Hernia or pulled muscle?
12/30/2020 at 7:45 am #28364RodriguesParticipant
I received three totally different diagnosis from three different specialists. I hurt my abdomen doing pull ups in September. At the moment, I felt a clear pull to the left of the umbilicus, an acute localized immediate pain inside the navel, and also something liquid down to the inguinal channel and the left testicle. Probably it was an intra abdominal excess pressure single event that left me with several small tendons teared and at least a major strained muscle. I stopped sports activities and switched to rest and walking. The muscles slowly healed over the next 12 weeks but an intermitent pain remained inside the navel. The feeling is that something is loose there and easily irritates.I feel it mostly at night (it wakes me daily at 3am) and when I exercise. I also developed an intolerance to any pressure at the waist. The umbilical region is always very tender, even a blanket seem to irritate it. I began wearing bigger clothes and no belts.
There is no bulge nor visible sign of swelling or hiperemia. No response to Valsava. I’m 41, athletic (CMI 23) and in good health.
The three specialists I consulted were:
1) Gastro surgeon with 30 years of experience who operated my brother in law’s inguinal hernia: with the tip of the finger he sensed a fatty tissue where it was not supposed to be, below the umbilical scar, and said it was a hernia with less than 1cm that should be only a nuissance. He also said the situation presents zero risk in the near future and I should only watch. He said surgery now would be premature because the defect can stabilize. He would wait and see. He didn’t felt necessary to do a US but I did one anyway in a specialized gastro clinic. After insisting many times about the exact point where I have pain and several passes, the doctor found nothing. He even said my musculature had regenerated well im the last three months.
2) Traumatologist: he examimed me and saw the US. Very dismissive, he said I should wait some weeks because probably thing will accomodate. The sensitiviness I was having could not be explained by my clinical condition. It would be impossible for such a small hernia to give me so much pain and discomfort in that specific region. He said surgery would be unwise, considering potential sensitiviness I was already experiencing.
3) Pain specialist: he did a complete anamnese and concluded I unleashed a somatization process. I am experiencing central sensitivization and alodinia due to anxiety and psychosomatic disorder. The pain is 80% neuropathic. I should first treat my anxiety and defuse the hyperalgesia mechanisms, otherwise even surgery will be disastrous in the post-op stage. He thinks once I deal with my head, maybe the hernia will be menageble. He also examined me and found nothing. He saw the US result and suggested possible obsessive-compulsive disorder related to hypocondria. I should also seek psychiatric help.
Conclusion: I am really eager to go to surgery but everyone around me says I should wait. Surgery would not be convenient now because I am moving out to another country in the end of Jamuary. But is has been difficult, Im experiencing restrictions to exercises, pain, anxiety and some depression.
12/30/2020 at 10:05 am #28365Good intentionsParticipant
The gastro surgeon makes the most sense. One thing that you should consider is what, exactly, any surgery would be. What would the surgeon do to fix your problem, and what unintended consequences might you suffer? Surgery is very specific to the problem being addressed, and, ironically, incisional hernias are a very significant problem, after surgery. In other words, your small hernia repair could lead to a big hernia later, just through the act of surgery. Even laparoscopic surgery has the risk of adhesions and/or unintentional nerve damage.
The pain specialist story is a good example of what’s happening in medicine today. Specialists that can only see the world through the lens of their specialty.
@drbrown might have some thoughts. He has probably seen similar over the course of his career working on athletes and “sports hernias”.
It looks like you have been very healthy for most of your life and maybe have not had any significant medical problems. So, as a “first-timer” you might be expecting too much from the medical field. They are excellent at getting people back close to normal after disasters and major events, but recreating perfection from small amounts of damage doesn’t really happen. All of our bodies take some damage over time. Be careful trying to fix what looks like a minor issue. You might end up in a loop of fixing new problems created from the prior fixes. No offense intended, but if you look back through the posts in the forum you’ll find several stories from people who thought they were going to be fine after a “simple” procedure but ended up in terrible shape afterward.
12/30/2020 at 10:21 am #28366
12/31/2020 at 10:45 am #28369RodriguesParticipant
Thanks @good-intentions. I am in a classical hernia dilemna. Should I operate now opposed to later or not? The hernia is small and has only fay but symptomatic. The surgeon says symptoms will get better with time and there is no risk in the near future. He would not operate unless I report pain. Then he would offer open without mesh, general anesthesia, a day surgery and 30 day forfull recovery. I am experiencing symptoms worsening gradually: more pain and more discomfort. Maybe it is sensitivization or somatization. Maybe not.Maybe it’s getting worse to get better.Who knows? Nobody. But this time a operation would be terribly unconvinient for work and personal reasons.
01/02/2021 at 1:36 pm #28381MikeLParticipant
I personally would recommend to rule out concurrent groin disruption aka sports hernia first before concluding that incisional hernia is the only culprit. Unfortunately, oftentimes this can only be discovered at time of surgery done in open fashion. MRI and ultrasound may not be sensitive enough. May be 2 issues should be taken care of at the same time? Only surgeon makes call how to fix it: mesh or no mesh, should surgery be converted from open to lap etc… Personally, I would be pursuing fix and get 2-3 opinions from best top notch surgeons like Dr Towfigh and/or others mentioned in this forum. Good luck.
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