Inguinal Hernia as a Cause of Pudendal Pain

[donstore]

An inguinal hernia is often characterized by groin pain that is mild in the morning and gets worse throughout the day and is often aggravated by sitting or standing or lifting but you need a doctor that is looking for this problem. It can often be diagnosed by ultrasound preferably one that is dynamic where the patient is standing as well as bearing down. Many times these hernias are occult, that is they cannot be diagnosed by the conventional methods. When the patient lies down they withdraw into the abdominal cavity and cease to irritate the nerve that is causing the pain. Diagnosis by ultrasound only has a 33% sensitivity and often further tests can be performed for the diagnosis. The next step would be a CT exam with dye where the patient lies on their side and performs the Valsalva maneuver, that is bearing down in order to push the hernia through the small tear in the in inguinal canal. This exam will often show asymptomatic extra peritoneal fat masses pushing through the abdominal wall. Clinical correlation is required. After that an MRI of the groin has a 95% sensitivity and should be used in patients with clinically uncertain correlation. Even after all this imaging studies are not always successfull in diagnosing an inguinal hernia. Often the only way to find it is through the fingertips of an experienced and dedicated hernia specialist. Repeated standing and squatting straining etc. are often necessary during the physical exam to find the problem. Obesity makes it even more difficult and even more necessary to find the right doctor. Many doctors will dismiss this diagnosis if they cannot feel a bulge during a physical exam. Negative results of imaging studies also often make many doctors hesitant to pursue the diagnosis. No one cares as much as the patient. You have to be persistent. The good news here is that hernias are easy to fix. More than 600,000 of them are repaired every year in the United States.

Don
Mild to moderate PN for 5 plus years, pain controlled by lyrica and opiates.
Nerve block (unguided) 9/10 Dr. Jerome Weiss - sciatica for 5 months but got numb in painful perineal/scrotal area - he diagnosed entrapment - but no more cortisone for me
PT- 5 sessions with Liz Rummer - no change
Potter MRI 5/11 - rt STL entrapment of PN at Alcock's - also impingement of ilioinguinal and genitofemoral nerves
Consult with Dr. Hibner Feb. 2012

[kathyd]

Hi Don
Thx for posting the info about inguinal hernias.
I have wondered about hernias in my case. I know my main doc kinda dismised the idea, but she unfortunately has been wrong several times about me.
My pain is so intense and came on very gradually beginning with bladder symptoms that are still there, then sit pain and rt side vulvar pain, and finally severe anal rectal which set in 3 mos after a nerve resection surgery with Dellon..Thus I suspect the latest pain was caused by the surgery.
I also have one Tarlov cyst which I will investigate with a knoweledgable doc soon.
Im also the gal who had embolization done on one side as per Dr Potter's advice with no change
Hernias is the one area left which we haven't checked out.
It seems like hernia pain would not be this excruciating?
Thx for the info.

[Ruby]

This is mostly good information, but I'm concerned about the conclusion that "The good news here is that hernias are easy to fix. More than 600,000 of them are repaired every year in the United States."

Please, please, be very careful with any hernia repair surgery, as usually surgical mesh is used. This gives excellent anatomical repair but can lead to a host of undesirable complications, including intractable chronic pain.

http://meshmedicaldevicenewsdesk.com/re ... ould-know/

You don't want to trade one chronic pain condition for another. Hernia repair can be done without mesh but it is difficult to find doctors who know how. It's easier to get the right procedure the first time, than try to undo the damage later.

[kathyd]

Hi Ruby,
Thx for this valuable info.
Its so hard to know what the cause of this pain is..But if I ever did need the surgery I would heed your warning about the mesh.
There are so many things docs don't tell us. Who can we trust?

[donstore]

As Ruby says there is a chance of pain following hernia surgery. With that in mind you would want to research and select your surgeon very carefully as well as the method of repair. Try to find a doctor (preferably an old doctor) who only does hernia repair and is quite experienced in just that area to minimize the chance of problems following surgery. A hernia pressing on the nerves in the inguinal canal can cause pain in any of the areas inverrated by the nerves that run along the inguinal canal. This is statistically one of the most common reasons for pelvic pain.

Don