Sports hernias are being diagnosed more frequently. This article describes these hernias, as well as diagnosis and treatment.
In current practice, sports hernias are being diagnosed more frequently than ever before. It is unclear whether the increasing rate of diagnosis is due to an increased prevalence of these hernias, or due to heightened physician awareness of the problem. In either case, sports hernias are now recognized as a significant cause of abdominal wall pain in athletes. Several high profile athletes, most notably Donovan McNabb of the Philadelphia Eagles, have recently been diagnosed with sports hernias.
What is a Sports Hernia?
A hernia, as defined by Astley Cooper in 1804, is “a protrusion of any viscus from its proper cavity. The protruded parts are generally contained in a sac-like structure, formed by the membrane with which the cavity is naturally lined”. To simplify this definition, a hernia is an abnormal bulge of the abdominal or pelvic wall, which may or may not contain other organs (most commonly, parts of the bowel). A sports hernia differs from a “regular” hernia only in regards to its underlying cause. Routine hernias can be associated with obesity, heavy lifting, straining, chronic coughing, and family history. Sports hernias are related to intense exertion during sports.
Is there more than one type of Sports Hernia?
Yes; hernias are defined and named based on location. Hernias in the groin area are known as “inguinal hernias”. These hernias are further divided into “indirect” and “direct” hernias, depending on the origin of the defect. Other types of hernias include femoral hernias (lower pelvis into upper/inner thigh region), umbilical hernias (in the area of the umbilicus (belly button), incisional hernias (bulging in the area of an old surgical scar), and Spigelian hernias (bulging along the lateral margin of the midline abdominal muscles – involves weakness of the Spigelian connective tissue).
How is a Sports Hernia diagnosed?
Most sports hernias are diagnosed by history and physical examination. Athletes with hernias will often complain of pain at the hernia site, although some hernias may be asymptomatic. On physical exam, a bulge is felt at the hernia site, which increases when the patient strains. Generally, imaging studies are not needed for diagnosis, although ultrasound and/or CT scanning may be useful to diagnose difficult cases.
What are the complications of Sports Hernias?
In some cases, hernias can become “incarcerated”. This means that a segment of intestine has protruded into the hernia sac, and become trapped. This is not only painful, but can result in bowel obstruction, or necrosis (death) of the trapped bowel loop. Incarceration is more common in routine hernias than in sports hernias.
How are Sport Hernias treated?
Sports hernia defects will not heal spontaneously. Surgical repair of the defect is required to relieve the pain and eliminate the bulge associated with the hernia.
