Q. I need to have a hernia repaired and do not know how or when to safely get back into exercise afterward. — Jennifer, Colo.
A. The Greek word "hernia" means "sprouting forth," which inspires bucolic visions of hyacinths, rather than painful abdominal afflictions.
But since an abdominal bulge is part of the experience, this is a pretty apt description.
The most common hernia involves a weakening of the abdominal wall, creating a condition where a loop of the intestine or other tissue can push through. The pain can be severe. Hernias are generally the result of injury, genetic predisposition, obesity, chronic constipation or muscular weakness of the abdominal wall. If yours was caused by muscular weakness, then strengthening the muscles of the abdominal wall is essential; otherwise, another hernia could develop on the other side.
Surgery is stressful, so we often miss or forget a lot of the presurgery instructions, as well as information on probable post-surgical conditions. Take a list of questions in with you during your briefing with the physician or surgeon to be sure all of your concerns are answered, or ask a friend or relative to come with you to write down the details. Since everyone who has had surgery for a hernia has different protocols for recovery, one of the things you want to be sure to discuss is when it is safe to return to activity.
Ask for a referral to a physical therapist, who can help you re-enter activity safely, efficiently and effectively. A physical therapist will teach you a gentle progression of exercises to strengthen the abdominal muscles. A physical therapist will also present information on how to lift heavy objects to avoid straining.
Once you have been taught proper abdominal and other post-surgery exercises and have the green light from your physician to resume activity of a more vigorous nature, you can usually begin light activity. The North Penn Hernia Institute, Lansdale, suggests that gentle swimming and stretching, stationary biking, walking and light golfing activities, like "pitch and putt," can be resumed fairly soon after surgery.
As your healing progresses, you can increase your aerobic activity and add activities like hiking, skiing (easy runs), lap swimming, bowling and golf. Usually after two weeks, more vigorous sports activities can be resumed.
However, while the tissue may look healed on the outside, the tissue on the inside can take months to get back to normal, so nothing is served by rushing the process. If you enjoy heavy weight lifting, for example, you may need to forgo that pleasure for as long as three to four months. Regular exercise is vital, however. Well-toned, strong muscles — particularly those in the core area — are much less likely to rupture; a prudent delay should not evolve into a permanent dismissal.
Diet is also important for avoiding a recurrence. Since straining during bowel and bladder movements is problematic, be sure to eat a high-fiber diet (fruits, vegetables, whole grains) and drink plenty of fluids, in order to prevent constipation. A high-fiber diet can also help maintain a healthy weight, another key to hernia prevention, because this reduces pressure on the abdominal wall.
Finally, if you smoke, quit. Besides the risk of cancer, high blood pressure, stroke, heart disease and emphysema, smoking often causes chronic and persistent coughing, which increases the potential for herniation.
Linda Buch is a fitness trainer in Denver, Colo., and Lancaster County native. Her book, "The Commercial Break Workout" (Crown/Random House), is available in bookstores. Send questions to: Linda@LJBalance.com.
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