drtowfigh
Forum Replies Created
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Does surgery resolve occult hernia pain and symptoms?
Yes absolutely. The main purpose of repairing a hernia is to resolve symptoms.
There is no one repair superior to another. Your surgeon will have that discussion with you and should tailor the repair based on your needs and your surgeon’s practice of preference. The same is true for athletes, male or female.
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Unusual Abdominal Injury
This is clearly an abdominal wall muscle issue and I don’t believe most gastroenterologists will be finding interest in this. I do not feel there is anything intestinal with your story.
The more I think about it, the more I feel you must have had a tear in the rectus muscle. It peaked when it tore off its medial insertion. Then it smoothed out.
Initially, allow your body to heal and follow its natural inflammatory state. Dry needling is good but not in the acute stage. You can dry needle after 6 weeks.
Scar tissue constantly remodels. Do not worry about it. Your body takes care of that. It will not hinder any of your activities.
Minimize rectus muscle engagement exercises. Focus on the transversu abdominis muscles.
Muscles tear when there is an imbalance. For example, it is being tugged more in one direction than another. In your case, either you had not stretched enough, or you made a very rapid movement, or your rectus muscles are too large in comparison with your transversus muscles. There needs to be a balance in order to reduce the amount of strain between muscles. I would focus on that. If you’ve had imaging, you can analyze the girth of each muscle to see which you should focus on more.
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Why is needlescopic hernia repair not performed on adults?
Easy answer: adults are not larger children.
In children: Hernias are anatomical failures to close. The tissue itself is otherwise normal. If you close it surgically, it will heal.
In adults: Hernias are structurally abnormal tissues. They have poor collagen content. The tissue is weak. If you close it like in a child, it will reopen. It needs a mesh to facilitate its closure or strengthen the tissue. Or you need to close it with multiple layers of overlap and accept that a proportion of them may still fail and need mesh. -
Hernia Surgery Risks in an 88yr old Woman
A femoral hernia can be repaired under local anesthesia with some sedation. It is worth repairing especially in a symptomatic patient. The risk of not repairing such a hernia is very high in terms of complications and includes death. â…“ of patients who end up requiring surgery for femoral hernia need it done emergently and among those â…“, 10% do not survive due to complications from bowel strangulation, infection, etc. That is a very very high number. It is best to repair the femoral hernia non-emergently, that is, under controlled elective manner. The assumption is that the patient is healthy enough to undergo repair with less risk for surgery.
I do not recommend laparoscopy for most patients who are 88 years old, even if it is theoretically a superior repair than the open repair especially for femoral hernias. It is not worth the risks of the repair, such as need for general anesthesia.
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Are my symptoms from a hernia?
Some comments:
– hernias definitely have a genetic tendency. In fact in our study, having a female in the family (such as with your mother) has a stronger genetic linkage.
– I agree with Dr Goldstein. Your symptoms do not sound like a hidden hernia or a femoral hernia and let me explain why:– hernias do not cause tailbone pain
– hernias are also usually not crampy. Crampy pain is usually related to obstructions of tubular structures such as the ureter or the intestines.
– lying on the stomach is almost always painful with a hernia
– hernia patients almost never lose weight due to pain or fear of eating due to pain. If anything, they gain weight due to inactivity as most hernias are exacerbated with activities.I would look into internal hernias caused by adhesions or just adhesions alone as the cause of your pain. Though status studies may not show an obvious obstruction, an enterography (either upper GI study or CT/MR enterography) or reevaluation of your prior films may be able to show subtle differences in intestinal caliber or kinking which will lead one to diagnose adhesions as the cause of your pain. If it is so debilitating, and you are not thriving (massive weight loss, for example) and you are otherwise healthy, it may be worth it to perform a laparoscopic exploration, which is an operation.l but it may be worth it’s risks.
You need a general surgeon or a skilled and knowledgeable gastroenterologist who will take his time to look into all of this for you. If Dr Goldstein is offering you his expertise, I would chomp on it! B)
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Trying to Get A Hernia Diagnosis
As we have reported before, a negative ultrasound is not helpful if the clinical suspicion is high for a hernia. That is, there is a high false negative rate with ultrasounds. If there is a clinical suspicion, then further imaging (CT with Valsalva without contrast) may be warranted. That said, for umbilical hernia, a physical exam is all that is usually needed. And if she has discomfort and it affects her daily activities, that warrants intervention.
Before any procedure, I would address the straining with bowel movement. Why is she straining? That is not normal and poses a high risk for hernia development and recurrence after any repair. All straining must be cured prior to any hernia repair. If it is a constipation issue, I recommend to my patients any combination of milk of magnesia, mineral oil, and/or Miralax. -
Post Op Problems From Inguinal Hernia Repair
For some reason, Northern California is completely without any hernia specialists that I am familiar with. Perhaps others can chime in if they know of anyone. Sorry b
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Unusual Abdominal Injury
Thank you for the details as this is certainly a perplexing situation.
I would like to agree with your internist.
I wonder if you developed a tear or the beginning of a diastasis (spreading of the rectus muscles from their insertion in the middle), thus your symptoms. In either situation, there is no active intervention that is taken. Sounds like no hernia. I would not pursue any imaging. I would focus on more transversus abdominis exercises and reduce rectus abdominis and oblique muscle training for a while. That would reduce the strain on the rectus while maintaining your core. There are great forums, videos, and pictures online about transversus abdominis muscle training. Basically it is core muscle training without straining or crunches. These can include planks, squats against the wall, etc.
I would like to hear back from you in a few months after such training. I feel you had a rectus tear or diastasis occur and that is why you had the peak in the muscle and then it settled down with the lingering soreness for a while. Rest it and don’t strain it. No more crunches or engagement of the rectus. Focus on the rest of your core.
I hope this is helpful.
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Post Op Problems From Inguinal Hernia Repair
– pain 2 months after a hernia repair may be due to
A) mesh shrinkage, folding, pulling from the shrinkage
B) indirectly from the tacks (or sutures as the case may be) as the shrinking is pulling on the tacks that are holding it in place)
C) hernia recurrence
D) infection of the mesh (very rare)Tack pain is almost always immediately after the repair and does not present in such a delayed fashion.
You need a thorough evaluation to rule out #C. If there is no hernia recurrence, then dealing with pain from a tightly placed mesh that is now shrinking and pulling on the tacks placed on it is a more difficult problem to deal with. The tacks may have to be removed. Also the number of tacks may play a role in thee extent of pain associated with the shrinkage of the mesh.
I recommend evaluation by a top hernia specialist who has regularly dealt with these situations and is experienced enough to take you through the appropriate workup and treatment plan.
I tend to agree with you that logically speaking you should not all of a sudden have weakening and pooching out of your abdomen from your 4 pregnancies, no so many decades later and despite your athleticism.
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Pain in lower right abdomin
Some facts:
– CT scans are not very sensitive in finding small hernias in the pelvis. If the clinical suspicion for a groin hernia exists, and Cat is normal, a dynamic ultrasound and/or MRI is necessary.
Read this article to help clarify:
http://archsurg.jamanetwork.com/Mobile/article.aspx?articleid=1893806-pain can present with nausea. So perhaps your nausea is due to the hernia pain. I do see this often.
– there are a lot of very good to excellent hernia specialists in Florida, especially South Florida. Please go to the American Hernia Society website and click on Find a Hernia Specialist to find one near you.
– hernia specialists in Florida who are nationally recognized and who I personally know and can vouch for:
Bruce Ramshaw
Eduardo Parra-Davila
Jerrold Young
David EdelmanPlease provide us with a followup. And if it turns out that you had a hysterectomy for naught, please make sure your gynecologist is made aware of your diagnosis.
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Serious Concerns about my five year old daughter.
Please provide us with updates if we can learn from them.
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Looking for recommended hernia experts in Oregon?
Yes.
I already spoke to Dr Orenstein about you. Give him a try. He is at OHSU.
Dr Chet Hammil and the rest of the surgeons listed are also great. They belong to the same group as Dr Reavis and Hansen. -
Does my Grandma have a hernia
CT scan is a poor study for small inguinal hernias. If it doesn’t show anything then a really high quality dynamic ultrasound or dynamic MR pelvis is needed.
Read this:
http://archsurg.jamanetwork.com/Mobile/article.aspx?articleid=1893806
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specialist in (or near) Illinois
You need a surgeon who has laparoscopic surgery experience
Phillip Rosett
Mark Toyama
Mike Ujiki -
Post Op Problems From Inguinal Hernia Repair
Some questions to help clarify your story:
– when was your hernia repair? Vs when did your symptoms start?
– how many tacks were used?
– what does “pouching” mean? -
Female, lower right pelvis in groin area
Hernia pain does not seem to follow the pattern of symptoms you describe. Specifically, it rarely affects gait or weight bearing. These symptoms are often due to a hip problem or other orthopedic issue.
A good orthopedic examination is crucial. I assume you have seen your internist by now. What update do you have to share with us?
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What to tell the ultra sound technician
An ultrasound looking for an inguinal or groin hernia should be ordered specifically as a “dynamic hernia ultrasound.”
The patient should be asked to stand, lie flat, cough, push belly out, rotate hip out, and walk around if necessary. Ie, if a hernia is not visualizable at the groin, then much time needs to be spent to actively force out a hernia, using Gravity and pushing out (bearing down) movements. Videos should be taken of the area and reviewed. Also, in women especially, the femoral region should also be reviewed as should any scars in the area, such as from a Cesarean section.
Ultrasounds are best performed by a skilled radiologist. But, nowadays, that is hard to find. I have one in my town who does it and he is very excellent at it. Most of the time, however, it is done by a technologist and then the still pictures and maybe some video clips are sent to the radiologist to review, without any patient interaction. This, the quality of the images and interpretation are very technician-dependent. As a result, I see a lot of falsely negative ultrasounds in my practice.
If an ultrasound is “negative” and there is high clinica suspicion for a hernia, then another imaging tool should be pursued.
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Passing gas causes some pain relief
Some patients who have groin hernias or abdominal wall hernias note worsening of pain symptoms with meals and prior to a bowel movement. They may feel relief after a bowel movement. However, there are also patients who have constipation and strain to have a bowel movement. Thus the pain after bowel movement lingers.
In short, these symptoms are not necessarily specific to a hernia.
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Serious Concerns about my five year old daughter.
I reached out to Dr Todd Ponsky. He is a renowned pediatric surgeon who is also a hernia specialist. He would like to help you and he feels the situation may be more serious than a hernia. Please contact his office for guidance.
Good luck and please let us know final results.
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Hernia question
Jessica, let us know how you are doing.