Maybe a Hernia?

[drtowfigh]

Maybe a Hernia?

Shoelace method was done a couple of centuries ago.

Mesh is standard. Non-mesh repair is a good option for some, especially certain women. You surgeon should decide that.

If you have a palpable bulge, most general surgeons should have no problem diagnosing an inguinal hernia. Usually your GP would refer you after examining you.

[Kevinvt1]

Maybe a Hernia?

Thanks!!!!!!

Is the use of mesh pretty universal these days? The shoelace method not used much?

Also what of the potential difficulty of getting diagnosed as a women. Would that be avoided by going to a hernia expert instead of a GP?

[drtowfigh]

Could be Worse

Does not affect a tummy tuck

[Kevinvt1]

Could be Worse

OK. I guess all this could be so much worse.

I’m glad to know that it’s probably just fat poking through. !!!!!

I’m realizing now that the chance I will have to do two operations is quite high, due to the fact that the politics of bariatric surgery and related insurance is extremely byzantine :unsure: :unsure: Maybe even if the surgeons would be game for one operation, the rules and insurance might be another. :unsure:

Now the problem of getting doctors to take the possibility of a hernia seriously in a female has been discussed. Would that be less true or hernia experts? Does the problem mostly come from GPs? Or maybe other specialists?

I’m surprised you think what I described sounded like a hernia bulge, because the pictures I’ve seen seem much more dramatic.

BTW. How would this likely effect the prospect of me getting a tummy tuck down the road?

[drtowfigh]

Thank You!!

I’m not sure where people got the misconception that women don’t get hernias, because they do. They just don’t get it as often as men. The ratio is quoted to be about 7:1 male:female ratio. Most of these are regular hernias, not femoral hernias. Femoral hernias are rare, even for women. However, women are more likely to get them, by a factor of 10. Does that make sense?

My personal bias is that th 7:1 ratio is probably underestimating the true number of women with hernias. There are probably many-fold women that have hernias that are undiagnosed or misdiagnosed. You and others may be perfect examples of such.

In any case, the likelihood that there is intestine in most hernias is low, especially small ones. It is usually fat. Obesity has not yet been linked with development of groin hernias. Nor has rapid weight loss. Exercise and muscle strengthening is protective against hernia development. Perhaps the weight loss has allowed you to notice the bulge better. That is a plus, because it makes the diagnosis easier.

[Kevinvt1]

Thank You!!

Well thank you for getting back to quickly!

But at the same time?

Oh No!!! 🙁 🙁 🙁

I hope that whatever is poking through is just a piece of fat and not intestines or worse :sick:

I wrote this expecting you to say that I was being a hypochondriac, and that I was letting my imagination run away with me!!! The VBLOC questions were almost a sort of “just in case” clause!!! I expected that you would say it was ridiculously unlikely to be a hernia and I could call it a day and maybe get acupuncture for the pain.

You think it’s reasonable that this might be a hernia? And your assumption is that it’s probably inguinal?

Most of the stuff I’ve seen says only men get inguinal hernias that women get femorals if they are in the groin area at all (as opposed to around the belly button or an old incision).

Could obesity and/or rapid weight loss have caused this?

The first thing, I noticed was towards the end of a period where I was losing weight at 3-4lbs/week and the pain was on a strong “high”, Until recently, I thought it might be my body adjusting. I was also anemic before and during the weight loss-due to a thyroid problem that was very poorly managed for a long time, and later to the caloric restriction despite being on prescription iron pills. Other deficiencies included zinc, very severe vitamin D, vitamin A, B12 (metformin related), and magnesium. Before and early in the weight loss I was always tired as well as having bad knees. The reason a VLCD was done despite the need for heavy monitoring was that I had an HbA1c of 6.4% and in four months managed to get it down to 5.8%. Now it’s been 5.5% for over a year. I also brought down my triglycerides from 420 to 125 mg/dL and my blood pressure from “not-quite-high-enough-for-medication” to normal. And I’m seriously struggling to maintain the weight I’ve lost let alone lose what I need to-which is why I think I need the sort of long term support a VBLOC would offer. Ever since I gained a lot of weight with the thyroid it’s all been extremely difficult.

Soon after I lost most of that weight, I started working out and a trainer at the gym told me that gaining 10 lbs of muscle would help me keep weight off, while I got into zumba in a big way-even though I was still somewhat recovering from deficiencies. A lot of that was made possible because a lot of the pain in my knees went away.

Although the pain waxed, waned, and persisted it never occurred to me that it was anything other than musculoskeletal-the new exercise regimens, my body adjusting to it’s new size, and the balancing act of heavy dieting with trying to treat deficiencies. The doctor prescribed citracal and kept monitoring all the other nutrients closely, and ran some other tests as a precaution, while telling me that it sometimes takes time for the body to adjust to a smaller size. Mostly I WAS overjoyed and the doctor quite pleased at the weight loss and the improvements mentioned above. And many of the aches and pains did gradually go away as he predicted-while the pain I described to you is the only one that remained. I think I had it somewhat before the weight loss, but on balance it’s much worse now.

I think before the weight loss my right side was like my left side is now, and the pain wasn’t present on the left at all. But it never occurred to me that it could be a hernia until an older gentleman I know moderately well got once fixed some months ago. I heard some jokes about it being a curse of the male sex, while my mother told me about how a female friend of the family (also quite obese) had a number of hernia repairs. So I went looking on the web to find out the truth and found an article you wrote in. And immediately the descriptions of pain in women with hernias struck me as identical to what I had. For a few days, I told myself that I was letting my imagination run away with me, and that it was just power of suggestion. Then I noticed the “asymmetry” while I was getting out of the shower. For a while I tried to convince myself that it was power of suggestion and I was imagining things. That the asymmetry was surely a trick of the light or angle, or I was making it bigger in my mind than it could possibly be. But I kept finding that standing different ways, changing angles or even lifting my tummy up while holding the right side higher didn’t really get rid of it. No matter how I tried to move around and find angle or method to prove that it was an illusion not a bulge, there it still was. I also hoped that asymmetry was some natural variation and the pain was just a pulled muscle or something.

My brother-who is a PA-insisted that women almost never get hernias. He said something to the effect that hernias in women being like HIV in lesbians.

Could a hernia have started when I was fat and just become more apparent because I’m more normal shaped and active. (My mother says that now I still look like a “big girl” but not the huge fat person I had been for many years.) Could rapid weight loss have somehow made it worse?

If it is a hernia, what are the odds, that I got it because I was morbidly obese (now I have a BMI of 33.7). Could the obesity epidemic be a factor in why the assumption of “Hernias are a male problem” is no longer well supported?

Now that I have to take the possibility of a real hernia seriously, I guess I’m thinking that whether I can have it fixed and get a VBLOC in the same surgery just might work out to be a “political question” rather than a medical one. The insurance and certification rules behind bariatric procedures are quite byzantine.

At any rate, I really appreciate your advice and getting back promptly. I suppose that as shocking and as much of a pain as this could be I’m much healthier than I was not long ago. It’s scary and something I thought women never had to deal with. But I suppose it’s better than diabetes, heart problems, or knee surgery.

Thank you!

[drtowfigh]

Maybe a Hernia?

Yes. Definitely can be a hernia. The area of your pain (to the side of the pubic bone, but not yet at the level of the hip bone), the type of pain you have (feel it in the labia, the leg, when coughing, with vomiting), noticing a slight bulge in the area… all are pretty classic for a hernia as noted in women. It is possible you may have a small one on the opposite side, too, based on your symptoms.

I do not recommend an MRI for all patients. It should be reserved for patients with prior hernia repairs and with those who have occult hernias (i.e., hernias that are not able to be found on examination but there is high clinical suspicion for them). In your situation, you are noting a slight bulge already. A dynamic hernia musculoskeletal ultrasound alone should be adequate, and if performed correctly should confirm the hernia diagnosis. In fact, if the examination is diagnostic of a hernia, no imaging is necessary. This is a very important point.
So, please seek consultation with a general surgeon who has interest and experience in hernias. A list may be found on the Americas Hernia Society webpage (www.americanherniasociety.org), by state, based on their membership with the AHS.

Lastly, if you indeed do have a hernia, and you plan on having an operation such as the VBLOC, then it would be up to your surgeon to determine if he/she would like to perform both operations at the same time. In some situations, the surgeon may want to ask a second surgeon to perform the hernia repair, if he/she does not routinely perform laparoscopic inguinal hernia repairs. I personally do not believe there is a contraindication to performing both procedures at the same time. They are both “clean” operations. However, I would defer to the preference of your surgeon to determine the plan of care.