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Is it reasonable to believe I have a hidden hernia?


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  • Is it reasonable to believe I have a hidden hernia?

    I am suspecting I may have a hidden hernia.

    In May, I began to have upper right quadrant discomfort and I consulted my general practitioner.
    She ordered tests: Blood Tests = normal
    Ultrasound = Report was for a Complete Abdominal Ultrasound: US Abdomen Complete
    This was normal.

    In July, I noticed that the discomfort/pain was concentrating more in my lower right quadrant, the area to the right of my belly button down towards my groin. My groin area feels started out feeling slightly pulled, but I now feel it more.

    I consulted my gynecologist.
    She ordered a transabdominal and transvaginal pelvic ultrasound.
    Findings: No pelvic masses, No free fluid in the pelvis however ovaries not identified

    My gynecologist also referred me to another general practitioner. I asked him about the possibility of a hernia. He did not believe I had a hernia.

    In August, I went back to my 1st GP and asked about an occult hernia.
    She examined me, but did not give me an opinion about a possible hernia.
    She suggested that I start pelvic floor therapy. Does pelvic floor therapy help a hidden hernia?
    Prior to the appointment I read that MRIs are the most reliable for a hidden hernia diagnosis. She was reluctant to order one.

    Also in August my right leg began to feel odd. This came on slowly and became worse.

    On September 5th I consulted a Gastroenterologist.
    During my consultation he did not give me a reason for my pain/discomfort.
    He did comment that the obscured right ovary was not a problem and that I did not have colon cancer.
    He scheduled me for a colonoscopy. I asked him about the possibility that I might have a hernia. He examined my abdomen while telling me to bear down.
    He commented that he might have felt something.

    I have continued to read more about hernia on the Hernia Talk website and in articles that reference Dr.Towfigh.

    Is it reasonable to believe I have a hernia?
    Since i am having problems with my leg could it be something else?

    I would like to have more testing, but I would like to find a doctor who will order the correct test.
    Could someone please suggest a doctor who is knowledgeable about hidden hernias in Tampa, Florida or within the state?

    I have read about dynamic testing with valsalva maneuvers.

    Should I ask for a dynamic ultrasound with valsalva or should I press for the dynamic MRI with valsalva?
    Also I am wondering if my other ultrasounds would be useful if a radiologist would look at them again for hernia.

    As of now, during the day, the discomfort does not go away. While I am sitting for longer periods of time I notice the discomfort more.
    I have not noticed any other movements that provoke the pain in an intense way. Sometimes I also feel discomfort in my waist.
    I would describe my pain as burning and gnawing. And sometimes I will feel a pinch. My groin feels like it is pulled, but it is not painful.
    My right leg feels different. It feels heavy. It does not feel numb or tingly.
    I am able to sleep. Lying down I feel somewhat better.

    I am 5'”2“" 105 lbs 60 years of age
    My bowel habit changed about 2 years ago to Bristol Stool Chart Type 1.
    I have had a chronic cough for 4 years. I do not feel more pain when I cough.
    I am active and do heavy lifting with some of my hobbies.

    Thank you for your help.
    Last edited by kcm; 09-17-2017, 05:11 AM.

  • #2
    Thank you for your post. By the way you wrote it, it seems you have done a lot of your homework. Also, it seems much of the information you researched on HerniaTalk was helpful. I am glad.

    Yes, your symptoms warrant a more in-depth look into whether an occult inguinal hernia may be the cause of your pain. I am interested that your gastroenterologist may have actually felt a hernia. Were you examined lying on the table or standing?

    None of the ultrasound images you mentioned would look for a hernia unless hernia was actually mentioned as something to look for. A "hernia ultrasound" needs to be ordered specifically. That technique has you do many maneuvers and beardowns and there are specific to look at the abdominal wall itself, not deeper.

    If your doctor was able to palpate a hernia, maybe, then a dynamic "hernia ultrasound" done by a talented technician or radiologist will give you the answer. If it is "normal" or there is no hernia, then I would consider following up with an MRI. The false negative rate for an ultrasound in the setting of an occult inguinal hernia can be as high as 50%.

    Search for Florida in HerniaTalk and you may find some names of surgeons. Those who I know and respect as hernia specialists include:

    - Dr. Eduardo Parra-Davila, MD, in Celebration
    - Dr. Jerrold Young, in Miami
    - Dr. David Edelman, in Miami
    - Dr. Jonathan Yunis, in Sarasota

    You can also search here for others near you:

    The nearest surgeon to you who has a special interest in women's hernias is Dr. Sharon Bachman in Virginia.

    Best of luck.


    • #3
      Dear Dr. Towfigh,

      Thank you for responding to my post.

      My gastroenterologist examined me while I was lying down on the table.

      I have an appointment with a GP tomorrow.
      Is there a specific protocol I should ask for during the physical examination?
      I will also ask her if she would order a dynamic hernia ultrasound.

      Thank you again for your advice. It is most appreciated.


      • #4
        Hi there,
        Checking into see if you had any luck with a diagnosis.


        • #5
          Dear Dr. Towfigh,

          Thank you for asking if I had any luck with a diagnosis.
          I have not received an answer to what is causing my symptoms.

          I had a CT Scan and a MRI (both with Valsalva)
          Neither of these tests showed a hernia

          My GP also ordered an MRI for my Lumbar Spine to check if my symptoms were referred pain.
          I am not sure if any of the below findings can contribute to the pain /discomfort I am having.

          1. Bilateral L5 pars defects result in grade I anterolisthesis at L5-S1.
          Disc bulge contributes to right greater than left lateral recess and neural foraminal narrowing or stenosis without focal herniation or impingement.
          2. Disc bulge at L4-5 without focal herniation or definite impingement. 

          3. Mild osseous degenerative change and mild scoliosis without acute osseous abnormality.

          I also know from reading the general surgery news article
          that only 33% of occult hernias are detected by an MRI.

          I was not sure if it is appropriate to attach the MRI imaging on this forum.
          If it is, I could attach my results.

          What would you advise me to do next? My symptoms continue.
          Thank you for following up with me I truly appreciate this forum and the your expertise.

          Last edited by kcm; 10-29-2017, 06:23 AM.


          • #6
            MRI can miss occult (hidden) hernias. If all other workups have been exhausted sometimes a diagnostic laparoscopy is warranted to look at the abdominal wall/groin from the inside and/or dissecting in the area of concern. I have operated on plenty of patients with a negative MRI, US, CT that have groin hernias found at laparoscopy.


            • #7

              Thank you Dr. Procter for answering my last post. I truly appreciate this forum.

              This is my update:
              I had a consultation with a hernia center surgeon on December 5.


              The doctor did not see a hernia on the imaging, but he saw that there was swelling in the groin area. He was not sure what was causing this swelling. He said with laparoscopic surgery there was a 70% chance that he would find what was going on and he would fix the problem with mesh. He also said there is a chance that the pain & symptoms may go away on their own. As of today, I still have the same symptoms that I listed in my first post, discomfort to the right of my belly button and in my groin plus my right leg feels odd and heavy.


              I was also informed that I had an umbilical hernia. The doctor’s notes stated that he would perform laparoscopic surgery if my right side symptoms persisted or worsened. The doctor wrote that he would repair my umbilical hernia, if needed; at the same time he was doing the laparoscopic exploratory surgery. The size of this hernia was not noted.

              Lately, the discomfort in my mid abdomen is very noticeable and constant. I have a gnawing, but tolerable, discomfort midline from beneath the belly button downwards. Sometimes the pain intensifies. Most days I am more conscious of this discomfort than the original right side pain.

              In early January, I examined my umbilical area and I observed that there is an indentation above my belly button and a slightly swollen oblong area above this crease. I am not sure if I failed to notice this over the past few months or if it is a new development.

              I do not know the size of my umbilical hernia, but I am surmising and hoping that it is small so that it can be repaired without mesh. I would rather not put off surgery if there were a chance my defect will enlarge and then lessen the chance of a non-mesh repair.

              I recently went back to yoga class. I scheduled with a pelvic floor therapist to help strengthen my abdominal core. I also came across the Tupler Technique. These exercises are supposed to prepare a patient before abdominal surgery. Is anyone familiar with this program?

              I have two problems that I know are not good for hernia: a chronic cough and constipation. I am making changes to address these issues. What other activities should I avoid that would cause the defect to enlarge?

              Dr. Towfigh and Dr. Earle your comments on this post concerning umbilical hernia were very informative.

              In regards to my right side symptoms could the umbilical hernia be causing the problems on my right side? I am wondering if the swelling shown on the imaging and the pain/discomfort could be referred pain from the umbilical hernia and not another hernia.

              Although the surgeon was very reassuring during my consultation, I am considering making other appointments to explore my surgical options. I noticed that some of the patients on this forum have had more than one consultation and that the doctors can differ in their approach to repairing the hernia. Please let me know if you have any other advice regarding my diagnosis. I will post again when I have new information.

              Thank you again. The Hernia Talk Forum has been a most helpful resource. I am indebted to all those who contribute their expertise and to the patients who share their stories.


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