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Possible Hernia and Seeking Insight
Hi All!
I am reaching for some insight regarding a potential inguinal hernia.I am a fit 31 year old woman. All of this discomfort started to occur after my first c-section in October of 2017.
Within days of my c-section, I was at home in bed and our new baby was sleeping in the bassinet in our bedroom. She started crying and in a rush to get out of bed and soothe her, I sat straight up from a laying position (not the best idea when you have a fresh abdominal incision!). I immediately felt a very sharp sensation just to the left of my c-section incision. I remember thinking that I must have burst my incision open, but after checking in the mirror and having my husband look, we determined that everything appeared fine. I assumed it was just normal post-op pain.After my 6 week checkup, I was cleared to start back into my usual activities again. I noticed that I would often have this dull, pulling lower left quadrant pain that felt almost like a really sore muscle, to the left of my incision scar. The pain was also noticeable when I would push down on the area. The pain would radiate up into my hip and lower back, and almost felt similar to a side stitch that you get from running, except it would never fully go away.
Initially, I assumed I had just pulled something (since I was just starting back into my regular fitness routine after months off), but the pain would often linger, and would get particularly uncomfortable during ovulation and when I had a full bladder. So much so that it was very uncomfortable to carry my daughter around or do any sort of bending. The pain would lessen after ovulation, but was still noticeable. As such, I consulted with my OB/GYN. When she completed an internal exam, she could pinpoint the location of the discomfort and told me she felt an area of “fullness” on that side. She ordered an ultrasound of my pelvis, assuming I had a cyst, but the scan showed no abnormalities. Everything looked great. I even had a followup ultrasound to that first one since my uterine lining was thickened at the time of the original test (due to normal cyclic changes) and they had wanted to confirm that it thinned out after my period (which it did). The second ultrasound also showed no abnormalities.
After that, my doc told me it was likely adhesions from my CS and suggested I hold off on any further laproscopic exploration until after I was admittedly done having babies.
In addition, my mom is an ultrasound tech at both a local hospital and private office. The physician who owns the private office graciously allowed her to scan me 2 additional times to evaluate the pelvic area since the pain continued thereafter. She scanned me two additional times, and did a complete pelvic and abdominal workup, and didn’t see anything abnormal either time.
At that point, I assumed that my GYN was correct in her assumption of adhesions. My husband and I decided to try and get pregnant again as we wanted to have two children close together. We conceived when our daughter was about 10 months old. The discomfort had continued up until that point, and the ovulation just prior to conceiving our daughter was very, very uncomfortable. So much so that I called my GYN office in concern. The OB nurse again suggested it was just cyclic pain and told me to take advil.
At 6 weeks pregnant, I went for my first office visit. The discomfort in my side was really uncomfortable. I mentioned it to my OB and she said it was possibly a Corpus Luteal cyst, and that the tech could check during my 8 week ultrasound. During that test, the tech (my mom) performed a very meticulous ultrasound and looked for any sign of abnormality but found nothing but a happy, growing baby and a very small corpus luteal cyst (nothing, she said, that would cause the level of discomfort I was feeling).
The pain continued through my entire pregnancy, and got progressively more uncomfortable towards my last trimester. At my 20 week ultrasound: Nothing abnormal visible in the area of pain. I had various ultrasounds in my 3rd trimester to verify proper fetal growth (as my belly was measuring small): None of these tests could find any evidence of what was causing my discomfort. My mom even looked at my kidneys to verify that the pain in my lower back wasn’t coming from them, and they looked fine.
After my most recent csection this past May, I have finally pursued a consult with a local general surgeon to try and figure out the culprit of this longstanding pain.
His initial evaluation was that, because he cannot feel a hernia and I do not have pain with coughing or lifting, that I likely do not have one.
He ordered a CT Scan (as he said that is the “Gold standard” for hernia imaging?), but only at my insistence. He said that he doubts he will find anything on it.
He has offered to explore the area of pain surgically, but only after waiting a few additional months since I just had my baby 3 months back.I’m happy to have the CT scan as I think it will put my mind at ease to ensure that there are no other major issues at play that could be causing this pain, but I’m concerned that if this is a hernia, I will not find out from this test.
Here is a quick run down of my discomfort:
-Lower left side, to the left of my c-section incision (between incision and my hip)
-Dull ache that persists; exacerbated by full bladder and ovulation (but not affected by menses?)
-pain can be pinpointed when pressing on the region
-no palpable bulge
-no pain with coughing or lifting
-Pain radiates out to hip and into lower back
-seems to make me feel bloated on just that side
-Feels similar to a side stitch (like one that you’d get from running), but it lingers and does not go away
-it doesn’t seem to be gastro related as I don’t notice any changes with eating or drinking, and my bowel habits are all very normal
-is not made worse by activity: sometimes running actually makes it feel better
-I can feel it more by bending over and touching the floor, or when I’ve been standing for long periods of time, or holding my babies for extended periods of time (rocking a baby for long periods of time make me feel very uncomfortable).
-I get relief from lying down; I usually feel pretty good in the morning after getting up, but after I get into the day, I am uncomfortable by evening
-sometimes, certain pivot or twisting movements will make me notice it, but not alwaysAt this point, I just want to know what is causing my pain.
If you can advise on whether or not this sounds reminiscent of an occult hernia, I would be most appreciative.
Also, If anyone has suggestions for surgeons in the Pittsburgh area with success in evaluating these, please let me know.
Thank you in advance!
-Brooke -
3 Replies
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Hi Brooke-
While I cannot address the hernia specifically, I suspect that at least some of your problems may be due to a diastasis recti – a stretching of the connective tissue (linea alba) which joins your rectus abdominis muscles along the midline of your abdomen. This is common during pregnancy due to pregnancy hormones which relax the connective tissue. You have a greater chance of a lasting diastasis if you have multiple pregnancies or bigger babies.It s also possible to have groin area edema after surgery, which can put pressure on sensitive areas. (I say this because your symptoms worsen with prolonged standing, and improve when lying down or exercising)
You can find lots of information on diastasis recti on the web- some of it conflicting, but I strongly suggest that you also find good physical therapist who specializes in this. They usually seem to be listed under pelvic floor physical therapy or women’s rehabilitation (even though men can also have DR).
Since I also live near Pittsburgh, PA, I will tell you that I have found very helpful physical therapists in this area. I’m not sure of your insurance, but I have a UPMC plan and PT visits are covered with a copay. If you go online, look for UPMC centers for Rehab Services (they have several locations) and look under Pelvic Floor Physical Therapy and/ or Women’s Rehabilitation. Also, if you search their site for diastasis recti, they have good info there.
In the meantime, avoid doing exercises like sit-ups and crunches, which can exacerbate DR. Your PT can show you how to strengthen your core without further stretching the connective tissue. They often seem like “easy” exercises, to start, because you are using small movements to activate your weaker transverse abdominis instead of stronger efforts using your rectus abdominis, but my results were very noticeable.
(I am in my mid-50s, and have a DR and incisional hernia which developed 5 mos. after midline incision hysterectomy/cancer surgery in 9/2018. I did have a milder DR visible on my CT-scan prior to surgery ( I had 2 kids over 25 years ago) but was never told. The hernia is still there, but PT has strengthened my core, making lifting easier and eliminating back pain.)
I hope your CT-scan gives you some answers.
Best of Luck -
[USER=”2580″]DrBrown[/USER] Hi Dr. Brown –
Sorry for the slow reply here – I only just recently found time to respond.
I’ve attached two pictures. The first shows where the pain in my lower left side is occuring.
To answer your questions:
Yes – I have normal skin sensation
The pain feels deeper than the skin/subcutaneous tissue.
The pain is most uncomfortable leading up to and around ovulation.
It is also tender after intercourse (for up to a day or so after) and feels similar in sensation to a sore muscle pull.I have considered the possibility of endometriosis, although I don’t notice a significant increase in pain during periods.
The second photo is of my belly button.
Since this second pregnancy, I’ve also started to have pain around my belly button.
It’s not severe, but feels like a chronic gas or bloating pain that is made more significant by pushing onto my belly button.
My belly button itself feels very … smushy…right above it.
I believe I may have an umbilical hernia from my most recent pregnancy (just welcomed our baby in May), but I’m not sure if this is something to be concerned with?Thank you again
Brooke
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[USER=”2955″]B_Rebovich12[/USER]
Please post a photo with a mark on the skin that identifies the site of your pain.
Do you have Normal skin sensation? Does the pain feel like it is deep or is the pain in the skin or subcutaneous tissues?
Does the pain cycle with your menstrual cycle?
Regards.
Bill Brown MD
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