title: Single strenuous event: does it predispose to inguinal herniation?
abstract: BACKGROUND
  There is a general belief that inguinal hernias are often caused by a single strenuous event, however there are no data to support this association. This study aims to assess the frequency with which inguinal hernia is attributed to a single muscular strain and to identify predisposing factors.
  
  
  METHODS
  All patients who underwent inguinal hernia repair under the care of one surgeon over a nine-year period were studied. Five hundred and twenty patients were sent a structured postal questionnaire.
  
  
  RESULTS
  There was a 62% response rate (320). The median age of the study group was 61.5 (range 19-88) years. Out of a total 320 hernias, 51% (163) of the hernias were gradual in onset and in 42.5% (137) of hernias there was a history suggesting an association between a particular strenuous event and the sudden onset of hernia. In the sudden-onset group 101 (74%) patients had indirect hernias while in the gradual-onset group, 93 patients (57%) had indirect hernias (P < 0.05). Thirty-four patients (25%) had direct hernias in the sudden-onset group and 63 (39%) in the gradual-onset group (P < 0.05). The various predisposing factors were lifting (67.8%, 93), coughing (14.5%, 20), exercise (10.2%, 14), and gardening (7.3%, 10). Heavy work was associated with sudden inguinal herniation.
  
  
  CONCLUSIONS
  This study supports the hypothesis that the appearance of inguinal herniation may be attributed to a single strenuous event. Indirect hernias are more likely to present following such an event.
authors.affiliation: Ninewells Hospital and Medical School, Dundee, Scotland.
authors.forename: P
authors.initials: P
authors.lastname: Sanjay
authors.forename: A
authors.initials: A
authors.lastname: Woodward
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003371:Cough / Q000150:complications*; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D014891:Weight Lifting