Granted, given the alternative, exercise is great for one’s physical, mental, and emotional health. It does come with some potential risks, however. Sprains, strains, joint injuries, dropping a weight on your foot or even a hernia could be the result! Most men remember the lineup in the locker room where the doctor doing all the sports physicals went down the line with each boy turning his head and coughing, remember? Even now, a routine part of a male physical is to check for a hernia. While there are different types, an inguinal hernia is the most common type at up to 75% of all abdominal hernias. Inguinal hernias are further divided into the more common indirect, in which the inguinal canal is entered via a congenital weakness at its entrance (the internal inguinal ring). The direct type is when the hernia contents push through a weak spot in the back wall of the inguinal canal. Some people refer to this as a sports hernia, but in reality that refers to a tear to the oblique abdominal muscles. Unlike a traditional hernia, the sports hernia does not create a hole in abdominal wall. As a result, there is no visible bulge under the skin. The most common symptom of a sports hernia is a dull, aching pain in the lower abdomen or groin that gradually increases in severity, and improves with rest. While one does not have to be an athlete to get an inguinal hernia, any chronic and repetitive increase in abdominal pressure such as with weight lifting certainly can contribute to its development. Just as likely, however, it is unrelated to any particular activity. When we cough or strain to go to the bathroom we increase our intra-abdominal pressure just as high as with weight lifting. As a general surgeon, we were always taught to ask about constipation, urination problems or chronic cough when evaluating an adult patient presenting with a hernia. This could be a marker of more serious pathology. I was one of the lucky ones that developed an inguinal hernia related to weight lifting. Many men have told me that they think they might have a small hernia or had one that went away. While they can be small and be more or less noticeable from time to time, a true hernia does not go away on its own. In my case, it was probably there for a year or two and only minimally noticeable or bothersome. There is no mistaking it now, as I described in my last blog, my new reinvigorated workout and diet efforts certainly made this bad boy appear. Body by Jose (my trainer) is now “hernia by Jose”. As with many people, men particularly, we like to deny a health problem and wait awhile to get it checked out. While a hernia is generally not dangerous, the bowel can get stuck in the hernia sack and become ‘incarcerated’. This would be a surgical emergency and if one is likely to be traveling to a third world country or camping in the backwoods for weeks, it should probably be fixed beforehand. In my case, the hernia became larger and was ‘out’ more frequently, especially when working out. Although it was not really painful, I knew it was there and it was somewhat uncomfortable. It was a bit embarrassing as well, pushing it back in the middle of my workout. No, I was not grabbing myself (see Meathead’s Blog regarding appropriate gym etiquette). Last week I decided to get it fixed. In general there are two approaches to repairing an inguinal hernia, laparoscopic or open repair. As with most things laparoscopic, the stated benefits are three very small incisions versus one larger one and possibly less pain and a quicker recovery. With either technique, the preferred repair is to use a piece of surgical mesh to close the defect. This is sewn or stapled to some pretty sensitive areas along the inguinal canal—so either way it will be sore for a while. I went for the laparoscopic route which is an outpatient procedure. I was very sore the first day or two but stopped any narcotics after 36 hours. You do not want to get constipated after this surgery and your abs are SORE. The first few days I did not even notice any discomfort from the patch or the inguinal site because my ‘rock hard abs’ felt like I had been stabbed in the belly. In reality, I kind of was. I am still sore and slowly but surely recovering and can’t wait to get back to the gym. I did allow one (maybe two) cheat days on my diet but my post-operative appetite is still depressed a bit. My advice is to workout, eat right, take supplements and don’t delay having a doctor check out a hernia. Surgery is surgery and if there is no way around it, laparoscopic versus open repair is a choice you will have to make.