Pain from lifting 10 years after repair

[Herniahelper]

@nacly

The hoops are:

1) See a doctor. Tell them you want to see a specialist about your chronic groin pain, but need an MRI. The reason for your visit is to obtain a prescription for this and for the referral to the specialist you researched(if required by your insurance).

2) Call outpatient imaging centers and find out how much a the MRI costs cash. $400-700.

3) Call your insurance company and ask how much the MRI will cost if you use insurance. Probably more. But it will count towards your deductible if you are anticipating surgery.

4) Make appointment with specialist you picked that takes your insurance.

And/ Or

Pay the flat rate to see Dr. Towfigh online, or in person if you’re serious.

Get as many opinions as you can.

Reguarding the pain being far from your surgical site and moving all around making sense… It makes anything but. Further explanation will be needed. You need to know what your chasing and what the goal is.

[Herniahelper]

It’s not an uncommon story. People have a difficult recovery the first year. Things settle down and they have a period of significantly reduced symptoms or they return to activity. But for lack of a better term it’s just not a good repair and they end up in a cycle of reinjuring themselves with minimal things and then convalescing and repeating.

I have heard about some improvement with exercise intermittently and always wondered about that. A question maybe a small cord lipoma or piece of fat getting trapped causing pain that then gets shifted with activity. I don’t have a good explanation.

But overall I would put people with the above in this category of “just a bad repair.”

They don’t have nerve pain, or major psychosomatic factors. The surgeon tells them it’s a success because he cannot detect recurrence but they can put their fingers right on the spot where the hernia was and say ‘this is where it hurts, your repair sucks.’

As basic as that sounds I think it’s often true.

I think what patients should take away from the ever common “there’s no reoccurance” statement is not that there’s nothing wrong. It’s basically their way of saying that they can’t help you.

People then get post holed into the chronic pain category. They are somewhat functional, but pain with activity severely limits their life and intuitively they know that something is wrong. They can’t walk their dog, pick up their child, or lift their groceries without fear.

But the prospect of exploratory surgery with nothing to fix is terrifying and many of the stories available on ‘mesh removal’ does indeed make it sound like a palliative last resort. The possibility of being worse not worth the risk.

Something that I know I would like to see discussed on Hernia Talk is the patient who has prolonged episodes of debilitating pain with activity after hernia repair that resolves with convalescence. What is the surgical experience with these patients? Do they do better and should they have a lower threshold for considering revision.

Do outcomes very when imaging appears normal versus when imaging is abnormal (folded mash, meshoma, bulky plugs, migrated plugs, heavy scaring, etc).

[Herniahelper]

@nacly

I think most surgeons will check for a hernia on physical exam and if none is detectable, and none is detectable on imaging, they just chalk it up to chronic pain. The surgery from their point of view is a success, “there is no recurrence” they will proclaim triumphantly and then walk out of the room.

However this story is a very common story.

And if most surgeons do not find something to operate on they will tell you that it’s a groin strain, a labral tear, a urologic problem even…

And if you get pelvic MRIs on just about anybody over 40 who has lead an active life a tiny labral tear is most likely going to be there even though it’s asymptomatic and unrelated.

And a percentage of these, if you leave them alone, will improve on their own. Intuitively I think that things are not stable, but when a little bit of tearing occurs, it causes pain, more scar tissue forms, and maybe things can stabilize. Or perhaps everything just calms down over time.

The fact that you were pain-free for a year following your surgery speaks against the idea of chronic pain related to the mesh.

And I think that that is the very important key piece of information.

If you give it a year, and it never settles down and you can’t live with it I think it’s reasonable to consider having it revised and treating it as if it’s a recurrence. However very few people feel confident about giving someone good odds. Two experts that I have spoken with regarding the above topic consider these procedures to be “palliative” in nature. And they try to emphasize that patients should not have hope of returning to a normal life, but just having less misery than they do now. So they really should think long and hard about whether or not it’s worth it. The subtext here being outcomes are not universally great in their hands.

A lot of people I think present with nerve damage that has already occurred, or vague minor symptoms like “brain fog” or just generalized anxiety over a foreign body being in them. In those situations better outcomes are probably much less clear-cut.

However for the cohort of people that were pain-free for a time after their surgery, and now have pain where they’re hernia was, that is of the same character as their original hernia…

I think it would be really interesting to know how often a recurrence is actually found interoperatively and if outcomes are better for them following a second repair as compared to the rest of the chronic pain group?

And this doesn’t have to be a study. I would love to hear from surgeons and patients that have seen this, and know what their personal experience has been like with it.

Many people are in this boat, but are afraid to do anything about it, however they may be more likely to have a good outcome because there is actually something that can be fixed.

[Nacly]

I’m in a slightly similar boat. Had a bilateral TAPP performed about 2 years ago. After 1 year, I was pain free. While riding my bike, felt a pull, and had pre op pain again. After having COVID (and coughing a LOT), my left side now feels like it’s constantly strained, and the pain radiates to my testicle, which develops an almost distended epididymis at random intervals. I’ve had a CT, 2 visits to the surgeon, 1 to the urologist, and 1 ER visit, and they’ve all chalked it up to standard chronic post repair pain.I too am frustrated, as each visit makes you feel crazier for thinking recurrence.

[Herniahelper]

@mitchtom6

It would be great to hear if anyone, patient or surgeon, had such a case operated on and what the result was?

[mitchtom6]

I have the same phenomenon. Lifting causes real discomfort and pain in my spot, although the pain usually does not present itself until a few hours later, or the next day. Will linger for weeks. I have totally backed off from lifting weights altogether due to this. Sounds like a recurrence. But with 2 MRIs and 4 independent exams from Gen Surgeons, no bulge can be found. Mesh irritation? Perhaps, but a total guessing game. @herniahelper

[Herniahelper]

Question for the surgeons:

When a patient complains of symptoms such as new onset pain with lifting, but has no exam/ imaging findings to suggest reoccurance, how often is an occult reoccurance found intraoperatively?

[Herniahelper]

[You speak specifically in the case of mesh? Such a “weak spot” is a precursor to hernia or is already formed one?]

Speaking of previously poorly placed mesh. If things get pulled on or torn, there’s still a foreign body reaction and perhaps if babied And I’ve scar tissue may form to stabilize things. It’s just a thought as a mechanism for why people could have problems similar to hernia recurrence that eventually resolve with conservative management. However these are generally not strong and will likely cause problems in the future.

If there is a weakness that is small theoretically it could heal but without a scaffold to promote that, hernia’s generally are considered to be a progressive disease. Once the hole is there it will just get bigger. There are anecdotal reports of people healing their questionsble hernias with physical therapy but without actually looking inside or imaging I don’t really know how you would prove that’s what happened. They could have simply had some other musculoskeletal problem that worked itself out with time.

[drtowfigh]

Apologies for the rude and disrespectful user. I do not tolerate any of that on our forum.

Please, if you do see anyone engaging in inappropriate banter in this forum, message me directly and I’ll take care of it.

Meanwhile, carry on! Thanks for your participation

[pinto]

@Herniahelper,
>Sometimes if you have a weak spot it will scar down.<
You speak specifically in the case of mesh? Such a “weak spot” is a precursor to hernia or is already formed one?

[Herniahelper]

I mean you will need to see somebody in order to get a plan together but in general overall you can probably give it a year and see if it works itself out. Sometimes if you have a weak spot it will scar down. Or if it doesn’t get better or you can’t live with it you’re probably going to be faced with having someone go in again.

If you are able to live 50 lb and it’s only sore for a few days I’m not sure it would be worth the risk. Because it doesn’t that debilitating by your description.

[Antony]

@herniahelper the pain is usually over w/in a few days, providing I make it a point to not lift anything heavy. It is very similar to pre-repair with the exception of any bulging or bulging feeling. It always improves upon laying down & is most uncomfortable when standing. As I mentioned, it presents itself mostly as soreness between hip bones, on opposite sides of the center point, along with the feeling of heaviness in my testicles. When I was diagnosed by the surgeon, he said it was the smallest hernia he’d been asked to repair. I guess I’m just ultra sensitive to something not feeling right & the only correlation I can find is with lifting things that are close to fifty pounds.

[Herniahelper]

If you were pain free and now have pain similar to your prior hernia… Illicited by lifting and better when laying flat…

That’s a great story for occult reoccurance. Sometimes I feel there’s enough coverage to prevent clinical reoccurance, but things are weak. Maybe there isn’t enough strength and when strained tissue tears or is pulled on.

Does the pain linger for weeks after such that you feel fragile reguarding core strain?

Or is it painful, but then immediately better.

50 lbs is pretty good.

[pinto]

Further @Antony, I just remembered that I came across the injunction against weight belts for people with hernia. I don’t think it was here HT but somewhere on the ‘net. Your weight belt could possibly be the root of the problem.

[Good intentions]

In 2011 the method was probably very similar to what was done to me in 2014. A single procedure bilateral repair was probably laparoscopic TEP or TAPP. A large cavity is created between the peritoneum and the fascia and two large pieces of mesh are slipped in between. The top of the cavity would be below the navel but pretty close to it. So after implantation there is a line from side-to-side below which is the inflexible, boardy, mesh/tissue composite after “mesh incorporation”, and above which is normal flexible tissue, although it is scarred from the blunt dissection process, the peeling apart of the two layers.

So, it might be that your efforts are tearing/damaging that area, as the flexible tissue stretches and the inflexible mesh composite does not. In engineering terms it might be called a “stress riser”. One side effect of the repeated damage is that more scar tissue will be created as the body heals the new damage.

I still have a stiff thick bowl shaped area where the mesh used to be in my abdomen. It’s getting softer and more flexible over time since mesh removal, and my after-effort pain levels are significantly lower now, at 3 1/2 years after removal, than they were at one and two years. I only had the mesh for three years but I was very active and I think the constant damage created a very thick layer of repair tissue from the constant damage.

None of this really helps your immediate problem but it might help you understand what’s going on in there. I think that your best option might be to let the area settle down and heal completely.

Don’t try to “work” it back into shape like you would a normal muscle injury. It’s not normal muscle or tissue. The foreign body reaction is constant and any newly exposed mesh increases the reaction rate, I think. I spent a lot of time and effort trying to exercise the mesh area in to something healthy, get it to “adapt” to the mesh, but the reality was that it was just damaged tissue that could never fully heal.

The typical surgeon will only see the mechanics of your problem. Is the mesh where it was placed, is there a recurrence, is the mesh impinging on any specific structure that could cause pain? That’s it. If you keep coming back they’ll send you to pain management.

Good luck. Read through as many posts on the site as you have time to. There is a lot already here.

[Scarletville]

Tough one to comment one, really going to need to see a doctor/surgeon maybe get a scan done to check on things again. Off the top of my head, maybe a small recurrence at the edge of the mesh. If the pain didn’t descend into your testicles I’d say maybe even IBS symptoms and if the pain was only in the lower region varicose veins. I think you really are just going to need to see a professional to have any idea of what’s going on and stress that you’ve experienced it for 4 years now it’s not a pulled muscle you want an answer.

[JamesDoncaster]

I lift weights on a regular basis. When I had the mesh inside of me, I had horrible pain in the area of the mesh for days after each lifting session. I’ve had the mesh out for about a year now and no longer have much pain after exercise (though, I still have some, presumably due to the scar tissue that has been left behind by the mesh and the mesh removal procedure).

[ajm222]

his situation mirrored mine and that of many others – there was no obvious hernia after mesh removal – when the surgeon peels and cuts away the mesh, they leave behind a ‘scar plate’ that covers the defect. no repair is necessarily needed at this time as a result. some tissue is removed though to get the mesh out, and the scar plate is of course not as strong as the mesh repair. i also had my mesh removed and did not have any sort of additional repair.

the question then is how long will this last. my surgeon said that for many patients who originally had an indirect hernia, the scar plate has held for several years for most (the 3-5 years since he’s been regularly doing robotic removals). i also know some folks that had a direct hernia, or both direct and indirect, and are years post-removal with no additional repair and still don’t have another hernia. but my surgeon also said he’s seen a number of patients that recurred within just a few months. most of these were originally direct hernias that had been repaired. something about the anatomy of an indirect hernia makes it less likely to recur, at least for a while.

in my case and others it remains to be seen if this will last a lifetime, or if an additional repair will be needed someday in the future. i know i can still get an open tissue repair in the future if something happens. but Dr. Towfigh and some other surgeons have also suggested that the scar plate isn’t nearly as strong and they expect another hernia to show up eventually in most cases. but it’s also hard to say for sure as i don’t think enough people are tracked and not enough time has elapsed since removals have become a little more common.

i do think the idea of a fully absorbable mesh is similar in that the mesh serves as a lattice for collagen to form around it and connect the edges of the hernia, and eventually the mesh disappears leaving the hernia fixed vy scar tissue. seems like the perfect solution, but for reasons I am not well versed in, the practical realities of this option apparently leave a lot to be desired and don’t work as well as you’d hope. otherwise this would obviously be the way to go. you’d have to google why or search here and have one of the surgeons chime in to explain.

[Nacly]

@herniahelper

Thank you for all of that, it helps clear up a lot. I found some AHS members in my state, and I made an appointment as a new patient with a local PCP, and I’ll give him the full story plus a request for imaging. Luckily, an ER visit pertaining to the pain made me hit my deductible, so that’s a less an issue. I’ll keep updating on progress.

[Nacly]

Yeah, as there seems to be a non-zero number of folks I’ve found in that situation. My hernia didn’t have a visible bulge, so I can’t exactly point to the location of the pain, but the new spot of pain onset is far away from the inguinal canal, and the pain actually moves around if that makes sense.

Based on the surgical notes, I got the classic 6×6 mesh coverage, so undersized mesh shouldn’t be the issue. I’d really love to have an MRI to see what the tube of truth can find for me, but I don’t know the hoops necessary to get it. I’m almost apprehensive to go back to my surgeon again.

[Nacly]

@herniahelper

Basically spot on right down to my surgeon verbatim declaring “there is no recurrence here” in the exam room.

I did have pain for most of the first year on the left, and had about a 3 month interval of absolutely no pain. I did have an event while lifting a patient that led to a few weeks of pain, but nothing like this. The pain ebbs and flows, but weirdly, it gets better during exercise, whereas I couldn’t tolerate vigorous exercise pre op.

As far as the risk v. Reward of revision surgery, that’s my current dilemma. If there is a recurrence that hasn’t been detected, I’m
Scared to roll the dice on another repair that opens the door for a higher chance of worse outcomes.

[Wim]

So you got the mesh out but how is than the hernia repaired? This raises the question why the mesh is needed then? Suppose thre is a mesh that dissolves after 1 year would this also lead to curing the hernia?

[pinto]

@Antony, has this pain come only recently or has it been pretty much present the past six years? Free weights? Say, from a dead lift position or whatever? No bulge ever? Quite interesting though I’m sorry to hear you’re in this fix.