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Occult Hernia Pain
I’m a 58 year old female who’s had groin pain for over 4 years but with no visible or palpable bulge. Two years ago, an ultrasound revealed a small, 6mm indirect inguinal hernia but the two surgeons I’ve consulted won’t operate because they don’t regard such a small defect as a hernia – nor do they believe it is the likely cause of my pain. They fear that surgery will not address my pain and that it could cause more.
Though my symptoms are classic, (groin, hip and back pain as well as some bloating), they are intermittent so I’ve been living with it rather than risking surgery. I am, however, concerned about Dr. Towfigh’s comment awhile back about ‘nerve pain’ – that the longer one is in pain, the harder it is to treat.
My questions:
– is occult inguinal hernia pain likely caused by tissue pressure on the genitofemoral nerve and is, therefore, nerve pain?
– is it true post-surgery pain is more likely if there was pain before surgery and is this because pain pathways have been established?
– can anyone explain why such pain would be intermittent (i.e. a week on, a month or so off)? It’s completely mysterious to me as there seem to be no particular triggers such as exercise or sitting too much.
– would nerve blocks be recommended in my situation?
– is it inevitable that an occult hernia will grow bigger and that a bulge will eventually appear and, if so, would it be better to get it repaired while it is small – particularly as it is symptomatic?
p.s. I live in Canada and am not sure where to find a surgeon who will listen or operate.
Thank you.
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3 Replies
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Dear Tilbis.
Determining the etiology of your pain is the most important next step. If physical examination and imaging tests cannot determine the source of your pain, then I often use diagnostic injections. For example, if the pain is thought to be related to the nerves, then a nerve block should help. If the pain is from the inguinal ligament, then injecting the inguinal ligament with local anesthetic should help. If the pain is related to a direct hernia, then injection of the external oblique with a local anesthetic. By doing the injections one at a time, your surgeon should be able to determine the source of your pain.
Regards.
Bill Brown MD -
Hi – Tilbis – I am wondering if you have been able to find a surgeon in Canada that deals with occult hernia?
Thanks,
g -
These are all good questions, and your case mimics many others seen on these forums and elsewhere (longterm groin pain, uncertain diagnosis, doctors punting the case). Hopefully a doctor can answer your questions and offer some insight.
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