. You're helping some friends move some furniture. You lift a particularly heavy chest of drawers. You feel a little bit of a pop in your abdomen area. Now there's, like, a protrusion down there. ER or not?

Dr. Madsen: Well, this is something, I think we've all done it sometimes, lifted something, you know, these moving scenarios, you're often trying to show off, you know, your strength, trying to carry some piano down the stairs. And as you're doing it, you say to yourself, "This was a really bad idea." But then, when something pops out in your belly . . .

Interviewer: "This was a really bad idea."

Dr. Madsen: Then you think, "This was a really bad idea." So it's not uncommon. We'll see people in the ER with hernias.

Interviewer: That's what that is.

Hernia Causes & Symptoms

Dr. Madsen: That's what it is. So a hernia is a tear in the lining of the abdomen. And when that muscle tissue tears there, and those fibers tear, then some of the contents of the abdomen can kind of bulge out. So that's intestines that are kind of sticking out there that you're feeling beneath the skin. You've got this bulge, often around your belly button. A lot of people experience it in their groin as well, particularly men. When you had your physical exam and the doctor touched you and said, "Turn your head and cough," he was checking for a hernia. That's what we're doing there.

Interviewer: Just kind of making sure you didn't have one and didn't realize it.

Dr. Madsen: Exactly. Just a small one, something like that. So that's exactly what a hernia is, it's a defect in the wall, but it is not a reason to rush to the ER.

Interviewer: What are you talking about? My insides are coming out. It's absolutely a reason.

Incarcerated & Strangulated Hernias

Dr. Madsen: Exactly. It's scary. The one time you'd want to rush to the ER would be if something changes with that hernia. And most people know they have hernias. It's happened to them. They've had hernias for years, and they know it's there and they just kind of deal with it. You can get it surgically repaired, but it becomes an emergency if it becomes what's called an incarcerated hernia. And that's a strangulated hernia.

So that's when you get enough of this stuff outside of the abdomen that the blood supply gets cut off to it. You try and touch it, it hurts, it's firm. You try and push it back inside, which you should easily be able to do, and it won't go back in. That becomes a very big deal, and it's definitely a reason to get to the ER. Often in the cases, we have to get these patients to the operating room pretty quickly to get this treated.

When to Go to the Emergency Room

Interviewer: Okay, so just to be square here, I'm moving furniture or I'm lifting weights and I get that pop-out. Just because it's not a reason to go to the ER, I should go see my doctor.

Dr. Madsen: Yes, you should. Yeah, because it could get worse.

Interviewer: But it's not something I have to do, like, then.

Dr. Madsen: It's not.

Interviewer: In the next couple of days. Unless, of course, it becomes painful to touch and I can't push it back in, then a trip to the ER is necessary.

Dr. Madsen: That's right. Most people with hernias live with them for years, but if something changes, you'll know it. Get to the ER.

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