Simply put, a hernia occurs any time that an internal body part pushes into an area that it shouldn’t. Although hernias can technically develop anywhere, they most often occur in the abdomen. In this case, the abdominal lining ruptures, and a portion of the soft tissue beneath — usually the intestines — protrudes through.
The rupture can either be caused by normal wear and tear and physical stress, called an acquired hernia, or by a weakness present from birth, called a congenital hernia. In either case, the hernia can grow larger and more painful over time and during strenuous physical activity.
Often, a hernia will make itself known. You might notice a bulge, pain, or swelling in the abdominal area, or experience pain or a heavy sensation while lifting, coughing, or bending over. Pain can range from sharp and sudden to a dull ache, and will usually hit near the end of the day or after periods of extended standing. Some hernias, however, do not cause any symptoms, and will only be noticed by your doctor during a routine checkup.
The first stage of an abdominal hernia is a weakened and torn abdominal wall. The weakened area then begins to form a hernia sac, which can contain fat, tissue, or a small amount of intestine. Soon, the intestine begins to push further and further into the sac, forming a noticeable bulge.
Usually, the bulge will flatten out when you lie down and can be pushed back behind the abdominal wall. After this point, the condition can become complicated, as the intestine may become trapped inside the sac, and will not be able to be pushed back in.
When this happens, the intestine may be trapped so tightly that it becomes strangulated. The trapped area starts to lose blood and, if left untreated, may die, causing intense pain and a blocked intestine. This requires emergency surgery.
Patients with groin pain that will not go away on its own may be suffering from sports hernia, a misunderstood condition that is often not properly diagnosed by doctors unless they are familiar with athletic pubalgia, the medical name for sports hernia.
Sports hernia is not a true hernia that involves a bulge. Rather, it is tear or weakness where muscles join at the pelvis.
During sports like football, soccer, hockey, tennis, and running where the body twists or turns, two muscles can oppose each other to cause a strain or tear. The rectus abdominus muscle across the belly and the adductor longus muscle in the upper thigh join at the pubis, a bone in the low abdomen. When the muscles are pulled the result can be a sports hernia, chronic radiating pain felt in the groin, low abdomen or even in the rectal area or testicles in men. No pain may be felt at rest, but during activity the pain reoccurs.
Diagnosing sports hernia can be difficult for most doctors because there is no test and a sports hernia usually isn’t visible using MRIs or Xrays, which are more useful in ruling out other causes of the pain. An experienced doctor in sports hernias can diagnose the condition through a physical exam and by having the athlete or patient attempt specific exercises.