Pain/discomfort on both sides from nerve irritation on one side

[William Bryant]

Now you’ve mentioned it Jack, when. Simon Bailey examined me he pressed quite hard down in about three to four areas around and on hernia asking “any pain” and then said “Good, not touching any nerves”. So I think you’ve got that right.

I’ve had prolapsed discs and they definitely did press on the sciatic nerve. Very painful.

[Jack2021]

It’s understandable that you were worried. I think it’s no insignificant trauma going through hernia surgery, worrying about recurrence, possible mesh issues (for those who have a mesh repair) and mesh removal as in your case unfortunately. There’s clearly plenty of people on this forum who regularly have it on their minds pre and post operation and it’s an emotional burden to carry and deal with.

On the plus side, it’s great that a bit of rest and ibuprofen sorted things out for you and hopefully that was reassuring, somewhat at least. It’s also very positive that your range is still lengthening, which must indicate that your long-term perseverance with physical rehabilitation following your surgeries is paying off. Definitely something to be pleased about.

With the variation in the course of the genitofemoral nerve in different people and I guess in all likelihood, other nerves too, it’s more understandable that hernia surgery has a risk of pain resulting, regardless of the repair method, as your reference alludes to as well, where it notes in relation to the nerves which ‘…serve regions of the abdominal wall, pelvis, and perineum.’ that ‘Any clinical involvement of these nerves may result in pain, loss of sensation, or motor deficits and reduce an individual’s quality of life.’

This may also be one of the key factors why some people have pain with a hernia before surgery and others not so much, due to nerve compression from the hernia and such like, depending on individual nerve location.

I know that there can also be long term pain and numbness following caesarean surgery in women, so surgery related nerve damage is likely a risk of many operations, with potential risks vs potential benefits always the key deciders.

With all surgeries, we clearly need an excellent surgeon to improve the odds in our favour.

[Good intentions]

Thanks Jack2021, those are some good references. It’s interesting that just a day of rest and a small amount of ibuprofen and things got back to normal. I was getting worried, again.

I had had a thought in the past, over the years, that cycles or number of steps seemed to bring on soreness and odd sensations, more than exertion. Kind of counterintuitive for hernia concerns but that’s what my memory and notes seem to show. Luckily, for me, my range seems to be lengthening, with more miles allowed before I have to take a day off. Actually, I think that I had moved on from monitoring distance travelled (I had been keeping a log) and was being more spontaneous and hiking and walking farther. I think that I had just hit the new limit recently.

One of your references described the motor function of one of the nerves in actuating the abdominal muscles. I wonder if that plays a part in the fact that my abdomen between the navel and about halfway to the pubic bone feels like a stiff plastic bowl.

I did a quick Google and another interesting very recent paper popped up. It describes the ilioinguinal nerve as following the spermatic cord. So, it sees what the cord sees, as far as irritation from internal abrasion or poor environment. It seems to fit what I was feeling with spermatic cord irritation.

It’s an interesting topic, especially considering what seems to be a trend toward prophylactic neurectomy. Besides just the broad effects of disturbing so much of the network during laparoscopic mesh implantation. Unintended consequences.

https://www.ncbi.nlm.nih.gov/books/NBK556034/

Anatomy, Anterolateral Abdominal Wall Nerves
Aurimas Kudzinskas; Bruno Cunha.

“Introduction
The anterolateral abdominal wall is a layered structure composed of skin, fascia, muscles, extraperitoneal fat, and peritoneum that extends from the thorax to the pelvis and bounds the abdominal cavity and its associated organs.[1] It plays an important role in the movement of the torso, stabilization of the spine, retention of a physical barrier, and increase and maintenance of intra-abdominal pressure.[2][3] Numerous nerves traverse the anterolateral abdominal wall to serve regions of the abdominal wall, pelvis, and perineum. A variety of pathologies have the potential to impact the anterolateral abdominal wall nerves, including trauma, neoplasm, and infection. Any clinical involvement of these nerves may result in pain, loss of sensation, or motor deficits and reduce an individual’s quality of life.
…

The ilioinguinal nerve travels within the neurovascular plane between the transversus abdominis and internal oblique muscles until it reaches the superficial inguinal ring. At the superficial inguinal ring, the ilioinguinal nerve pierces the internal oblique muscle enters the inguinal canal, and travels along the spermatic cord (in males) or the round ligament (in females). The ilioinguinal nerve innervates the skin overlying the inguinal ligament, medial thigh, mons pubis, scrotum, root of the penis, and labia majora. It also contributes to the motor innervation of the inferior portions of the transversus abdominis, external oblique, and internal oblique muscles.
…”

[Jack2021]

https://www.kenhub.com/en/library/anatomy/iliohypogastric-nerve

My research ruled out the likelihood of Pudendal neuralgia from hernias, though it is linked to pelvic mesh placement following pelvic organ prolapse, most commonly with women. If you’ve been a regular cyclist over the years it may be worth investigating, as this can apparently be a cause of Pudendal neuralgia.

Anatomy, Abdomen and Pelvis: Genitofemoral Nerve –
Perhaps an indicator as to why some people may get pain while others don’t following hernia surgery and why it’s so essential for surgeons to locate and carefully preserve the nerves during hernia surgery, albeit some may argue this is why it’s better to cut the genitofemoral nerve, is that apparently,

‘In at least 50% of individuals, there is some variation in the course of the genitofemoral nerve as it travels within the retroperitoneum and ultimately entering into the inguinal canal. Variation is also found at the level of its bifurcation into genital and femoral branches.’
This is from the ‘Structure and Function’ section of this link –
https://www.ncbi.nlm.nih.gov/books/NBK430733/

[Jack2021]

I don’t recall the post you mention GI and after all you’ve unfortunately been through, I guess the cause of your irritation may just be as you’re thinking.

I’m certain you’ll have thoroughly researched the following already, but just in case and for general forum info, here are some links re pain associated with hernias and hernia surgery that I’ve come across. I’ve had to split them into a couple of posts as it’s not allowing me to put them all in one reply:

Genitofemoral neuralgia – https://pubmed.ncbi.nlm.nih.gov/25377757/#:~:text=The%

Ilioinguinal neuralgia – https://www.ncbi.nlm.nih.gov/books/NBK538256/

Iliohypogastric neuralgia – https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-018-0391-6

[Good intentions]

Thanks Watchful. After taking a day off and resting, and taking one ibuprofren/Advil, the right groin pain has disappeared and other minor discomforts have crept in. I think I’ve just been overdoing it. I also think that my whole pelvic area is unbalanced after the multi-year process of mesh, mesh pain, mesh removal, mesh removal pain, etc. It’s a twisty road back.

FAI and osteitis pubis symptoms seem to fit in a minor way. Which are both kind of mystery conditions, like occult hernias and athletics pubalgia. Once the area gets screwed up I think it’s hard to get it back in to shape.

[Watchful]

I’ve had some pain symptoms on both sides after my surgery even though the surgery was only on one side. It is possible that some direct or indirect damage was caused on the left side even though the surgery was on the right side. Inflammation can spread, for example.

Also, the nervous system isn’t really all that well understood. For example, there are some documented cases of testicular pain where the patient had an orchiectomy for the painful testicle, and the pain then moved to the other testicle.