Recurrent hernia?

[Damien10]

About 9 years ago I had an open surgery for right inguinal hernia where mesh was placed.

Two months ago after gym, I had severe discomfort in the location, following which it was difficult to properly stretch or even lie on my stomach.

Those symptoms have largedly subsided and I am left with nothing more than slight heavyish feeling in the area and “tension feeling” (it feels like groin spasms and also a pulling feeling) whenever i ejaculate from masturbation.

I am wondering if my hernia may have reoccurred? I don’t lift heavy in the gym and I can’t feel any bulge or lump near the area. Apart from the ejaculation pain, I feel ok.

Also, reoccurring hernia surgeries sound like a nightmare and highly risky. Are they really that bad? I’ve seen stories of people having 5+ surgeries in the area and not reporting loss of testicles etc.

Is it possible that I stretched the scar tissue or something and if that is possible? Should I try anti inflammatory medication for relief?

How does one confirm a recurrent hernia without significant bulge? Does it come through the mesh or does it protrude through a secondary hole? Would it ever descend into the testicles or would looking for these symptoms be pointless at this point?

Any information would be useful at this point. Also, I don’t reside in the USA and where I am laparoscopic surgery for hernias are rare. What are the risk for a second open surgery to repair a hernia? Are there significant risk?

[pszotek]

Damien10,
Thanks for contacting us here at HerniaTalk. Will try to answer your questions in order but have to ask exactly where the pain is located and where the “tension feeling” is located (above the base of the penis, slightly more lateral toward the hip bone, halfway to the hip bone, or much more lateral) and does it hurt when you push on it with your hand?. Also what were you doing in the gym? (lunges, squats, etc with your lower body/core)

1. Your hernia could have recurred but impossible to know for sure without exam/imaging. You could have athletic pubalgia also.
2. Recurring hernia surgery can be challenging. I would recommend Dr. Towfigh, Dr. Orenstein, Dr. Chen, Dr. Jacob, myself or someone who specializes in it to get the best results.

3. Stretch scar tissue: Yes it is possible. IF you would like to consider an online rehab program for this we are currently beta testing one and I would be glad to work with you to arrange this and go over your issue more in depth via a telehealth visit. You can find us at http://www.indianahernia.com, fill out your information and we will get things set up.

4. Ultrasound, CT, MRI all can work to confirm. It can come through the mesh or most often an area that was not covered by the mesh completely. It could descend into the scrotum but unlikely at this point as that usually takes a bit of time.

5. Usually I would not recommend a second open repair unless you have chronic groin pain that I suspect the mesh is causing the problem and needs to come out. We would approach these Laparoscopic/Robotic.

Thanks!
Dr. Szotek
[email protected]
http://www.indianahernia.com

[Damien10]

Doc

Thanks for your prompt and informative response. I don’t have any recurring pain etc. I had pain a couple months ago but that has largely subsided. I stopped all physical activity when it occurred. The tension feeling occurs during ejaculation(I did it today and observed no pain at all and barely noticeable tension) and feels like it is right below my surgical area but moving towards my hip bone. I don’t feel any pain whenever I push on the area with my hand, sneeze or cough.

I can’t remember the exact exercise but I was doing possible overhead shoulder press/ hammer curls when I got the pain. I may have exacerbated the pain the following day by doing abs and very light deadlifts with poor forms ( I should know better).

Recently, I haven’t even gotten the heavy feeling. I spent yesterday shoveling dirt etc and I don’t feel any pain or sensation etc.

Any idea the type of costs associated with this type of procedure. I am outside the USA so if I were to travel then I would have to pay out of pocket. London(United Kingdom) may be more realistic to me since I will have to go to further my studies there in the immediate future. Do you have any references for doctors or hospitals in London?

Regards
Damien

[drtowfigh]

UK has very few surgeons who see and treat chronic pain after hernia repair. There are a couple of my colleagues who I will reach out to to see if they will see you. Stay in touch.

[drtowfigh]

You’re in luck:

Try Dr. Aali Sheen of the Groin Pain Clinic based in Cheadle, Cheshire. Find him on http://www.groinpainclinic.co.uk

[Damien10]

Hi Doc

I don’t have any groin pain.

I am just trying to see if this can be a recurrence.

The area feels weird but I don’t experience any pain whatsoever.

If I get any discomfort then I get it when I bed down and then it’s barely noticeable.

I’m just trying to see if maybe the area was stretched resulting in tissue coming apart etc.

I don’t see or feel any bulges either and pushing down on the area doesn’t result in pain.

Something is definetly different though. When the symptoms started I felt what felt like a burning sensation in my stomach and it was difficult to fully stretch the area. Leaning back was problematic etc.

Now those symptoms have largely disappeared.

If it is a recurrence, would additional mesh be placed etc and the old one removed?

Regards

[Damien10]

Also I don’t have any pain or tension whenever I ejaculate anymore.

[Damien10]

The pain and tension is still there. I’m taking some ibuprofen and the pain has lessen. I am now finding it difficult to get an maintain an erection…would a recurrent inguinal hernia or “sports hernia” cause that? Can I be experiencing some “mesh issues”. I dont feel a bump or even pain when I cough or sneeze etc.

When I do ejaculate, it’s in very minute amounts almost nothing. I am beginning to worry continuously.

Any ideas? I hope to visit the doctor soon but at this time I simply cant afford it.

[drtowfigh]

If your symptoms started 9 years after your hernia surgery, then a hernia recurrence is top on the list of why you are having symptoms.

[Damien10]

Thanks for the response Doctor

Would a regular doctor be able to do the appropriate test if there is no bulge etc present.

Where I live there isn’t any hernia specialist so I am wondering if they GP would be able to identify a hernia and request the appropriate test.

I have read other persons’ experiences online where no bulge was present, the doctors were adamant that there wasn’t a hernia.

What should I do or expect my doctor to request? Any questions I should ask?

Regards

[Damien10]

Also

Can it be anything else such as an Abdominal strain, scar tissue injury, sports hernia?

Most likely I would be undergoing the surgery in London when I go there for postgraduate study. The British Hernia Center seems to be the go to place for surgeries of this nature. Anyone familiar with this hospital? My main worry is damage to my testicles etc and any other injury that may cause erectile dysfunction. I am already finding it difficult to maintain an erection obviously this “thing” has begun to have adverse effects.

They claim to use a posterior or pre-peritinoeal approach to a recurrent hernia to avoid scar tissue etc. Is this standard operating procedure for these types of hernias or is this specialist expertise that only a few have? Should I ask my doctors here at home if it’s possible to have this approach for the prospective surgery? It may be up to 15 months before I am able to relocate to London etc so time is of the essence.

I’m sorry if I appear to be spamming this board, seems that recurrent hernias are a rarity so information on surgical approach and treatment is scarce. By the way, I am only 28 years old and haven’t even got around to having children so any complications down there worry me.

Regards

[drtowfigh]

If you have a recurrence from an anterior approach, then a posterior approach is indicated as the next way to repair it, for the reasons you mentioned (less scar tissue, so less risk of injury.)

In the US, this is usually done laparoscopically. That said, an open posterior approach is also an option, though with longer recovery time, usually.

Dr. Sheen can perhaps help you find someone in London or perhaps it is worth traveling.

By the way, erectile dysfunction is not directly affected by any hernia-related problems or complications. Any ED you may have is secondary (e.g., there is pain, so erection is painful and therefore difficult). Do not fear that ED will be maimed by a hernia repair.

[Damien10]

Just a quick update.

I went to the doctor and he did both an examination and ultrasound. Nothing was felt but the ultrasound showed a swollen lymph node in the area so the belief is that it/they were reacting to inflammation in the area. Does that sound like a reasonable diagnosis? All of my symptoms(pain/erectile dysfunction) have pretty much decreased and I haven’t taken any pain medication recently as well. I was taking ibuprofen so I guess that cleared up the inflammation.

[drtowfigh]

As long as your pain is gone, there is no need for surgery.

[Damien10]

Hi Doc. I hope that all is well.

Is it possible that I may have damaged my suspensory ligament of penis due to over-extending during deadlifts(poor form etc). My The “hernia” pain is none existant but my penis doesn’t get as erect as it used to and the pain does seem to have come from that area. Could this be the cause of my problem? Could the mesh have maybe migrated whilst deadlifting and cut the ligament or something?

[Damien10]

Is it possible that I am suffering venous leakage? Could the mesh have possibly damaged a blood vessel in the area? Mind you I had an open repair 9 years ago.

My symptoms included swollen lymph node in the groin, pain during ejaculatiom and significantly weaker erections as well as difficulty maintaining an erection without manual stimulation. Any advice would be greatly appreciated. This all started after a bad day at the gym.

[Damien10]

Is it possible for the mesh to damage surounding structures resulting in erectile dysfunction? I had surgery over 9 years ago but I’m now suffering complications following what I thought was scar tissue pulling following a rigourous workout in the gym. I don’t have any pain etc anymore but difficulty attaining and keeping an erection.Could the mesh have broken off and “sliced into tissues” or nerves due to intra-abdominal pressure somehow? This is depressing me

[Good intentions]

Damien, I had that problem, among others related to that area, when I had large pieces of Bard Soft Mesh inside. It was associated with physical activity, like running and biking. Maybe just general edema from tissue damage, producing an inflammatory response. After I had the mesh removed the problem went away, and I became normal again, although it did come back for a few days while I was healing from the mesh removal, when I must have strained the tissue down by the pubic bone. I had soreness, the problem signs started to come back, but it resolved like a normal injury would, after a few more days. I was worried.

And it wasn’t just erectile dysfunction, it was a loss of overall sensation for everything in that area. Like the penis was dying and slowly losing all vitality. It didn’t respond normally to any stimuli; cold, heat, or sexual. Even the normal sleeping reactions were diminished.

If you have had good results with your mesh implant over nine years then you’d hope the problem would resolve as the strained area heals. You probably don’t want to try to make it heal through more activity though, You might start a bad cycle of constant inflammation.

I would let it rest and see if it resolves. Just my view, from my experience. Good luck.

[Damien10]

Thanks for your kind words. All functions as far as I am aware have returned to normal. I’m guessing my other “issues” were anxiety based due to the pain I had felt in the past. Today, I’m not in any pain whatsoever but I haven’t been to the gym in over a year so hopefully all is healed. I’m hoping that it was a scar tissue problem and not a mesh coming loose problem. Anyway I shall see in a couple of days when I start back physical activity. This was a wake up call to me that my body is fragile even 9 years after hernia surgery and I need to listen to it more.

Are meshes new? Are there people living with mesh for 30 and 40 years etc? All this mesh talk got me thinking about what the future holds for me as I age…Will the area get weaker and would the mesh disintegrate etc.

[Good intentions]

Just realized that I was on Page 1. Double posted, told the same story.

The mesh shrinks over time as tissue grows in and shrinks itself. The question of time is a big one, especially since the quantities that are being implanted have grown dramatically. They’re covering side to side and top to bottom now if they can.

[Damien10]

I think I may have found the culprit. I shall be bringing this up with my Doctor soon,

I believe that one of two things occured.

One being that I got an injury(scar tissue probably) during my workout resulting in a seroma being formed resulting in the area becoming inflamed etc. This seroma calcified forming some sort of blockage of the spermatic chord.

Another idea I have it that the edge of the mesh somehow sits near or on top of the spermatic chord causing disability. I am a bit sceptical about this because I don’t suffer any debilitating pain and the area is pretty much pain free. Also in the early days constant use of ibuprofen resulted in the pain leaving.

Anyone have any opinions to share especially any experiences with seromas etc.

[Damien10]

Anyone in here familiar with the cavernous nerve? Is it possible for the cavernous nerve to interact with or even be damaged by the hernia mesh? Can excess intra abdominal pressure stretch the hernia mesh and this particular nerve?

Can the doctors provide some insight?

[DrEarle]

Damien – The cavernous nerves are not anatomically related to your hernia repair and mesh placement. Further, if the hernia repair was 9 years ago, and you have been fine the entire time, it seems less likely for the repair to tbe the culprit, even if some scar tissue was torn/stretched. Therefore, it is not logical the two could be related. Having said that, the human body is quite complex, and there is no good test to see pain. The groin is complex, with lots of muscles from the abdomen and leg attaching to the pelvis in that location. Further, there could have been a torn tendon or aponeurosis (like a tendon, but a large flat one that covers the surface of the muscle) as the cause of the pain, and with constant use during normal activity, these can be notoriously slow to heal, and even require operative exploration for diagnosis. I have seen this once during a reoperation for groin pain after open hernia repair, and repairing the torn aponeurosis mostly resolved the pain, but not completely. Finally, erectile dysfunction (ED) also has multiple causes. If that is the main concern currently, I would suggest seeing a urologist who specializes in ED, and looking for more common causes of this. Since we’re in this forum, my opinion would be that mesh removal would have a low probability of solving the ED problem. The chances aren’t zero however, but I would look in to more common causes first. Hope this helps! DE

[Good intentions]

quote Damien10:

Anyone in here familiar with the cavernous nerve? Is it possible for the cavernous nerve to interact with or even be damaged by the hernia mesh? Can excess intra abdominal pressure stretch the hernia mesh and this particular nerve?

The problem that I had, mentioned above, was very concentrated at the corpus cavernosum. The corpus spongiform was still functional. It was very strange.

I also ended up seeing a urologist, part of the same clinic that performed the mesh implantation. He even knew the surgeon who did the hernia repair. It was a complete waste of time and money. His only comment was about how sometimes they have to cut through mesh to remove prostates. He had no ideas at all about what might be the cause of the problem. To make it worse, once the surgeon who referred me labeled my problem as “ED” instead of mesh-induced pain and dysfunction, my insurance company refused to reimburse. “ED is not a hernia repair related issue, claim denied”. I called the insurance representative and she understood the situation and said she’d clear it up but once I got the label it could not be removed. The connection to mesh got broken, in the system, and I ended up paying full fee to listen to a guy tell me he didn’t have a clue. The surgeon who did the work was off the hook also.

Once the mesh was removed full function returned. The correlation is very clear.

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