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Occult Hernia or Scar Tissue?
I’ve experienced groin pain for 10 of the last 15 years. For the last two years, I’ve experience groin pain from activities such as lifting (5+ lbs.), walking fast, and bending forward while sitting. I also experience frequent bloating which can exacerbate the pain. The pain is located in my left groin just above the crease between my leg and lower abdomen; the location is painful to pressure. However, there is no detectable bulge and a hernia hasn’t been detected with an ultrasound, so doctors dismiss hernia as the problem. I had laparoscopic repair of a left inguinal hernia nine years ago with mesh repair. I’m a 62-year-old male.
Physical therapists believe that the problem is scar tissue. Besides the previous hernia surgery, I had open surgery in my left groin with Dr. William Meyers in 2013 and again in 2014 for core muscle repair. The 2014 surgery also included a left hip arthroscopy for a labral repair. I returned to normal activity following those surgeries but regressed to my current conditions within about six months.
The PTs note that abdominal surgery is a common cause of scar tissue. Results from a sonogram five months ago seem to support that premise, reporting Inflammation of the pubic symphysis and tendinosis of both the rectus abdominis insertion and adductor origin on the pubic bone. And I do experience pain in my pubic symphysis from prolonged standing. I’ve had active release physical therapy with a pelvic specialist for six months with no improvement. I also had platelet rich plasma injections last fall with no improvement.
Thoughts on my conditions or how to improve them? Recommendations for a hernia specialist near the Washington DC area who effectively diagnosis and treats occult hernias?
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5 Replies
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Lifeboat, I assume that mesh was left when other groin reconstruction was done years later. Your lap repair was done in tension free fashoin while following core muscle surgeries have been performed using pure tissue repair techniques. No mesh repair does induce tension in the groin (besides scar tissue problem). Even if the scar tissue breaks mesh and surrounding tissues under tension may still contribute to your symptoms. Possibly, if symptoms persist for a ling time, you should seek second opinion and specifically ask hernia surgeon about neurectomy, which is done as open repair.
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Also, in response to Chaunce1234 questions: Over the years, I’ve tried all of the options mentioned with no positive results. That’s not to say that some of them may be worth reconsidering. The active/myofascial release has been most effective of all but even it has been hit or miss. I’m not inclined to revisit Dr. Meyers. He performs open surgery which, as I understand, can contribute significantly to scar tissue.
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My condition is looking more like scar tissue. I saw Dr. Bachman and had an MRI. The MRI showed some adductor longus and pubis symphysis tendinopathy but nothing in the left groin where I’ve experienced most of my pain. Dr. Bachman didn’t feel that there was a hernia or that the other MRI findings were the cause of the left groin pain.
Oddly, I have had some improvement recently. When I initially posted, I was experiencing more pain than usual which coincided with more aggressive active release (myofascial release) from physical therapy. My PT says that the treatment can break up some of the scar tissue, causing more pain initially but less pain later.
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lifeboat, I’m just a fellow patient so don’t take this as pro medical advice…
Was your groin/hernia ultrasound with valsava to rule out hernia or recurrence? Have you tried a long course of anti-inflammatory? Assuming you can tolerate it, many clinics will try 30 and 60 day courses of strong prescription NSAID (not generic ibuprofen) which can apparently have a cumulative effect on reducing inflammation. Have you tried nerve block injections? Also I wonder if you had pain relief after a particular surgery, but the pain returned over time, it may be that the injury has returned or did not heal entirely before being re-damaged?
Dr William Meyers in PA is well known for groin pain and sports injuries. It may be worth re-visiting the clinic if you had good results there before.
Dr. Andrew Boyarsky in New Jersey is another potential east coast resource for inguinal disruption and sports hernia injuries
Keep us updated on your case, good luck.
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Sounds like complications related to a disruption injury, sometimes referred to as a sports hernia. Which is a misnomer.
In Va, seek consultation with Dr Sharon Bachman. In Md, it’s Dr Igor Belyansky. They may be able to help.
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