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  • Possible Hidden Hernia?

    Thank you for this awesome forum and for taking the time to answer questions. I'm a 60 year old female RN living in the Bay Area. I have a family and personal history of hernias along with a history of heavy lifting. I've had a large left inguinal hernia repair and have a small right inguinal hernia that doesn't seem to cause symptoms. My history includes a cystocele - rectocele repair in 1994. In 1996 I noticed that my cervix had shifted into the right side of my vagina. At the same time I started having infrequent, intermittent, severe right groin pain. Over the years this pain has become much more frequently severe. Both sitting and standing can increase the pain. Lying down or walking tend to bring relief although at times nothing helps. I have developed severe constipation which will coincide with a dramatic increase in the intensity of the pain and nausea.
    While living in NY I was a patient of Drs. Conway and Quesada. Recently, I have been seeing Dr. Hibner and Dr. Castellanos. My diagnoses include pudendal and obturator neuralgia. Treatment, thus far, has been unsuccessful. The current plan is surgery to remove my uterus and possible scar tissue that seems to be pulling it into my right side. While the possibility of an internal hernia hasn't been ruled out I haven't been diagnosed with one either.
    The pain is best described as intermittently severe, pinching and burning. Externally it is near the area of my femoral pulse, however, the pain is somewhat deep in my pelvis. It is reproduced by pressing on a specific area on the right side of my vagina. While it radiates sometimes when severe it is mostly very localized and specific. I can easily point to the epicenter of the pain. It never moves around. I am 5'1" and weigh under 110 lbs. just in case that matters.
    A reason I think it could be a hernia is that I sometimes feel a sliding, popping sensation that reminds me of the sensation I would get when my other hernia would pop out. I had that hernia for over 15 years before it was repaired because it was undetectable on exam unless it was protruding. Several doctors looked at me like I was crazy when I told them I had a hernia there. It was only diagnosed when it happened to be protruding during a visit to a surgeon for a different matter, so I know these things can be a challenge to diagnose. Recently I feel pressure and discomfort at the site of the repair which makes me concerned about whether the repair is holding. I greatly appreciate any advice or input you can give to me.

  • #2
    Possible Hidden Hernia?

    Sounds like it could be an obturator hernia, which is difficult to diagnose. Involving an experienced hernia surgeon at the hysterectomy can help diagnose and treat this if it is present. You can find surgeons interested in hernia repair at the Americas Hernia Society website. Best of luck! You're not crazy. DE

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    • #3
      Possible Hidden Hernia?

      Thank you for your response and for the reassurance that I'm not crazy. I knew I wasn't crazy as I had a lime size protrusion in my groin that would come and go. It was obviously a hernia.
      When I go to the AHA site to find a surgeon it asks me for the physicians name, which I don't have. My home is in the Bay Area of CA, but my hysterectomy is to be done in Phoenix, AZ by Dr. Castellanos. I would be willing to travel to LA (or elsewhere) to see a hernia specialist if there are none in northern CA or Phoenix. If most of my pain is due to a hernia my priority would be to get that fixed and see if the pain resolves, especially if it is an obturator hernia, as I understand that these can be dangerous if undiagnosed and not repaired. For quite some time I have suspected that I have regular episodes of partial bowel obstruction. Now that I've learned more about obturator hernias this concerns me.
      Could I have developed an obturator hernia from POP surgery that involved going through the obturator foramen?

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      • #4
        Possible Hidden Hernia?

        If you're going to be in Phoenix, look up Dr. Conrad Ballecer. Let him know all the details, and ask him to check for an obturator hernia as well. All the Best. DE

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        • #5
          Possible Hidden Hernia?

          On the AHS website (www.americanherniasociety.org) you can just click on your state and a full list will show you member surgeons.

          In San Francisco, Try Dr Hobart Harris. He is a senior surgeon and should be able to help diagnose and treat an obturator hernia. Let him know you were referred by HerniaTalk.com. I'm also happy to see you down in Los Angeles.

          I have not seen reports of hernia after trans-obturator tape sling.
          #ItsNotJustAHernia
          www.BeverlyHillsHerniaCenter.com

          Comment


          • #6
            Possible Hidden Hernia?

            I very much appreciate the time and dedication that goes into making this forum such a wonderful source of information. My cystocele/rectocele repair surgery was done in 1994 and I'm told that it is unlikely my surgeon would have used a sling. I've made an appointment to be seen in LA in October. It's reassuring to know that I will be examined by a physician who is so experienced and knowledgable.

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            • #7
              I am in the same boat.

              I am a 34 year old 118 lb female.
              I have been in pain for over 4 months now in my lower right pelvis area /just over from hope bone between hip & pubic bone.
              All doctors kept saying it was just a muscle strain ( even though I have a slight swelling like a rounded triangular shape). Sent me to CT scans and ultrasound. Both showed nothing.

              It started as a warm almost like a hot compress over a consistent cramp feeling. Went away for a bit and I did believe then that it was a strain and was gone. But then it came back and the pain is worse then ever. I feel it all day, every day, sitting or standing. Sometimes dull, most of the time vwey sharp. Like a tight sharp cramp. I do also feel gurgling, popping sensation. That when I put my hand over it feels like an alien moving around.
              The area also has bulgy veins across and around it. I get swelling in the pelvic area and it's firm. On occasion, I've experienced stabbing like sharp stomach aches around my stomach sides and all over the abdomen or lower stomach.
              i can now also see a slight swelling continued down from the bulge, almost like the U shape of an intestine or uterus. Does that mean my intestine is falling out or stuck? I was having harder to pass bowels, but that's gotten better/ normal.

              It wasn't until I went to a private ultrasound place that they found what appears to be a " right & also left bowel containing inguinal hernias".
              I am planning/hoping to get surgery by a hernia specialist here in Seattle, WA..... But currently am waiting in the hands of my terrible insurance for them to approve the out of network surgery.

              I do not trust them to perform my surgery, since they kept disregarding mine as nothing. Especially since I'm female and have 2, would prefer an experienced surgeon.

              Dr. Towfigh, do you have any advice on if waiting for the right surgeon can run the risk of incarcerated or strangulated?
              Also any idea what the continued swelling going down pelvis is?? And based on my size, would mesh be safe?

              I'll attach photos (various days apart)
              Thank you!!

              Comment


              • #8
                drtowfigh if you could please take a look at my above post when you get a chance. Thank you

                Comment


                • #9
                  Originally posted by Mariel View Post
                  It wasn't until I went to a private ultrasound place that they found what appears to be a " right & also left bowel containing inguinal hernias".
                  I am planning/hoping to get surgery by a hernia specialist here in Seattle, WA..... But currently am waiting in the hands of my terrible insurance for them to approve the out of network surgery.

                  I do not trust them to perform my surgery, since they kept disregarding mine as nothing. Especially since I'm female and have 2, would prefer an experienced surgeon.
                  Be careful, and don't rush. You are on the path for bilateral mesh implantation. They are probably planning exploratory surgery based on the imaging results, but ready to implant mesh if any sign of herniation is present. The "standard of care" is to implant as much mesh as can be fit in to the area. Low body fat small women seem to be a high risk category for chronic pain or discomfort after mesh implantation You could easily end up in a much worse situation that you are now with two large pieces of mesh implanted across all of your lower abdomen. It's what they do now.

                  You might have better luck contacting Dr. Towfigh's practice directly. The contact info is on the site somewhere, but also here on her Twitter page, below. Good luck.

                  https://twitter.com/Herniadoc

                  Comment


                  • #10
                    Be careful, and don't rush. You are on the path for bilateral mesh .... implantation. They are probably planning exploratory surgery based on the imaging results, but ready to implant mesh if any sign of herniation is present. The "standard of care" is to implant as much mesh as can be fit in to the area. Low body fat small women seem to be a high risk category for chronic pain or discomfort after mesh implantation You could easily end up in a much worse situation that you are now with two large pieces of mesh implanted across all of your lower abdomen. It's what they do now.

                    You might have better luck contacting Dr. Towfigh's practice directly. The contact info is on the site somewhere, but also here on her Twitter page, below. Good luck.

                    https://twitter.com/Herniadoc

                    Comment


                    • #11
                      Mariel hard to tell based on the photos.
                      There are excellent hernia surgeons at University of Washington.
                      #ItsNotJustAHernia
                      www.BeverlyHillsHerniaCenter.com

                      Comment


                      • #12
                        drtowfigh Thanks. I am very interested in seeing someone at the UW Hernia center- however, am currently in the hands of the general surgeon my insurance provider allows in network.... Unless he decides to allow the referral to them.
                        Are you familiar with whether anyone at the UW does non mwsg repair OR lightweight mesh for certain patients?

                        I asked the the non UW surgeon whether he can use lightweight mesh based on my being small. He said they use the same Medium weight mesh with laparoscopy repair. And he said he does not do / believe non mesh is reliable. He also said he did not feel a hernia, so I have to get ANOTHER ultrasound and maybe MRI first .

                        Do you drtowfigh know if a smaller framed female would do ok with a medium weight mesh (laparoscopy) / and not likely to have chronic pain? Thank you

                        Comment


                        • #13
                          For ventral hernias, chronic pain is lower risk with mesh than for groin hernias.

                          Search this site for more information about the great surgeons st UW. The search tool is in the menu.

                          #ItsNotJustAHernia
                          www.BeverlyHillsHerniaCenter.com

                          Comment


                          • #14
                            drtowfigh Thanks. I received the results from my ( 3rd now) uktraultra and also an mri. The doctor said "there was no sign of hernia. The MRI also did not show any sign of ligament, muscular, or bone inflammation to suggest a "sports hernia" as the cause of your pain. "
                            However, one of the ultrasounds I had (outside of network/on my own) said that 2 inguinal hernias were found. But based on the fact it wasn't done by one of their techs they don't believe it. Do you recommend another way to diagnose ? It's insane that nobody can figure out what's wrong with me.

                            Comment


                            • #15
                              In our study, if the ultrasound showed a hernia, it was always accurate and we believed it. The reverse is not true. If an ultrasound or MRI does NOT show a hernia, it’s often incorrectly interpreted.

                              History is more important than imaging. Imaging helps confirm the clinical suspicion based on history and exam.
                              #ItsNotJustAHernia
                              www.BeverlyHillsHerniaCenter.com

                              Comment

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