Imagine, if you will, that you finally made it to  the gym. Here you started lifting free weights, even though you hadn’t touched the weights in years, perhaps even decades. As you start the squats, burdened with what for you seems an awfully heavy forty pound weight, you suddenly experience severe, tearing pain in the groin. Fortunately, the pain resolves but every so often, you feel a little twitch there. Grounds for worry?

Hernias are very common in all age groups. Males, perhaps as payback for not having to go through childbirth,  are more likely to have hernias than females. A hernia occurs when a break in the fascia, muscle and sometimes other layers occurs. This allows the contents underneath-bowel, fat for example to exit its normal location-say in the abdomen. If the hole  is small, it may restrict the herniated tissue to the outside in which case it is deemed incarcerated; if the blood supply is restricted as a result of swelling or just being in the wrong place then the hernia is strangulated. These expressions fortunately are mainly used among medical professionals, for whom eight years of training permit us to talk funny.

Hernias can be caused by a weak abdominal muscles which in turn can be inherited or due to obesity, poor fitness, lifting heavy weights or prior surgeries. They can occur in the groin or almost anywhere in the abdominal wall.  Many confusing names are attached to hernias and make for nice small talk subjects: direct, indirect, ventral, femoral, Spiegelian and so forth.

If the hole is large, more bowel or fat can move around. While these hernias may be large and thus unsightly (dooming you to cancel that Playboy or Playgirl photo shoot), they are usually not dangerous. It is the small hernias in which bowel gets out but can’t easily get back in that are more dangerous. With time these small hernias, if not reduced, can cause death of the bowel and lead to peritonitis or other serious problems.

Sometimes, if you are evaluated early on, the hernia can be reduced by simple pressure, after some narcotics and perhaps listening to mellow Pink Floyd type music. If not, and there is a danger of bowel death, then urgent surgery must be done. However, for most hernias after reduction is completed, an elective procedure can be planned.

When should you worry? If you develop fever with increasing pain, redness in the area of the hernia, are vomiting or weak then you should not wait until the last minute like you did with last year’s tax returns and go to the emergency room. Oh, and by the way next time you stop off at the gym, leave the weights for the young dudes!