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Do you have to use the Valsalva Method to find a tiny Spigelian Hernia via MRI?
Hello, this site is a terrific resource for information! Starting in October I ended up in the Emergency Room for severe pain on my lower left abdomen that radiated to my lower left back. I also had a strong pulse on the left of my belly button. I was checked for kidney stones and femoral aneurism and then sent home. I was then bed ridden for 3 weeks with severe burning pain on my lower left abdomen, where my ovaries and sigmoid colon are. I had an ultrasound on my ovaries too that was fine and then I had a colonoscopy which did show some mild inflammation in the sigmoid colon. I have Lupus so it was thought to just be Lupus inflammation since it didn’t look like Crohns. However, my Lupus has been controlled very well (not even on prescriptions), so it was odd that this happened so quickly. I was then put on steroids for a few weeks to help the inflammation but although I could walk around again, I still had burning pain on the lower left. I saw 2 different gastroenterologists and a Gastro PA who all didn’t understand why I would still be having any pain after the steroids, due to how minor the inflammation was in my colon. I then realized that the pain got worse again after using my big camera lens again (I’m a family photographer), and the day before this started I had a long photo session with that heavy lens. So, I started looking into hernias. I went to my local general surgeon yesterday who does hernias but is not a hernia specialist. I explained to him that I thought I had a hidden/ occult hernia. He examined me and actually thought he felt a tiny Spigelian hernia. He wanted to do a Cat Scan but from my research from Dr. Towfigh I learned that MRI is better for hidden hernias. He got the MRI approved by my insurance and my appointment is Tuesday. I asked him if I should do the Valsalva method (although I described it and couldn’t remember the name of it at the time), he said that I should just relax when doing the MRI and not to tighten up my muscles. I’ve read that Spigelian hernia’s can often be dangerous and contain part of the colon and due to the amount of pain I’m in and how small the hole might be, I’m concerned that may be happening but that it could still get missed. Questions… 1. Do tiny Spegelian hernias still usually show up on MRIs even without the Valsalva method? And… 2. being that if it is a Spigelian hernia, it would need surgery… I’m tiny, 5’1” and 106 pounds and would not want mesh because of that, and because of having Lupus and already being sensitive to everything that goes on or in my body. Does mesh usually have to be used for Spigelian hernias?
Other things to note… I’m 45 and my youngest child is 11 but was almost 10 pounds when he was born. I had also gained 70 pounds of mostly fluid with both of my pregnancies due to me having undiagnosed Lupus at the time so I know those things could have also contributed to this possibly being a Spigelian hernia, right??… Both time, about 36 pounds of that fluid was gone by 1 week after delivery. My normal weight at the time was 98 lbs. Thank you for any info that you may have!!!
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4 Replies
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Thank you graciously for your reply. The open MRI was done laying down and unfortunately, without the Valsalva method. It did not show any hernia either… BUT…. because doctors couldn’t figure out why I was in as much pain as I was with the small amount of colon inflammation, a colon specialist just had my colonoscopy slides re-read at Brigham & Women’s hospital in Boston (I’m in NH). Their pathology results actually showed that I had Ischemia in the Sigmoid colon. I am still in a lot of pain at times so I’m worried that there is still Ischemia going on at that it still could be a Spigelian hernia because it hurts mostly when bending… sitting in car and during peristalsis when my stool starts to come down through the sigmoid each morning. And, each time it starts hurting, I’m basically bedridden for hours so now I’m concerned that further damage is being done and people here think it is not a hernia due to the negative MRI. We are looking into other reasons for the Ischemia, especially because I have Lupus, but my Lupus had been well under control and I have not even on any prescription medications for a while. I have a few questions regarding your message above:
1. Could you plz explain how a spigelian hernia may not show on an MRI?
2. Aside from having exploratory surgery to search for a hernia, what other options would there be? And,
3. If it actually is a Spigelian hernia causing the Ischemia in my Sigmoid… how dangerous is this to keep going in pain like this without anyone knowing what to do?
Thank you so much for any info you may have!! -
Yep. Open may be more beneficial as gravity will help pull abdominal wall down and intestines upright push against the anterior abdominal wall. Better than lying flat. Even if your MRI is negative you could still have a Spigelian hernia. It’s premature to comment on repair types (mesh, etc) until it is known what you have. Let us know what the MRI shows.
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Thank you for your reply. They have me scheduled for an open MRI too, is that still ok to look for small Spigelian hernia?
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Valsalva won’t hurt and can help find smaller hernias. If you can do it I would recommend it.
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