195. Hernia Belts, Trusses and Binders

This week, the topic of discussion was: 

• Inguinal Hernia Truss (comfort-truss.com)
• Abdominal Binder (caromed.com)
• Hernia Belt
• Scrotal Hernia
• Postoperative Recovery
• Rib Belt
• Compression Garment (yummie.com, maidenform.com, underarmour.com)

Welcome to HerniaTalk LIVE, a Q&A hosted by Dr. Shirin Towfigh, hernia and laparoscopic surgery specialist who practices at the Beverly Hills Hernia Center. This is the only Q&A of its kind, aimed at educating and empowering patients about all things related to hernias and hernia-related complications. For a personal consultation with Dr. Towfigh, call +1-310-358-5020 or email info@beverlyhillsherniacenter.com.

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Transcript

Dr. Towfigh (00:00:10):

Hi everyone, it’s Dr. Towfigh. Welcome to Hernia Talk Live. I am your host, Dr. Sharon Towfigh, hernia and laparoscopic surgery specialist. Thanks for joining me here every week on our Hernia Talk Live episodes. Many of you are joining us via Facebook Live at Dr. Towfigh or let’s see, some of you’re here on there. You are on the Zoom channel. So know that this episode and all prior episodes are available for you to see on my YouTube channel at Hernia Doc. And if you just want to follow what I do, there’s some meetings coming up and I try to go on X to live tweet what I learn at these meetings, I’ll let you know more at the end of the show about what meetings are coming up. And lastly, don’t forget the fun stuff is on Instagram. So follow me on Instagram at hernia doc.

(00:01:09):

So as you know, I have spoken to many of you and the audience about different ways of supporting your hernias, whether it’s the use of a binder or a belt or a truss. And sprinkled throughout many of my podcasts, I’ve mentioned different usages for binders and trusses and belts, when to use it. Do you use it before surgery? Did you use it after surgery? What if you don’t want to have surgery? And I thought it would be a good idea to spend the next hour or so getting really deep into this topic. So what we’re going to do is we’re going to talk about hernia belts, trusses and binders, when to use them, when not to use them, the benefits, the risks. And I have a bunch of samples here. So for those of you that are watching either on YouTube or today as a Facebook Live or Zoom, then you can see what I’m showing. But I’ll try and be as descriptive as possible for those of you that prefer to join me as a podcast, which will be basically all, what do you call it, audio only. So just to start, I have no financial interest in anything that I talk about.

(00:02:40):

I’m not paid by anyone to promote any marketing thing. I’m just a very curious person. And so throughout the years I have learned about different hernia belts, trusses, and binders. Through my own research, I’ve spent tons of money ordering off of websites and Amazon to try and figure out which ones are good for my patients and which ones are bad. And then my patients will show up and I’d say, that’s a really good compression garment. Why don’t you share with me where you bought it, how you bought it, et cetera. So I learned that way and then maybe I’ll go buy it myself to try it out. We have our own inventory of stuff that we buy and give to some of our patients who would benefit from it. And some have been sent to me for free because I’m interested and others I’ve heard like a doctor or a plastic surgeon or a physical therapist or something has used it. So I’m sharing with you 20 years of inquisitiveness on different types of support garments for people with hernias and hernia related problems. So I think it’s going to be a fun one this time because it’s a little bit of show and tell. So let’s first start with a nomenclature. So a binder is something that binds you, so it kind of cinch you in. And traditionally binders wrap around your back towards the front and they close in the front.

(00:04:21):

A belt is usually narrower and not as wide and is used generically for anything. And then a truss is specifically used for patients that have hernias in the groin. So truss, T-R-U-S-S is basically like, so people call it a hernia belt, but it’s very, very old. In fact, for those of you that come to my office, one of my rooms has some antique drawings of different types of hernia trusses. Back in the day when people had obvious bulging in the groin and there wasn’t really good surgical options. So the original hernia trusses were all made of either thick leather, kind of like those belts that you wear if you’re a weightlifter or a combination of leather and metal. And nowadays we’ve moved towards neoprene and spandex and the stuff that’s a little bit easier on the skin. And we’re going to talk about all that because the quality of what you wear is also very important because you can actually get injured by some of these products, believe it or not.

(00:05:44):

So let’s see. Should we start simple? Let’s start simple and let’s just talk about binders. Binders are for the abdominal wall and they come in varieties. This one is, this Dale Binder is the most common one that you see at the hospital. They usually sell in bulk. There’s also, let’s see, there’s also another one called ProCare. ProCare and Dale are the two major low quality mass produced binders. You can buy them at your local pharmacy or you can get them at from the hospital. Usually the specialty ones are the ones that I prefer, but the key is to get the soft one. So here’s the dale, it says abdominal binder 12 inch. So they usually come in nine, 10 or 12 inches. And that relates to the height. So the shorter you are, the kind of the shorter you want it, usually nine inch is adequate for most people, 12 inches is usually too long, but depends on your body habitus.

(00:07:05):

So the problem with some of these binders is if you have a narrow waist and a very wide buttock or thick hips, a k, a female, then you’re going to have a more difficult time with binders. So if you have a lot of disparity between your waist and your hips, you really want a longer one so you can drape more of the binder over your hips down into your groin area and that will prevent the binder from rolling up. So let’s just open up the typical Dale binder. You can buy these on Amazon as well, and you can tell already it’s they’re usually white, although they come in black as well. And can you hear it? It’s kind of very scrunchie a little bit. This is actually not that bad. I’ve seen worse where they’re really cardboard really hard. Usually these are too stiff to be placed over your skin and you want it wear like a t-shirt, like a soft cotton, like a Hanes type soft cotton and then wear this on top of it.

(00:08:18):

Otherwise it can get too scratchy. It can actually cause bruising in some people or it can cut into you if you don’t wear it right. So this is actually the 12 inch. It doesn’t look like a 12 inch, but I guess it’s a 12 inch and it comes with a Velcro on one end and most of these have a single Velcro on the end. So if you’re wearing it in the hospital, a nurse or a doctor can put it on for you. It usually takes two people to do it and to wrap it around you. And that’s what I don’t like for people that are outside on their own because they only have two hands and you need four hands to correctly wear. These longer binders that have a single row of Velcro, this one happens to come with an extra little strip and this strip is intended to wrap around and further secure the binder.

(00:09:29):

Or if you have a drain, for example, you can secure the drain to the binder with the Velcro in the hospital often we don’t have this extra strip and we use safety pins, but safety pins can fall off and then they can poke you. So it’s not the best design. We really need a better binder than what’s currently available and hopefully one day I’ll be the one that develops that for you, but right now there’s too much on my plate. So this is your traditional white 12 inch binder and then how much it wraps around depends on your girth, right? So it comes in different sizes. This one happens to be, let’s see, what does it say, 30 to 45 inches, which is pretty standard. There’s some that are in the 60 inch range that you don’t want that one that’s too big for you.

(00:10:26):

You have to wrap it around yourself multiple times. But these can also be washed, so you can wash these in cold water and I often recommend for people who really want to use their binders a lot by two, so you wash one and let it dry while you’re using the other one. These have a limited lifespan, so if you want to use your binder every single day and you want to use it for more than three or four months, these will start loosening up and then becoming irregular and the Velcro will destroy the binder part. So you kind of get what you pay for if you go cheap, but if you just need it for a short period of time, the Dale or ProCare is perfectly fine brand. This is like a, what does this say? Oh, let’s see. I prefer the Caromed. This is Caromed, C-A-R-O-M-E-D. I was taught to use this by a plastic surgeon friend of mine who’s very particular about his abdominal plasty tummy tuck. And what’s unique about, first of all, unfortunately you cannot buy this on Amazon. You have to buy it from their website themself.

(00:11:52):

It comes everything from extra small to three xl. It comes in white and black. I like the black because it looks cuter than the white. Why is this different? So the caramel actually is a brand that specializes in compression garments for plastic surgery. So you can get a facelift and get a kind of facelift binder. You can do breast surgery and get the care breasts kind of bras. You can have thighs skin removed or whatever. They have all sorts of specialty compression garments. They have a limited amount of products specifically for the abdominal wall. So they really only have two types of binders. One is the single flap, like the other one I showed you, which has a single strip of, let me show it to you, A single strip of Velcro like this. I do not recommend that one. You can ask, I recommend the multi flap.

(00:13:05):

What did I say before? When you have the single strip, then it’s really hard to get it around and tight enough with just two hands. You really need more than two hands, like four hands. So the hospital, that’s not a big deal because a nurse and maybe a resident or the surgeon can do that for you, but when you’re at home you may be alone. So care specifically has this cute design, which is a multi flap. So it’s three flaps and there you go. So there’s three flaps and there’s two flaps depending on the length, the length that you want. So the nine inch has two flaps. The 12 inch has three flaps and I prefer the longer, the 12 inch for most patients because then it can come nicely over your hip and so when you sit and so on, it doesn’t roll up and cause problems.

(00:14:06):

Why is that different? So instead of having three, sorry, one single long strip, you now have two or three narrower strips. So when you are on your own, you can very easily close, close one strip around yourself, secure that, and then close the other strip in the next level. So now you have a multiple layer or multiple layers of closure that overlap each other, that overlap each other and give you a little bit more tailoring to your outfit. So instead of having a single binder that goes all the way around, this caramel product has a two or three different wings to it, and my friend Dr. Rabon is the one that taught me actually if you use this upside down, then have the patient do the bottom flap first and then build their way up because the bottom flap is the most important one. You want it right over the hip bones down low so it doesn’t roll up.

(00:15:29):

So you close the bottom flap and then you do the next flap above it and the next flap above that and it provides you good compression. The other thing I like about the binder, the Velcro is pretty strong, but the inside is lined with a soft T-shirt type quality, whereas the typical binder has no lining to it and therefore I recommended you wear it over a t-shirt so that it doesn’t scratch or dig into your skin. But this binder already has a lining to it and is got a very secure but soft, stretchy, elastic outside and then the lining inside that way if you wish to, you can wear it underneath your clothing without needing another layer between your skin and the binder. So I prefer the caramel. They’re not that expensive.

(00:16:28):

I would say a cheap binder is like 10 to $20 and these are like 50 to $60, so it is a bit more expensive. These also have the caramel and the more expensive also have a lifespan. So if you wear it every single day for about six to eight months, you’re going to notice that it starts getting stretchy in certain areas and not stretchy in other areas and so on. Now all of these are very soft and flexible. If you’ve ever had back surgery or if you know someone who’s had back surgery or if you yourself have worn a back brace or the ones that you see, if you go to Home Depot and you see them wearing these back braces, that is not a binder. Those specifically support your back and are very stiff in the back and you from hyperextending your back and have very little fabric in the front to just close.

New Speaker (00:17:30):

Let’s see,

Dr. Towfigh (00:17:34):

We don’t have any of those for me to share, but those tend to be for your back. So don’t try and use a back brace as an abdominal binder. It’s too stiff in the back. They’re not comfortable to wear all the time and they can dig in because they have these almost metal or some more plastic bones to them. You really don’t want the binders with the bones because that can cause problems with stiffness or even, what do you call it, poke into you. So let me show you some other options. This is a brand called Veronique. I believe I saw this in Europe.

(00:18:28):

I got a sample from them. It’s pretty good. Let’s see how I can open this. There we go. Let’s see. Do they sell this in the United States? Yeah, FDA. Actually it’s made in the United States, but I saw it in Europe. So at first glance it’s kind of cute, it’s got a little flower decoration on it. It does have these bones to it. I don’t like the bones because it’s not flexible enough and the bones are there to give it structure, but they often just break or bend and then dig into you. So don’t get the, I don’t recommend binders with bones. The stretchiness is pretty good. I would say a medium, medium to high and the fabric portion is also very soft. Similar to the caramel brand, the Veronique has two flaps that overlap, which again make it much easier to put on yourself with the help of anyone.

(00:19:46):

It’s a little bit thinner than the caramel and it’s still soft. It says you can hand wash cold and then just line dry it. It is latex free. That’s good and it’s just stiffer. Even the Velcro is stiffer and has these very sharp edges to it, whereas the pyramid does not, and we’ve never used this. It’s just as a sample that was sent to us. And if you look already the, I don’t know if you can see, but you already have the Velcro destroying the elastic fabric. So there’s an art to these and if you’re going to be using a binder for long enough, you need to invest a little bit of money. You don’t need to do hundreds of dollars, but they’re all under a hundred, but a little bit of money goes a long way and so on. This also comes with the little straps, which can be used either to support the closure like this across or to add a Velcro closure to support if you have a drain or something like that. So that’s something cute that care does not have.

(00:21:08):

Okay, so in summary, those are the binders. You can go cheap but don’t get the ones that are super stiff. Some of them are even stiffer than what I have here. They actually carry it at the hospital. Why do you even spend money on this? It’s so horrible. I hope they’re not charging you a lot, but if you have a big abdominal reconstruction with me, sometimes I just provide this for you because I don’t want you to get injured from a poor quality binder. So I would either have you buy it or sometimes I bring it to the hospital. So risks. Are there risks with using these products? Well, one risk is that you’re using it incorrectly and often I see I come to see my patient and the binder’s over their chest and I’m like, I put it over your hip. Why is it over your chest? And the patient’s like, oh, I was moving around. I was so hard for me to fix it. And then no one was around or whatever the situation was. Some people don’t look under the covers to check the patient’s binder to understand how important it is for it to be perfectly over the area of surgery.

(00:22:20):

So if you’re wearing a binder and you see that it rides up or something, either reposition it or get a better binder that doesn’t ride up often it can ride up into the chest and so on. Then the question is, when should you wear a binder? I usually recommend a binder immediately after surgery for most of my abdominal wall surgeries, not the small ones, not the little belly button ones, but if there’s any tension on the suture or if I want to reduce swelling or bruising, I do rely on binders. I love binders. I think it’s great. Patients love it. They feel more secure, they feel snatched a little bit. That’s not the purpose of it. I do think that it helps with reduce swelling, it reduces bruising. It can help with pain control by taking some tension off of the suturing and holding everything in while you’re healing.

(00:23:28):

It may reduce fluid accumulation and in some people it does a very, very good job. However, there are situations where binder is, for example, if you have really bad blood flow to your tissues and you put a constrictive garment like this binder over it, you can reduce the blood flow to your tissues even more and that can cause serious damage. I’ve seen patients where their skin dies as a result of the binder and if the binder is placed incorrectly, what can happen is you can have, let’s say a fold in the binder or the binder bends and digs into your skin and that can cause a pressure and the pressure can cause death of that skin. And I’ve seen patients with these really ugly linear scars on their belly. I’m like, what happened to this? Oh, I had skin necrosis. They’ll say that the binder was incorrectly put on or was bending or something and they had skin necrosis and then that skin needed to regrow and then it’s discolored when it regrows and all that. So there are risks with it. If I think that there’s any risk at all of the binder causing poor blood flow to a skin flap or anything like that, I will just not use a binder and it’s perfectly fine. There are plenty of surgeons that don’t use binders and their patients do just well. So it’s not, not having the binder is going to be such a bad outcome, but I do like it. I’ll tell you, some patients come and they’re like, I love this binder. Can I still wear it?

(00:25:29):

We don’t know if wearing it long-term is bad for you. There’s some concern that if you are dependent on a binder, then maybe your core is not as strong making it get used to external compression and not using your own core. That’s probably true, but at least while you’re healing, I think it’s totally fine to wear the binders. So that’s what happens when you wear a binder or your postoperative recovery. When should you wear a binder before surgery? So I would recommend that if you have a big hanging hernia, these are big hernias, these are what we call giant hernias and we talk with Dr. Michael Rosen, I think episode 55, formerly of Cleveland Clinic now at Northwestern in Chicago about giant hernias. These huge hernias were half your intestines or are outside the muscles into the skin just sagging huge. Those patients tend to really benefit from binders.

(00:26:42):

So even without surgery or before surgery, a lot of people will benefit from binders. If there’s a lot of pressure pushing out on the hernia, sometimes what I see is the skin starts to get thinned and if your skin gets thinned over the hernia because there’s all this pressure, maybe you’re obese or the hernia is huge and there’s pressure in the intestines are pushing out against the skin and the skin is thinning. In those situations in particular, I highly recommend using a binder over a very soft t-shirt because it will take some tension and pressure off of the skin so the skin doesn’t thin out because what happens if your skin thins out, eventually it’ll pop or it’ll get scratched or it’ll die and now you have intestines outside just hanging out. That’s a surgical emergency and it’s a horrible emergency because it means you can’t get your hernia fixed. It’s no longer sterile. So it’s a bad situation. You don’t want that to happen, and therefore I personally recommend that if you have any thinning of your skin that you want, consider a binder to help reduce that problem.

(00:28:04):

Okay. Oh, on that note, most people who have hernias of the belly do not need a binder. Just so you know, here’s an interesting product. It’s called a rib belt, RIB rib belt. So it comes for males and females and it’s as you can see, much narrower, much narrower than your typical abdominal binder. It’s usually four to six inches wide and it’s usually marketed for people that have broken ribs and it’s really difficult to take breaths. So they end up not taking deep enough breaths because every time you breathe, your ribs are moving and it really hurts until your ribs heal. So you only need compression over a very narrow range wherever your one or two ribs are broken. However, I use this for people that either have an epigastric, yeah, usually for people that have an epigastric hernia or a hernia way up top or a small belly button hernia, but usually epigastric way up top because all you need is a little bit of narrow binder on the lower edge of your ribs.

(00:29:28):

You can’t use a huge binder because you don’t need anything below your belly button covered and it’s just uncomfortable For women, the rip belt has a unique cutout in the front. You can see here the front of the binder is narrower than the back of the binder. So the freezer for that is this can come way up underneath your breast and provide closure underneath your breast without digging into your breast. So these other binders that are just flat are good for the mid abdomen and lower abdomen, but for the way up higher abdomen, they don’t give good enough compression. And I prefer a rib belt and this is not a good one. It’s very, very stiff, very stiff, but there are other brands that have good rib belts. You really want them to be soft and you can buy those at Amazon. We, I think ran out already of these.

New Speaker (00:30:41):

Okay,

Dr. Towfigh (00:30:44):

Next I want to talk about trusses. So we talked about rip belts, we talked about binders. Let’s talk about trusses. So a truss is an inguinal hernia or groin focused belt, okay? So what a truss does is it pushes in a bulging hernia. It is not meant to fix your hernia. It is also not meant to cure your hernia, and it’s not necessary for most patients with groin hernias. However, who benefits from a hernia truss? Sonia? An inguinal truss or inguinal belt only is, I think in my mind, helpful for people who have pain from their groin hernia when the groin hernia sticks out, and therefore this helps keep in or push in the hernia so that you can do your normal daily activities. So perfect example is let’s say a security guard and the security guard needs to be on their feet for their entire eight hour shift basically.

(00:32:07):

And if they have a hernia, it may be uncomfortable for them to be standing for so long or they have the fidget so they can wear an angle, hernia belt or hernia truss to specifically focus on the bulging and the groin and hold it in and in order to hold it in, I’m sorry, once you hold it in, the pain goes away. It’s when it’s pooching out or bulging out, that hurts. It does not make his hernia outcome better. It will not improve outcomes from hernias or reduce the risk of needing surgery. It’s basically just a belt. Now these tended to be very thick, very hard.

(00:32:54):

Here’s one of the more common ones you can buy. They’re usually tan in color and very, very stiff. They’re called, this one’s called soft form. And let me tell you, it’s not very soft. It’s completely false advertising. So it’s also very odd to wear these. So if you look at the picture, we’re dealing with a lot of anatomy here. So you want the groin area covered, and of course, I’m only talking about men here, by the way. You want the groin anatomy covered, but you still want the area to be able to urinate and it wraps around the back, but you still need to be able to go to the bathroom without the belt falling off. So these are meant to be put on right over the skin, and then your underwear is supposed to go over it that way you can take off the underwear and go to the bathroom, put the underwear back on without having to undo to redo and undo the belt itself.

(00:34:01):

So if you look at this one, it’s very complicated. You kind of need a PhD to figure out how to put all these components together. It’s got the main component is in the middle, so there’s a left and a right, and this left and right area has usually a pocket. And within the pocket you can put these foam inserts. It’s like ranges from flat to almost like a huge half of a tennis ball. And think of it as an inside, like a fist, trying to push that hernia back in. So this area is intended for these inserts to add pressure externally to push the hernia in. You can get one that has both of them in. You can get one with only one side, and then you have to figure out this contraption that goes around your back and then under your inner thigh, around your buttock. And as you can see, it’s very complicated and some men love it. They think it’s just this great idea and they’re able to just snap it on and snap it off. But I don’t know if you can see it’s, it’s really firm and stiff and I think in an area of the body where you have so much movement and sensitivity, I don’t think it’s a good design.

(00:35:42):

Here’s another brand of the same, the H two hernia belt by Adamson. This I think was sent to us as a sample. What

New Speaker (00:35:57):

Happened? Lost my lights. All right, nevermind.

Dr. Towfigh (00:36:15):

So where were we? We’re talking about these, I mean, look how huge this is. It’s like a big ball and a very scratchy, very stiff Velcro. I don’t know why they make it so cheap, I think because there’s not much profitability in these things, but these are one sided and you can wow, really stiff. I mean I can just bang it on. Very low quality, super stiff, completely not appropriate for the groin I think. But similar concept you have, this is the one-sided truss. So you have an area here where you can open up the region and let’s see how we can open this up and put in, oh, it looks like you just have to push it in, put in some type of extra support like that, and then it’s externally compresses. This waistline wraps around the waist and there’s always this third kind of portion that goes between the legs. There’s a one sided one, but look how stiff this is just, it’s just like rock hard. I would never want this rock hard area in my inner thigh between my legs. That’s just bad design. But there’s tons of these online that you can buy. I personally prefer the comfort trust.

(00:38:02):

It’s called comfort Trusts. It’s pretty comfortable comfort trusts. They have their own website. I think it’s comfort trust.com. You can also buy these, I don’t know if you can buy these on Amazon, I think you cannot. So this is interesting. If you look in the back or if you go on their website, the person that designed this is a young man who has hernias himself and he’s chosen specifically not to get surgery, which is fine, and he’s decided to wear a truss because he was symptomatic. Now as you know, there’s no evidence that symptomatic hernias are good options for watchful waiting, but that’s, that’s been his choice. So what he basically decide is he’s going to wear a truss, however,

New Speaker (00:39:09):

Sorry, I plugged in my computer.

Dr. Towfigh (00:39:17):

So he’s decided that he’s going to wear a truss to prevent himself from,

New Speaker (00:39:29):

Can you guys hear me okay?

Dr. Towfigh (00:39:39):

Okay, and me notice that these are horrible. What’s out there? So he developed something much, much softer, and that’s called the comfort trust. So the comfort trust basically has a much softer and lower profile design. So let me see, I’m going to take this one out, which is the heavy duty one, but they have a regular heavy duty and I believe they have an athletic one. And so what they have chosen to do is take the same concept, which is push in the hernia and wrap it around the leg, and then in the meantime, make it so that it’s soft and the area doesn’t burn or you don’t get problems with rashes and burns and discomfort from,

New Speaker (00:40:47):

Let’s see, rashes and burns

Dr. Towfigh (00:40:55):

And so on. So let me show you this. First of all, much more beautiful design. It’s super soft, you can’t even hear it. I’m moving it by the microphone. And relative to all the crackling of the other ones, you can barely hear any of this. It doesn’t have a lot of seams exposed, so that allows you to have a very much softer interaction between the truss and your body. The inside is super soft, it’s neoprene, so you may actually sweat a little bit more than usual as a result, but it’s also much more flexible. So this one is, I’m going to show you the insight. It’s got two compartments that you can buy it for the left, right or bilateral left and right, and it only had one set of Velcro, which makes it a little bit more idiot proof than the ones that were so complicated requiring a lot of moving parts.

(00:42:09):

It’s soft. This is a heavy duty one for maybe larger hernias or more obese patient. He also has a very much thinner, lighter weight one for people that want to go surfing or people that are quite athletic. And I just like the fact that he put his brain to it, designed it and is helping people like him. There aren’t that many people that use hernia trusses, but personally I think all the crap that’s out there with these super stiff here, but hear how stiff this is, it’s just horrible and it’s like rock hard. I can’t even open up this. I can cut myself, by the way, at the edge of these poorly designed velcros, that’s how bad it is. Instead of relying on these, these should be outlawed. These are like 18 hundreds, 17 hundreds technology, and I think the comfort trust is a good one.

(00:43:15):

And then you have these other designs which are really more like underwear. This is embrace M-B-R-A-C-E, and it’s like underwear with a little extra area of compression. So I don’t know, I think it’s really difficult to put these on and off. In general, I don’t like underwear for men that has the little area for the addition to be put in because what can happen is most people who need these, so let me tell you this design where it’s underwear and has an integrated little pouch to put the compression in means you don’t understand hernias. If you design that, it sounds like a good idea, not a good idea. Why? Most people who need hernia trusses have a bulging hernia. And when you have the bulging hernia, the correct way to put these trusses on is you lay in bed flat and you shimmy your hernia back into place so you’re perfectly flat.

(00:44:38):

Then you put the binder on and make sure that compression the ball, the half dome ball that holds the hernia in is directly over the hole for your hernia while after your hernia is pushed back in. So if you cannot push your hernia back in, you cannot wear a truss. Let me just tell you that some people think, oh, I’ll just wear this as extra external compression. Please do not. You should only wear the truss if your hernia is pushing out and painful and painful and you can fully reduce it because then you can put the truss on and holds in place while you’re up and about and active. So then you have to go to the bathroom. Well, I just explained to you the way to correctly put these binders on is to lay flat, push the hernia back in and then put it on, then get up and about and walk. Well, guess what? If it’s part of your underwear, then every time you go to the bathroom, that support gets undone. And that’s just incorrect design. So it means whoever designed it was not thinking.

(00:45:57):

Okay, that’s pretty much it. With trusses, I would like to say there’s a third category of just compression garments and it’s different for men and women. Women actually don’t mind compression garments. Spanx is a billion dollar company because of it, but there are some options for men. So I particularly like an Under Armour. It’s a good athletic brand that has compression garments for athletes. So for example, and all of these athletic wears specifically Under Armour, others, they have different types, levels of compression. If you have a hernia, you want maximum compression. So just by yourself, compression underwear. So they look like bicycling shorts, you want them to have a leg. You don’t want it to be short because otherwise it’ll cut into your hernia area. You want half the legs. So these are boxer brief type situations. And then Under Armour has different levels of compression. I personally like the ones that have the zigzag, so you have the zigzag, it adds extra kind of compression right over the groin area. This is not as good as a truss by any means, but if you feel like you need a little bit extra support as a male or you feel that holding everything in a little bit feels better, then buy yourself compression underwear, which is easily available online even through Under Armour and similar brands.

(00:48:07):

I do use these for my post-op patients in the open inguinal hernias that require that are really huge. So if you have a big scrotal hernia and I then do a big open surgery and reduce everything, and now you have a area in your scrotum that the hernia is gone, now you’re at risk of bleeding into that scrotum or developing fluid in that scrotum. So we have a contraption where we add compression with some gauze or a sock and scrotal support. And then I have you wear a compression garment over it for extra support and it works really well and that allows our patients not to be in as much pain. And these underwear are not cheap. This one’s like $35, which is a lot for underwear, but you have to think of it as like a compression garment. How much is this one? $25?

(00:49:06):

Yeah, so the higher the compression rate, the more expensive they are. I would say that for women there are also compression underwears specifically for women. I recommend the maiden form brand. If you go online on maiden form, they have compression garments. So by yourself, if you have an abdominal wall hernia that needs a little bit of support is not a binder level, but a little bit of support by yourself, either a compression tank top or a compression tank top with a cutout for your bra, and that tank top will come way down below your hip and it provides you just enough external compression to help you with the healing of your hernia and the swelling from your hernia or if it hurts when you’re up and about and you want some more support before.

(00:50:15):

I think wearing a compression garment really helps. I’m not a big fan of Spanx for this purpose because Spanx is way too tight and that makes it so just the act of putting it on and off causes a lot of abdominal pressure to do so, and therefore it’s almost like making your hernia worse. I mean, it’s like a struggle. You can die in these things. They’re so tight. The other option for women also is the reverse. So it’s to have underwear that’s compression underwear, but very, very high waist. So when you pull up the underwear, it comes all the way to below your bra line, and those are really good. You can buy them also from maiden form. Another good brand that I like is Yummy Tummy. Yummy Tummy is a local brand that you can buy.

(00:51:18):

They’re all bought on their own website, but they have really good quality compression tank tops as well as these high underwear. So it’s basically an underwear. You don’t have to get it with legs. You can get it without legs that the waist goes all the way up to below the Braw line, and that gives you good compression without having to wear something that you have to take off over your shoulder. Let’s see if I have any more goodies here. Okay, this is interesting. This is called Mamas. Let’s see, I don’t want to mispronounce. It’s called, I think it’s called Mama Slut. Oh, excuse me, mama Strut. S-T-R-U-T.

(00:52:24):

So I thought this was interesting, right? So this is a brand that has multiple different compression garments for women who’ve had C-sections, women who’ve had pelvic floor surgeries, hysterectomies, et cetera. So of course I thought, oh, maybe that’ll be good for my patients too. So it’s also I believe a local brand. So also complicated, very similar to the truss, but it’s a binder and underwear as one. And the purpose of this is, like I mentioned earlier, the binders can ride up or fold. And so if you add legs to it, like an underwear, that by default keeps the lower end down that part. I like that part. I like what I don’t like is it’s a very poor quality. It’s good strength, but it’s super tight. It’s not conformable and it’s a little complicated. You have this very stiff, almost can cut yourself on it. Velcro, so it’s like underwear. And then you got the Velcro part. It’s got a part down here that’s breathable for the expanding belly.

(00:53:46):

Also, it’s got a little pouch you can put ice packs in. That’s unique. That’s interesting. It only has one single strip of Velcro, which as you know, I don’t prefer, but it’s not that wide and that it’s got this whole contraption of these three straps that go from your back to your front between your legs. And I think the purpose of that is there’s a pad here. So this is for C-section patients. So there’s a pad to kind of catch. Well, actually I think the pad, it’s not specifically to catch bleeding, but the pad is there to kind of add external compression and a soft mild compression because you can get a lot of swelling in the VUL vulva area. And so this helps with the swelling and the pain control from that. So I think, I’m sure there’s more binders I can review. I’ll do, I’ve already done one post on my Instagram and Facebook many years ago that specifically went through the Comfort Trust brand. I’ll probably do another one for you to memorialize what I like about the Carol Med and hopefully one day I’ll just do one of my own brands because I think all that can be improved.

(00:55:18):

But just remember, these are all things that are supposed to improve your quality of life. So whether it’s reducing your pain before surgery and reducing complications before surgery, or helping you heal better after surgery, these are not meant to be lifelong support systems unless you’re so sick. As we discussed in a couple episodes before you’re so sick that hernia surgery is the last thing on your list, then sometimes you can use these and therefore it’s very important that you have a high quality wine with soft, high quality product that doesn’t pinch and burn and scratch and cause rashes and so on. So I hope this was helpful to you all. Let’s see, I believe there was a question or two.

(00:56:15):

Can the compression shorts help speed up integration or mechanical support, or is mechanical support irrelevant and all depends on cell biology. Yeah, the compression shorts should not speed up your healing from the mesh, if that’s what you’re asking. It doesn’t help the mesh integrate more in a patient who is undergoing laparoscopic angle hernia repair for direct hernia actually had one today. More specifically, a large area of weak attenuate bulging inguinal floor where one of the goals of the surgery is to place mesh under tension to support or scaffold the inguinal floor. Can external support by any device you discussed, facilitate or speed up the integration of the mesh into the inguinal floor? No. Where it permanently supports the inguinal floor and allows use of absorbable fixations. Does interabdominal pressure keep the mesh against the inguinal floor without need for external mechanical force or this is a lot?

(00:57:16):

Or does it allow or does it depend on stem cells, fibroblasts growth factors, et cetera. And mechanical support is irrelevant. So mechanical support does not push your hernia mesh into your tissues and make it better at integrating. But if you do have a risk of developing fluid, let’s say into a big space, or you want to add external compression to kind of hold everything in place while it’s healing, I think it’s useful. I don’t usually recommend a truss after surgery, but the compression shorts I like and they’re easy. So you want to have a product you could wear, take on, take off easily and doesn’t need a lot of maneuvering and that it’s kind of easy so that you don’t make a mistake wearing it. And so that’s kind of my shtick about that. Alright, it seems like I answered some of your questions as well. I hope everything was fun. We had a little show and tell this time, I’ll do a post on my Instagram and Facebook specifically on the Carol Med because I’m a big fan of their product so far. And I think, oh, before we end next week, is it next week?

(00:58:58):

No, the week after next I’m going to be in Hawaii, believe it or not, at the Pacific Coast Surgical Association. My student in Kim got his research accepted as one of the top kind of papers actually, and he’ll be talking about residency education and how private practice surgeons can augment their education by exposing surgical residents to more than what a typical institution will have. So I’m a private practice surgeon. It’s kind of like a self-promoting research because it shows that if you look at the national data and how private practice doctors fix hernias versus how academic employed doctors in an institution do operations, it’s actually quite different. And we tailor surgery to patients a little bit differently. Our techniques are a little bit different. We tend to have more access to technology and are a bit more likely to embrace newer technologies than if you work at an institution. So the argument is do include residency rotations with private practice doctors like myself, and we do that at Cedar Sinai. It’s great. And actually now at Huntington Hospital, I’m integrated into their education. Every time I go, I get to teach the residents about hernias and they seem to like it.

(01:00:28):

So I will be there just for two nights. Don’t get much time to do much else, to just do the meeting, give our talk and come back. As you can imagine, I don’t like the sun very much. I mean, I like the sun, but I can’t bask in the sun. I burn easily. So I’m going to enjoy Hawaiian food and Hawaiian weather, but not the sunshine. So don’t expect me to come back with a tan. On that note, I appreciate you all. We got a lot more meetings coming up. European Hernia Society meeting is coming up this summer. I’m very excited about that one. Okay, thanks everyone. That was fun. Thanks for listening to Hernia Talk Live. I am your host, Dr. Shirin Towfigh. I enjoy this every week. I think we’re done because of these meetings. I’m not going to be able to do one for a couple of weeks, but I will see you when I get back and I’ll update you. So what you should do is go on Twitter and watch me live, tweet about my meeting so you can learn what I’m learning as well. In the meantime, please subscribe to my YouTube channel, and if you prefer podcast, go to Hernia Talk Live as a podcast, like, and subscribe as they say. And thanks everyone. It’s been lovely. See you later.