Training with an Inguinal Hernia

author : AMSSM

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It is hard to have to take time out of a training program to recover from surgery. The good news is that most of the time patients with this type of surgery are back to full activity in two weeks.

Member Question

I have been diagnosed with an inguinal hernia with surgery recommended.  I have been engaged in some kind of athletic activity since grade school with no serious injuries.  I am very apprehensive about the surgery and almost depressed about missing part of the triathlon season.  Can you tell me what to expect on the operation, recovery and how soon to get back into training?  Thanks!

Answer from Dr. Deanne Eccles-Rotar 
Member AMSSM 

I am sorry to hear that you have been diagnosed with an inguinal hernia.  It is hard to have to take time out of a training program to recover from surgery.  The good news is that most of the time patients with this type of surgery are back to full activity in two weeks.

An inguinal hernia is one of the more common types of hernias. A hernia occurs because there is a weakness or tear in the tissue of the abdominal wall.  The abdominal wall is made up of layers of muscle, tendon and fascia in addition to skin and subcutaneous fat.  In the groin area there is an area called the internal ring where the tissue joins together.  This is a potential area of weakness and a common place for hernias to occur.  When the weakness occurs the intestines will push against the peritoneum (lining of the abdomen) and will cause a bulge to form.  This bulge will be seen in the groin area.  When you are evaluated by the doctor they will examine the area and determine if the bulge can be reduced - pushed back into the abdomen.  If so, then surgery is recommended but not emergent.  Surgery becomes emergent however if the bulge cannot be reduced.  This is called an incarcerated hernia.  In severe cases the defect in the abdominal wall is small and the intestines get pinched cutting off blood supply causing the tissue can die.  This is called a strangulated hernia and is an emergency. So it is a good idea to schedule your surgery so it can be done before the intestinal tissue gets incarcerated or strangulated.

These days most inguinal hernia repairs can be done using laparoscopy.  This is where the surgeon makes 3 small 5-10 mm incisions in the abdominal wall and inserts a thin telescope with a camera and light to allow full visualization of the defect.  The defect is repaired using suture, staples or clips.  Mesh is then used over the area and secured with suture, staples or clips to provide additional support to the weak area and prevent recurrence.  The surgery is done as an outpatient and typically will take one hour.  

In our area the surgeons will have you up and walking as tolerated right after surgery.  Light spinning on a stationary trainer can also start fairly quickly based on comfort in the abdominal/groin area with bike position.  If the position is painful then I would wait another 1-2 days and retest it until it is comfortable.  Pain is your guide as to what you can do; think of what may delay healing vs what is going to facilitate healing.  Increasing blood flow facilitates healing but creating more inflammation at the surgical site will delay healing.  So be honest with yourself on how it feels when you test it out.  Moderate intensity seated spinning on a trainer and swimming with open turns can be done in seven days - again listen to the level of pain with the activity.  Running, swimming with flip turns and full intensity biking can safely be resumed in 10-14 days based on comfort.  Lifting is limited to light objects (10# or so) initially for the first week.  The weight limit is then advanced by 10-20# each week.  This is usually not a big issue for triathletes in season but would be more important in the off season.    

The advantage to laparoscopic surgery is that the incisions are smaller and the recovery is much quicker.  Open abdominal incisions will be about 5 cm in length and take 3-4 weeks to return to outdoor biking and running.  The recurrence rate for laparoscopic surgery is around 4% with open procedures being slightly less at 1-4% recurrence.

My recommendation would be to schedule your surgery during one of your easy weeks in your training program.  I know it is hard to take off time from training but I have seen many cases where an athlete was forced to take a week off due to surgery (such as an emergency appendectomy) and they were able to return to racing within weeks and actually preformed better because their body had some forced rest/recovery.

So don't think of this as a detriment to your program. Healing is part physical but also part mental; have faith in your body to recover quickly and focus on helping it heal (eat right, get enough sleep and go for lots of walks). Work the surgery into your training program and let your body recover well.  You may find yourself performing better than ever this season.  

Good luck!

Deanne Eccles-Rotar
Dean Clinic Sports Medicine
Madison, Stoughton and Janesville Area
Wisconsin

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date: June 7, 2013