How best to exercise with an inguinal hernia?

Jane mugshot for JQAI am a 52-​year-​old man and have been going to the gym for eight months now. I’m doing well and have lost a stone and a half, but I have an inguinal her­nia. What activ­it­ies can I still do and what should I avoid?

Inguinal her­nia is fairly com­mon among men, more so as you age. Because of a spe­cific weak­ness in the abdom­inal wall, there is a tend­ency in men for the large intest­ine to bulge through the con­nect­ive tis­sue and form a small sac in the groin. When you lie down, you can some­times coax the bulge back but it won’t stay there unless the abdom­inal lin­ing is repaired. While the her­nia is not harm­ful in itself, it can get pro­gress­ively more pain­ful, and if the intest­inal bulge becomes trapped (“stran­gu­lated”), it may rap­idly become a life-​threatening con­di­tion.

It sounds as though you are pretty sure of your dia­gnosis, but it is worth point­ing out that many injur­ies can cause groin symp­toms, includ­ing back and hip prob­lems. A her­nia dia­gnosis should be made or con­firmed by a spe­cial­ist.

As things stand, the only treat­ment is a sur­gical repair of the weak tis­sue. Until then, you will need to take care with a num­ber of activ­it­ies, includ­ing exer­cise. Any actions that sharply increase internal pres­sure in the abdo­men (any­thing where you are bra­cing or hold­ing your breath to push or pull a heavy load) risks worsen­ing the her­nia. Lifting boxes or cases, mov­ing heavy fur­niture or even strain­ing on the loo are all best avoided.

In the gym you need to keep away from weight train­ing. If you are care­ful – best to work this out with the help of an exper­i­enced gym instructor – you can con­tinue doing light weight-​training for mus­cu­lar endur­ance, but not heavy weights.

You should also steer well clear of many stom­ach exer­cises. Push ups, curl ups or crunches — or any­thing else that involves bend­ing for­wards for abs strength­en­ing – are unsuit­able. So, for instance, are those exer­cises where you lift and lower both legs while you are lying on your back.

This can be a bit frus­trat­ing, not least because abdom­inal mus­cu­lar weak­ness is often a factor in devel­op­ing a her­nia in the first place – unfor­tu­nately it’s too late to start cor­rect­ing that prob­lem once the her­nia has already appeared.

It’s a dif­fer­ent story after an oper­a­tion. Once the spe­cial­ist gives you the all-​clear for strength train­ing – any­thing from a couple of days to sev­eral weeks, depend­ing on you and the type of op you had – you should make abdom­inal or core strength­en­ing a pri­or­ity. As with all new exer­cises, go gently at first, so you don’t end up re-​injuring your­self.

It’s really good that you’ve lost some weight, as this alone takes pres­sure off your her­nia. Keep up the good work by con­tinu­ing your car­di­ovas­cu­lar workouts: tread­mill walk­ing or jogs, cyc­ling (sitting-​down bike is best) and cross trainer are all fine. Swimming or run­ning in the pool are good, as the water will sup­port your body and you’ll be able to push your­self a bit harder without worry.

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