MEDARVA: Know Your Weak Spot

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By Rich Gazette
Henrico Monthly
September 2014

Groin pain? A bulge? Maybe it’s a sports hernia.

Dr. Clifford Deal, a U.S. Army Reserve lieutenant colonel who recently returned from Afghanistan, specializes in hernia and breast surgery so when we had questions about sports hernias, we knew he was the person to turn to.

What is a sports hernia?

Sports hernia is a pain or a bulge in the groin. It’s a very small area that we would sometimes refer to as a sportsman’s hernia. It’s probably only one out of a thousand actual hernias. There’s people who have pain in their groin, but there’s no bulge. When most people talk about sports hernia, they’re talking about an inguinal hernia.

There’s a small subset of people who are hard to figure out. … They may have a small muscle tear that’s hard to pick up, but that’s not most people.

How do you get a sports hernia?

There are two ways. The first way is that you’re born with it. It may show up as a newborn or adolescent. Before you’re born, when your testicles develop, they’re inside your abdomen. During development, they descend into the scrotum and sometimes they drag a little tissue with them. It’s called the processus vaginalis and that can develop into a hernia.

An adult or acquired hernia is a bulge in your groin that develops through the abdominal wall, but the treatment is essentially the same. People generally notice one of two things: they notice pain in their groin or they look down and see a bulge.

Who is susceptible to sports hernias?

Anyone, but men experience it more than women.

Is age a factor in being prone to sports hernias?

No, it happens across all ages.

Is there any way to prevent getting a sports hernia?

Not that we know of. Sometimes people ask, “Should I not exercise?” or “Should I not do certain things?” As a general physician, I want to encourage a healthy lifestyle, which includes being active and athletics.

Can you get it from playing sports or being active?

You can – and that’s where people generally notice it – but the reality is you’re probably predisposed to it anyway. Athletics or lifting get blamed for the hernia, but the reality is you were probably going to get it anyway.

How do you diagnose a sports hernia?

An old-fashioned physical exam. An experienced examiner should be able to feel even a relatively small defect in the abdominal wall.

If you have a sports hernia, what are the options for treatment?

The nonsurgical treatment has been around since the time of the Greeks. It’s called a truss, and it’s essentially a glorified jockstrap which holds the hernia and pushes the bulge back in. It doesn’t work very well, and it’s very aggravating for people who are active.

The surgical treatment is a hernia repair, and there are two main ways to do that. One is an open hernia repair, which is an incision over the groin. Most open repairs involve the use of a prosthetic mesh to strengthen the reinforced area of repair. The other way to do it is a minimally invasive approach, called a laparoscopic repair.

What are the risks of undergoing surgery?

There’s a small risk of bleeding, a small risk of infection. The hernia could come back. One of the differences between the open and the laparoscopic repair is that there’s a slightly larger chance [with open surgery] that people would still have pain after their hernia repair because of nerve entrapment. And it’s really unusual to get that after laparoscopic repair.

How long does recovery from surgery take?

The [lessening of] discomfort and the return to work is usually faster with the laparoscopic repair. It’s highly dependent on what kind of work you do. If you’re a firefighter, it’s going to be a little longer before you are able to return to work because of the nature of your job. I’ve had attorneys go back to work within a couple of days.

What should I do if I suspect I have a hernia?

I would just see your doctor, your general practitioner for evaluation. There are a lot of other things, strains and muscle pulls, that it certainly could be.

If I have a hernia, do I have to get it fixed?

The natural history of a hernia is that they enlarge over time. A hernia is a bit like a weak spot in your tire when you get a bulge. They don’t usually rupture, but they enlarge over time. Every time you cough, you sneeze, have sex, bear down to move your bowels or strain, the hernia gets a bit bigger. Some grow slower, some grow faster.

You run into people sometimes who have had the same groin bulge for 10 years. But over the course of their lifetime, it’s going to get bigger as your tissues weaken. In general, all hernias should be repaired.

If I don’t get my hernia repaired, could something terrible happen?

Over time it will get bigger, and if they are bigger they are harder to fix. Secondly, there’s a small chance that your intestines could get caught in the hernia and become strangulated. The intestines could possibly perforate, which causes a lot of problems. Your intestine could die, though that doesn’t happen very often.
The way you can tell the difference is that you can usually push the hernia back in. It’s much more worrisome when the hernia is bulging and you can’t get it to push back in.

Sometimes I see people with some really large, almost Third-World hernias, and you wish that had been fixed for them earlier. It would have been a less extensive repair. They’re easier to fix when they’re smaller. ■

Clifford L. Deal III, MD, is a surgeon with Richmond Surgical. He also serves as chairman of the Department of Surgery at Henrico Doctors’ Hospital and is a clinical assistant professor of surgery in the Division of Trauma and Critical Care Surgery at Virginia Commonwealth University in Richmond, Virginia.