A runner with an undiagnosed issue weighs his options.
Brian asks: I’m a week out from my marathon, but I’ve developed a small protrusion in my lower abdomen, just below my pelvic bone. It’s a tad painful if I really press it, but overall I have no pain when running and the spot isn’t growing in size or discoloured. My brother, a physical therapist, says it’s likely a sports hernia. Considering my training is going well and there’s no pain, 1) how much risk is there for me to run 42 kilometres if it is in fact a hernia, and 2) if it isn’t a hernia, what else could the protrusion be?
A hernia occurs when tissue or an organ bulges through the wall of a cavity in your body. Common examples are an inguinal hernia in the groin, a hiatal hernia in the diaphragm, an umbilical hernia through the belly button, or a muscle hernia through the muscle fascia.
Your story fits with an inguinal hernia. This is a relatively common problem that occurs more often in men than women. There is a weak spot in the abdominal wall tissues where the muscle and fascia come together leaving a small gap for the sperm cord (vas deferens) to pass through and connect the testes to the urethra. This area can weaken over time, allowing part of the bowels to pass through, producing the hernia.
As long as the bulge is not painful or inflamed, there is very little risk for you to continue running. However, if the hernia strangulates, so blood flow to the bowel tissue is compromised, then the hernia becomes an emergency.
A strangulated hernia will be painful, and you will experience bloating from bowel obstruction, and vomiting, all of which usually makes a person ill enough to seek immediate medical attention.
Medical providers used to look for hernias during a physical exam, but now they generally wait for a hernia to appear, as most people notice the bulge and are within easy reach of emergency care.
A hernia with a bulge is different, however, from a sports hernia. A sports hernia or athletic pubalgia is located where the muscles of the abdomen and leg attach to the pubic bone and involves a tearing of the muscle, tendon, and ligament tissues in the lower abdomen or groin area. The tearing can sometimes be contained to a very small area.
The bulge typical of an inguinal hernia is usually not found in a sports hernia. Athletes with a sports hernia tend to complain of “groin pain”, and the problem is usually associated with the repetitive twisting and turning that occurs in ice hockey, soccer or tennis.
I have seen this issue in a few runners, and the pain is often resolved with surgery. That said, there are physicians who consider this to be a soft tissue injury, and don’t recommend surgery.
Since you have a bulge, it would be best for you to meet with your physician. The repair is usually done with mesh, either by an open technique or through a laparoscope. The mesh technology allows new tissue to heal in over the mesh matrix and does not require the tension of surgically pulling the tissues together to close the hernia space.
This way the postoperative restrictions are more “relaxed”, and recovery is much quicker. As long as the bulge is not causing you problems, it should be fine for you to continue your training.