drtowfigh
Forum Replies Created
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pain lower right quad for 14 months
Have you seen Dr Clint Eastman?
Also, you don’t have a sports hernia. That’s when you tear your muscle off the bony attachment. It occurs in athletes with large bulky muscles. Your symptoms and activities don’t match that.
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Chronic Pain Post Left Inguinal Hernia Repair
Standing MRI or supine MRI with valsalva are both good.
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Hidden Internal Hernia? At My Wits End!
Have you had any progress or treatment since your last post? I worried about the symptoms you are describing.
A couple of things:
– Sounds like you never had an internal hernia in the past, just an abdominal wall hernia, which was repaired with mesh. Is that correct? Or did you have both?
– the ultrasound shows bulging of the mesh but the mesh looks intact, ie, nothing is coming through the mesh. You can feel a bulge from this, but it may or may not be a true hernia. A hernia is a hole through which things (fat, intestine) can go through.
– why are you coughing violently? This is putting your hernia repair at risk of failure, pulling apart.
– why are you vomiting? Is it due to an obstruction? Did the CT scan show anything abnormal? A swirling sign is not normal. It is suggestive of an internal hernia through a hole in between intestinal layers or mesentery this can occur with any prior operation as well as with gastric bypass.
– just because there is no bowel within your hernia does not mean it cannot be diagnosed on CT. The fascism defect can still be seen if that is the case. However, my greater concern is a possible internal hernia, which is very dangerous if not addressed properly, especially if it is causing your vomiting.If you wish, send me your films to review by mail and sign up for an online consultation with me so we can figure this out. I am concerned about this situation you are presenting.
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Maybe a Hernia?
Shoelace method was done a couple of centuries ago.
Mesh is standard. Non-mesh repair is a good option for some, especially certain women. You surgeon should decide that.
If you have a palpable bulge, most general surgeons should have no problem diagnosing an inguinal hernia. Usually your GP would refer you after examining you.
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UTI? Cystitis? Psoas? Hernia? What is it?!?!
The palpable areas seem to be where a small groin hernia may be. The symptoms of tight psoas muscle, tight pelvic floor muse are consistent with an inguinal hernia. It definitely deserves to be evaluated by a general surgeon with an interest in hernias. Go to the American Hernia Society website to look for a surgeon in your area or let us know where you live andwe can refer you.
Have you been evaluated for interstitial cystitis?
That said, bladder spasm, in the same scope as pelvic floor spasm, can be an uncommon manifestation of inguinal hernias that are symptomatic.
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Could this be a hidden hernia ?
Looking forward to taking care of you!
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Opinions on mesh removal & managing chronic pain
Based on your symptoms, it seems there are no neuropathic (nerve-related) symptoms.
The Parietex ProGrip mesh is a Velcro-type Polyester mesh placed as an onlay mesh. Usually it is not sewn in or a maximum of one stitch is used. Can you describe what technique was used to repair your hernia? Was a separate tissue repair performed before mesh onlay? Was the mesh sutured in place?
It sounds like your symptoms armed due to a tight repair. Tight repairs include symptoms such as inability to stretch out in bed, pain with any fullness, such as full bladder, full colon prior to a bowel movement, full stomach after a meal. Also, muscle contractions, such as during orgasm, can be painful. Physical therapy does not help because the mesh does not stretch and the scar tissue associated with the mesh is not the primary problem.
Mesh removal may be necessary if the pain is debilitating. If not debilitating, sometimes time will allow your muscles to accommodate to the tightness. If mesh is removed, it should be done by a skilled surgeon who does these routinely. Risk of testicle loss is not zero but it is very low. You may or may not need more mesh placed. There are also mesh alternatives such as hybrid mesh.
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pain lower right quad for 14 months
I’m willing to bet you have a straight forward inguinal (groin) hernia. The following signs and symptoms are very consistent with such a diagnosis:
– right lower quadrant pain- radiating down the leg but not below the knee
– pain with prolonged standing, lifting, walking
– pain with pushing on vaginal wall
– best when resting
– burning tugging pain
– cannot carry son
– pain during pregnancyJust because the interpretation of your imaging was negative does not mean that interpretation was correct. In our studies, more than 70% of imaging studies inaccurately diagnosed hernias or completely missed hernias altogether on imaging studies.
I would go to the American Hernia a Society website for someone local who has an interest in hernias. There are no specialists that I know of in AL but I will ask around for you. You may have to travel to get the cure you need. (yes, I meant CURE!)
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Parastomal hernia
Please see your primary doctor, gastroenterologist, or surgeon. These symptoms are suggestive of an intestinal blockage and a physician needs to evaluate him on an urgent basis.
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Could be Worse
Does not affect a tummy tuck
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Hernia or Psoas?
Correct.
Not all hernias cause pain with lifting, coughing, getting out of a car. You have to look at the whole spectrum of symptoms that it presents.
That said, the best is to be seen and evaluated in person to really know what is your diagnosis. The examination is very important as well.
I hope you can get help at the Shouldice Clinic, but if you cannot, please do revert back. I and others in the US are eager to give women such as yourself help in diagnosing your pain, even if it is not a hernia. -
inguinal hernia/recurrent hernia using desarda
Perhaps you can provide more about your story.
Why do you feel you had a botched hysterectomy? How did you have two hysterectomies? How are the hernias related to your hysterectomy?
Did your surgeons lead you to believe that your groin lump was from a hip labral tear or a gynecologic problem?
In general, for inguinal hernias, women are more prone to chronic pain related to mesh repairs than men. That may not be true for you or any specific patient, and so the surgeon should make their best determination as to what is the best repair. Among mesh repairs, laparoscopic mesh repair has a much much lower risk of mesh-related chronic pain than an open mesh repair. And if you choose to have a laparoscopic repair, then it should be done by a specialist who performs laparoscopic hernias routinely and has excellent outcomes.
With regard to mesh vs non-mesh repair, the non-mesh repair is preferable especially among thin young women. If you are overweight, are older, or have a lot of risk factors for hernia recurrence, I usually do not recommend non-mesh repair, as the risk of hernia recurrence is a bit high and the risk of mesh-related pain with laparoscopic repair is so low, relatively speaking.
The Desarda technique is a revival of an old technique that was abandoned in the 1950’s and 1960’s because the recurrence rate was too high. The best validated tissue repairs for women are the Shouldice technique, Bassini technique, and in some cases the Marcy repair. Like laparoscopy, tissue non-mesh repairs are best performed by surgeons who are versatile in doing them. In today’s world, that usually means the surgeon is either older or they are hernia specialists who are versatile in a wide variety of techniques. The tissue repairs are not widely taught anymore in normal general surgery training.
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Hernia or Psoas?
The normal Inguinal canal is a diagonal tunnel that travels through multiple layers of muscle. In women, that tunnel is large enough to accommodate the round ligament, the size of a noodle, and the genital nerve, the size of a thread. So, it’s a relatively narrow tunnel. If it dilates up due to weakened muscles or abdominal pressure, fat, and rarely intestine, can creep into it. In the early stages, the tunnel remains diagonal or angled, and it is hard for contents to easily travel through. If a piece of fat gets stuck in it, the pressure causes pain. Exercises such as Pilates can provide muscle support to reduce the gaping of the tunnel and reduce chances of the hole getting bigger. At later stages, the muscles surroinding and supporting the tunnel gape open, the tunnel is no longer a diagonal narrow tunnel, rather a wide direct tube or hole that allows for contents to go in and out. That is when a bulge is noticeable on examination. Prior to that, imaging is helpful to detect a hernia.
I usually do not offer laparoscopic exploration prior to imaging as there are instances where non-hernia diagnoses arise, such as hip labral tears, sacroiliitis, tumors, which may explain the groin pain. Also, once the hernia diagnosis is made, the discussion about the type of hernia repair is an important discussion to be had. Laparoscopic repair may not be the right choice for each patient. So preoperative planning is very important in order to tailor the repair to the needs of each patient. -
Thank You!!
I’m not sure where people got the misconception that women don’t get hernias, because they do. They just don’t get it as often as men. The ratio is quoted to be about 7:1 male:female ratio. Most of these are regular hernias, not femoral hernias. Femoral hernias are rare, even for women. However, women are more likely to get them, by a factor of 10. Does that make sense?
My personal bias is that th 7:1 ratio is probably underestimating the true number of women with hernias. There are probably many-fold women that have hernias that are undiagnosed or misdiagnosed. You and others may be perfect examples of such.
In any case, the likelihood that there is intestine in most hernias is low, especially small ones. It is usually fat. Obesity has not yet been linked with development of groin hernias. Nor has rapid weight loss. Exercise and muscle strengthening is protective against hernia development. Perhaps the weight loss has allowed you to notice the bulge better. That is a plus, because it makes the diagnosis easier.
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Hernia or Psoas?
Wow, I wish all my patients came with such thorough and insightful histories. Thank you for that!
Well, you hit every single point that I usually tackle during the detailed hernia questionnaire that we go through during consultation (you can find a copy of it on my website if you don’t believe me!). You pretty much said “Yes” to everything on our list: pain at the groin that radiates up and around to the back and down the upper thigh, worse with sitting and standing, best with lying flat, associated nausea and bloating, notably worse with bull bladder and pain lingers after a bowel movement. Exercise does not make it worse, as most exercises do not cause an increase in abdominal pressure.
You do have a risk factor of hernia: family history. And we have noticed that a female link is stronger than a male link.
Ultrasounds for hernias must be done as a dynamic study. That means, standing, coughing, walking around. It should never be done while lying flat. That would likely result in a “false negative” study, that is, a report that says there is no hernia, when in fact there is one. In our study, we found that for small hernias, 50% of the time, the ultrasound was falsely negative. It is possible that this is because of technique more than the ultrasound quality itself.
If there is no actual bulge at your groin area, but your symptoms are suggestive of an inguinal hernia, then you fall into the category of an occult or hidden hernia. This is most likely to be found among women. In these circumstances, I recommend an ultrasound, and if that is not diagnostic, then a dynamic MRI. We have noted in our studies that the dynamic portion of the MRI pelvis is actually highly important in helping diagnose small occult hernias. A flat MRI pelvis may be adequate in many situations.
So, based on this assessment, which, granted, is based on your story, without any review of your films or any examination…
I do recommend that you seek a hernia specialist for your situation. You can start with a general surgeon who has interest in hernias, but most are not in tune with the concept of occult hernias among women, and so you may need to be patient and seek another consultant if the first one does not provide you with an answer to help rid you of your pain.
I am not familiar with specialists in Alberta. You can first try the Americas Hernia Society website (www.americanherniasociety.org) to see if any members live in your Province. The Shouldice Clinic in Ontario is another option, and I am in contact with them to discuss the concept of occult hernias among women.
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Could this be a hidden hernia ?
Ok, good luck.
Dr. Ramshaw can at the least confirm your diagnosis and point you in the right direction. Good luck with that and thanks for keeping us in the loop.
CPR involves a lot of ab-work. I can imagine it can definitely irritate a hernia.
Your CT did show a hernia of the right groin, and MRI confirmed it. The repeat CT scan you had recently should show the same. The reading may not have focused on it, which is not uncommon, unfortunately, as hernias are often not read or misread. This is the reason that I insist on reading my own images and do not rely on reports alone. We are trying to publish our results on exactly this problem, as we have noted that the majority of CT scans (70-80%) are either misread about hernias or no hernia is commented on at all, despite the fact that there is one on the image. Radiology is truly more of an art than a science.
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Maybe a Hernia?
Yes. Definitely can be a hernia. The area of your pain (to the side of the pubic bone, but not yet at the level of the hip bone), the type of pain you have (feel it in the labia, the leg, when coughing, with vomiting), noticing a slight bulge in the area… all are pretty classic for a hernia as noted in women. It is possible you may have a small one on the opposite side, too, based on your symptoms.
I do not recommend an MRI for all patients. It should be reserved for patients with prior hernia repairs and with those who have occult hernias (i.e., hernias that are not able to be found on examination but there is high clinical suspicion for them). In your situation, you are noting a slight bulge already. A dynamic hernia musculoskeletal ultrasound alone should be adequate, and if performed correctly should confirm the hernia diagnosis. In fact, if the examination is diagnostic of a hernia, no imaging is necessary. This is a very important point.
So, please seek consultation with a general surgeon who has interest and experience in hernias. A list may be found on the Americas Hernia Society webpage (www.americanherniasociety.org), by state, based on their membership with the AHS.Lastly, if you indeed do have a hernia, and you plan on having an operation such as the VBLOC, then it would be up to your surgeon to determine if he/she would like to perform both operations at the same time. In some situations, the surgeon may want to ask a second surgeon to perform the hernia repair, if he/she does not routinely perform laparoscopic inguinal hernia repairs. I personally do not believe there is a contraindication to performing both procedures at the same time. They are both “clean” operations. However, I would defer to the preference of your surgeon to determine the plan of care.
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Are these symptoms of an “occult female hernia?
Try Dr David Chen at UCLA.
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Feeling frustrated
Sometimes there are small “epigastric hernias” in the middle between the belly button and the lower rib cage area. A piece of fat can get trapped there and cause pain with certain crunches. That is the only thing I can think of that may be causing your pain that would be hernia-related. An ultrasound or CT scan should identify it. Surgery will cure it.
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Feeling frustrated
Where exactly is the cramp? Do you have associated bulge, nausea, radiation of the pain elsewhere? Any other activities cause the pain, such as coughing, bending, lifting?