Incisional hernias are more common after emergency abdominal surgery, especially if there has been a wound infection during the healing period, or if the wound is reopened for a second time.

Incisional hernias are also more common in people who smoke.

To try to avoid an incisional hernia, follow your surgeon’s advice regarding recovery and activity after surgery.

An incisional is normally identified as a swelling or lump. It does not cause any symptoms and disappears on lying flat. Gradually they can enlarge and occasionally can become irreducible, that is you are unable to push the hernia back in.

If the hernia is irreducible and becomes tender, then this lead to the more serious complication of a strangulated hernia.

Incisional hernia can be treated with an operation, either an open repair or a laparoscopic ‘keyhole repair’.

The advantages and disadvantages of the different methods will be discussed with you at your consultation.

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Several names are given to the condition found in sportsmen and women characterised by groin pain. Symptoms may start during exercise but there is rarely a history of sudden pain. Following exercise, the early stages are characterised by pain and stiffness. The stiffness gradually improves but the symptoms fail to improve despite rest.

The condition was first described by Jerry Gilmore, London in 1980.

Pain is exacerbated by running, jumping, change of direction, coughing and sneezing. It is usually possible in the early stages to continue exercising.

No lump is palpable in the groin, but on close clinical examination, there is often a dilated superficial ring on the affected side.

Ultrasound is helpful. On straining there is a protrusion of the posterior wall of the inguinal canal. The pain in the groin and pelvis can be referred from a number of problems, including injuries to the lumbar spine, the hip joint, the sacroiliac joint, the abdomen, and the genito-urinary system.

Osteitis Pubis

Refers to inflammation of the joint of the symphysis pubis (pubic bone). The inflammation leads to both acute and chronic pain.
It is most prevalent amongst athletes, runners, and footballers and may represent an overuse injury. Symptoms can be so severe that it is not possible to continue exercising.
Osteitis pubis is diagnosed on an Xray. MRI scanning can be very helpful in assessing the severity of the inflammation.
Until recently no treatment was available. Physiotherapy however has developed rehabilitation strategies in the past few years which are proving very effective. Rest and anti-inflammatory agents are recommended. Considerable success has been noted using prolotherapy (glucose and local anaesthetic injection) for those patients who failed to improve with conservative management.

Abdominal strain

An abdominal muscle strain is an injury to one of the muscles of the abdominal wall. This usually occurs in response to excessive stretching. Rectus abdominis and the oblique muscles can all be affected.

As with groin strains, the symptoms are sudden onset of pain, muscle spasms and bruising.
Injuries are usually managed conservatively with rest, ice and analgesia.

You would be advised to see a Physiotherapist who can help you with your recovery.

Groin strain

A groin strain is a common injury for the sportsman, of all abilities. The term usually refers to a injury to one of the adductor muscles or tendons, either in the muscle itself or at its attachment to the pelvis. There are 5 adductor muscles, Adductor magnus, Adductor longus and Adductor brevis, Gracilis and Pectineus. These adductor muscles are found on the upper inner thigh. Their action is to adduct the legs,ie squeeze the legs together.

These injuries usually occur during sprinting, running and kicking.

Groin strains are graded 1-3 depending upon their severity.
GRADE 1 Minor tear <10% of fibres torn
GRADE 2 Intermediate tear <90% of muscle fibres torn
GRADE 3 Major tear 90 – 100% of muscle fibres torn

Injuries are usually managed conservatively with rest, ice and analgesia.

You would be advised to see a Physiotherapist who can help you with your recovery.

Sacroiliac joint dysfunction / Sacroiliitis

The sacroiliac joints are situated at the bottom end of the spine where the sacrum joins to the pelvis. The joints act as shock absorbers for the body whilst standing, walking and sitting.

The SIJ commonly suffers from ‘disorders’, especially from running. These disorders are best described as jamming or restriction to the movement of the joint. As the two SIJs make up two of the three joints of the circular pelvis one of them not working has an impact on the whole circle. Sometimes an unrecognised/untreated issue in the SIJ leads to repeated stress across the pubic symphysis at the front of the pelvis, producing pain and possibly leading to Ostitis Pubis in some cases.

Inflammation of the sacroiliac joint gives rise to sacroiliitis, which is a common cause of unilateral low back pain, with pain extending from the low back into the buttock or thigh.
The pain can extend into the hip and groin, thereby confusing this condition with causes for groin pain.

You would be advised to see a Physiotherapist who can help you with your recovery.

Hip joint

The hip joint can produce pain in younger athletes as well as the more widely recognised Osteoarthritic changes seen in the older community. Hip pain is often felt deep in the front of the groin and can be confused with hernia-type pain. An assessment with an experienced physio in this field will differentiate the problems.

Adductor Tendinopathy

The adductor tendons are a group of muscles which attach to the bottom of the pelvis. Onto the very Pubic bone associated with Ostitis Pubis. This tendon can become damaged and torn, often repeatedly during sports like football. This can lead to a chronic condition which gives pain in the lower groin.

You would be advised to see a Physiotherapist who can help you with your recovery.

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Symptoms and Signs

The commonest presentation is a lump, with or without a cough impulse. The lump may disappear lying down. These hernias are small but their risk of strangulation is high. In these circumstances, the lump is irreducible and tender/painful.

Investigation

Ultrasound may be helpful but where the diagnosis is uncertain, CT usually provides the most useful information.

Treatment

Laparoscopy repair either sutured or mesh repair is the preferred treatment choice.

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In Children

Umbilical hernia may be present from birth and are the result of the muscle wall failing to close around the site of the umbilical cord. Umbilical hernias will usually improve spontaneously as the muscle wall strengthens and develops. In fact, 85% of all umbilical hernias will close spontaneously. If the hernia persists beyond the age of 4 or 5 years, they are less likely to improve and may well require surgery.

Complications

It is uncommon for umbilical hernias in children to strangulate, and hence it is reasonable to avoid surgery and adopt a wait-and-see policy.

In Adults

In adults, hernias which occur in the area around the umbilicus are termed paraumbilical hernias.
The umbilicus is a natural point of weakness in the abdominal wall. The size of the hole in the abdominal wall is often small. As a result, paraumbilical hernias can become strangulated. For this reason, surgery is usually recommended.

Symptoms and Signs

A palpable lump around the umbilicus, often but not always with a cough impulse.

Diagnosis

The diagnosis is usually made based on findings at clinical examination

Investigations

Usually, the diagnosis is made clinically. Ultrasound, CT and MRI may be helpful but are not usually necessary.

Management

Surgical repair is usually recommended. This is generally performed under general anaesthesia (asleep). If small the hernia is repaired directly with stitches, if larger then the hernia is repaired using a mesh, inserted through a small incision or laparoscopically (keyhole surgery).

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The femoral canal is a naturally occurring weakness and is a small and confined space. As a consequence, these hernias are at greater risk of strangulation and obstruction and should be repaired. (See complications of hernias)

Femoral herniae are seen more commonly in women than in men and are only rarely seen in children.

Symptoms and Signs

Femoral Hernias typically present with a bulge in the groin, most noticeable on standing and straining. the lump often disappears on lying down. Pain and tenderness is usually a sign of the hernia becoming irreducible.

Diagnosis

It is diagnosed clinically by the recognition of a lump which may or may not have a cough impulse in the classical position of the femoral canal, (below and lateral to the pubic tubercle).

Imaging

Ultrasound, CT and MRI may help with the diagnosis but are not usually necessary.

Alternative diagnoses

Inguinal hernia, femoral lymph node, saphena varix, femoral artery aneurysm.

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Pain is a common feature. It is usually located in the groin, and in most instances is localised to one side.

The pain is frequently difficult to locate but is usually described as a dull ache or burning pain. Occasionally the pain is sharp but usually comes on gradually without any specific training injury.

Often the pain will initially improve with rest, but there is a high chance of relapse when training is resumed.

Stiffness after exercise is a common symptom.

A Sportsman’s groin however need not be painful locally. It may be that the athlete has a variety of symptoms from inner thigh pain, glut pain and tightness or a feeling of weakness, especially when running fast. It is often a condition that is overlooked as traditionally clinicians look for bigger more obvious symptoms.

Examination

• No clinically detectable lump or hernia
• Dilated superficial inguinal ring
• Inguinal pain with resisted sit-ups
• Pain on straining, sneezing, coughing
• Reduced range of movement – hip/pelvis/lumbar spine

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Inguinal hernias are seen more commonly in men than in women.

They may be caused by excessive lifting, coughing and straining. Occasionally there are no predisposing factors evident.

Symptoms and Signs
They usually present with a lump in the groin which is more prominent on standing or straining, coughing lifting or straining. The lump often disappears on lying flat. Less commonly they present with pain and discomfort.

Diagnosis
The diagnosis is most commonly made clinically. When there is doubt ultrasound, CT and MRI may be helpful.

Treatment
Once present a hernia does not repair itself. Over time it can increase in size. There is also a risk of the hernia becoming strangulated, (twisted). For this reason, your surgeon would usually recommend surgical repair.

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