-
Hernia or Psoas?
The normal Inguinal canal is a diagonal tunnel that travels through multiple layers of muscle. In women, that tunnel is large enough to accommodate the round ligament, the size of a noodle, and the genital nerve, the size of a thread. So, it’s a relatively narrow tunnel. If it dilates up due to weakened muscles or abdominal pressure, fat, and rarely intestine, can creep into it. In the early stages, the tunnel remains diagonal or angled, and it is hard for contents to easily travel through. If a piece of fat gets stuck in it, the pressure causes pain. Exercises such as Pilates can provide muscle support to reduce the gaping of the tunnel and reduce chances of the hole getting bigger. At later stages, the muscles surroinding and supporting the tunnel gape open, the tunnel is no longer a diagonal narrow tunnel, rather a wide direct tube or hole that allows for contents to go in and out. That is when a bulge is noticeable on examination. Prior to that, imaging is helpful to detect a hernia.
I usually do not offer laparoscopic exploration prior to imaging as there are instances where non-hernia diagnoses arise, such as hip labral tears, sacroiliitis, tumors, which may explain the groin pain. Also, once the hernia diagnosis is made, the discussion about the type of hernia repair is an important discussion to be had. Laparoscopic repair may not be the right choice for each patient. So preoperative planning is very important in order to tailor the repair to the needs of each patient.