“How Hernias Can Cause Pelvic Pain”

In Female Pelvic Pain, Male Pelvic Pain, Post-Surgical Pelvic Floor Rehabilitation by Stephanie Prendergast59 Comments

 

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This week, our guest writer Dr. Shirin Towfigh will discuss Inguinal Hernia’s and how they may be related to pelvic pain. 

Hi all. This is Dr. Shirin Towfigh. I am a Board Certified General Surgeon who specializes exclusively in all things hernia, with specialty in hernias among women and complications related to hernia repair. Inguinal hernias are a common and under diagnosed cause of pelvic pain. Here, I’ll share my secrets, tips, and tricks on how to accurately diagnose  inguinal hernias. Early and accurate diagnosis can lead to reduction in cost and suffering!

 

SIGNS & SYMPTOMS OF AN INGUINAL HERNIA

What is an inguinal hernia?

A hernia is a hole, usually through a muscle or fascia defect. Most hernias occur through natural weaknesses or natural holes. This is true of the inguinal region, where the inguinal canal is a natural tunnel through multiple muscle and fascial layers. In men, this allows for the spermatic cord contents to travel through. In women, it is much smaller and only fits the thin round ligament. Any hernias in this region are called indirect inguinal hernias. They are the most common among both men and women. Other hernias in the groin region include direct inguinal hernias (weakness through the transversus abdominis muscle), femoral hernia (medial to the femoral vessels, through the femoral space), and obturator hernia (through the obturator canal).

 

What is an occult inguinal hernia and how can it cause pelvic pain?

As the topic of inguinal hernias evolves, my practice has been at the forefront of studying and promoting the entity of occult inguinal hernias. These are hernias that do not present with a palpable bulge, and yet they are quite symptomatic. We see these mostly among women. In my practice, women comprise of 82% of those with occult hernias, whereas 88% of males present with the more typical hernia with a palpable or visible bulge. Many believe that a small hernia that can barely even be palpable cannot possibly cause any pain. Au contraire mon frère. The smaller the hernia, the more the associated pain. Imaging can help diagnose the majority of these hernias if there is a clinical suspicion. Hernia repair is a cure. In my series, 87% of those with occult hernias are pain-free within weeks of their hernia repair, and 93% had resolution of their preoperative pain by undergoing hernia repair.

 

How do you get inguinal hernias?

Inguinal hernias are common and can occur in a person of any age, with any lifestyle. In fact, we feel that most of the hernias that we treat have an underlying genetic component to them. If you have a relative with a hernia then you are likely slightly more likely to have a hernia. In my practice, we have noted that specifically having a female relative with a hernia confers an even stronger genetic link to hernia formation.

In some cases, patients may report a physical activity, such as lifting or moving a heavy object, associated with their hernia. They may have felt a tear or burning sensation in the groin at the time of this activity. Did that activity actually cause the hernia? We don’t know. Most likely, the patient always had a hernia, though occult or asymptomatic, and the strenuous activity resulted in further opening of the hole, or more content pushed through the hole.

Most inguinal hernias are asymptomatic, that is, there is no pain or discomfort associated with them. There may be a bulge in the area of the groin. Also, most of the time, the bulge is reducible.

 

What are risk factors for hernia formation?

Activities that are thought to increase hernia formation include those that increase your abdominal pressure. These include straining to have a bowel movement, straining to urinate, long or multiple labors, repetitive heavy lifting of objects, chronic cough. This is why treating of constipation, cystocele, rectocele, asthma, bronchitis are important prior to any hernia operation.

Obesity has not been validated as a risk for hernia formation, but it has been shown to increase abdominal pressure. It is possible that there is an overall underdiagnosis of hernias among the obese, as they are asymptomatic and a bulge is poorly discernable on examination.

Nicotine use has not been associated with development of a primary hernia, however, it confers a higher risk of an incisional hernia or hernia recurrence after hernia surgery. This is because nicotine directly affects the quality of collagen deposition during the healing process. In my practice, the patient must be nicotine-free (no smoking, gum, or patches) for 6 weeks prior to their hernia repair and is encouraged to be nicotine-free afterward.

 

What activities should be restricted with a hernia?

Fortunately, most activities, including almost all exercises, have not been shown to increase abdominal pressure. These include sit-ups, bench press, weight lifting, dead lifts, and other exercises which one may think would “hurt” a hernia. Only two exercises—jumping and leg squats—have been associated with increase in abdominal pressure, and thus may increase the risk of hernia formation.

Patients who exercise regularly are less likely to have hernias. This is especially true among women. I regularly encourage patients to exercise both before and after their hernia operation. Yoga and Pilates are especially great for abdominal core and pelvic floor strengthening. Cycling and most gym exercises are also helpful. Golfing is safe. I tend to discourage crossfit-type exercises, as they tend to involve a lot of jumping, leg squats, and rapid movements with weights. Anecdotally, I have seen a disproportionate number of patients with groin pain after P90X and Insanity –type workouts.

Exercise is protective of hernias and in many cases can strengthen the pelvic floor and help reduce symptoms of hernias. Most of us hernia specialists do not recommend restriction of activity once a hernia is diagnosed.

 

What are key questions to ask to diagnose an inguinal hernia?

A detailed history is indispensible. By the time I finish my history taking, I can reliably predict if my patient has a hernia as the cause of his/her pelvic pain.

Most men will first complain of a bulge in their groin. Of course, that will most likely be from a groin hernia. There are very few other causes of bulge in that area, especially if it is a reducible mass. A physical examination will help confirm this.

Women with inguinal hernias more commonly present with groin pain than with a bulge. These are sometimes referred to as “occult” or “hidden” hernias. The pain is felt at or above the level of the groin. Half of the patients will have pain that may radiate up to the hip area, around to the lower back, into the testicle or vagina, to the scrotum or labia, down the front of the leg, and/or to the upper inner thigh region. Hernia-related pain never extends below the knee and is never at the buttock or down the back of the leg.

Symptoms can range from a dull discomfort to a disabling searing pain. The size of the hernia does not correlate with the severity of the pain. In fact, the reverse may be true: the smaller the hernia, the more pain associated with it. This may be due to increased pressure within the smaller defect.

Most patients with inguinal hernias have activity-related symptoms. Any activity that places extra pressure onto the inguinal canal and pelvic floor can theoretically cause pain at the hernia. This includes prolonged standing, prolonged sitting, bending, getting in and out of bed, getting in and out of the car, coughing, laughing. Sexual intercourse and/or orgasm may be painful. In women, ¼ of my patients report worsening pain during their menses.

Nausea and/or bloating are common complaints associated with hernias. I see this more often among my patients with pain. It seems that the nausea and bloating are the patient’s manifestation of groin or pelvic pain. Contrary to fears, most hernias contain fat only. It is uncommon for inguinal hernias to contain intestine, unless they are large. Even most scrotal hernias contain fat as their primary content.

 

What are tips to performing an accurate exam for inguinal hernia?

 

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The patient should be examined in standing position. This allows for gravity to accentuate any small hernia.

I approach the inguinal hernia exam in a very anatomic way. First, I identify the anterior superior iliac spine (ASIS) and the pubic tubercle. The line from the ASIS to the tubercle delineates the inguinal ligament. A typical inguinal hernia will be felt along this line, usually at the 60:40 mark (i.e., 40% of the way up from the tubercle, 60% away from the ASIS). Remember that the inguinal canal is typically oblique.

If there is a mass felt anatomically lateral to this 60:40 mark, which is thereby lateral to the femoral pulse, then this is not a hernia. More likely causes of masses felt lateral to the femoral pulse include abscess, lymphadenopathy, femoral artery aneurysm, or AV fistula.

 

What are examination findings for an inguinal hernia?

Large inguinal hernias of the indirect type, will have a scrotal (or labial) extension. If of the direct type, the hernia will jut out perpendicular to the lower abdominal wall skin. These are usually reducible and non-tender.

Moderate-sized hernias typically present with a bulge. While the patient is standing, you should be able to see this bulge. I compare the left and right sides and check for disparity in the groin area. Based on anatomic landmarks, you should be able to feel a soft mass, often reducible, rarely tender. Alternatively, a more invasive digital examination may be performed if you are unsure if there is a hernia. In men, use your index finger and start at the mid-scrotal skin; use this as your entry. Follow the spermatic cord cephalad and up to the inguinal canal. Feel the pelvic bone and slide your finger over the bone. Slowly and gently feel the lower abdominal muscles. Feel to feel for a weakness in the direct space. In women, an examination via the labia minora or alternatively through the vaginal wall may rarely be necessary. If you are unsure if there is any hernia, ask the patient to slowly bear down or cough.

For small hernias, an obvious mass or bulge may not be easily seen or palpated even after the maneuvers described above. In my experience, tenderness alone at the internal ring (the 60:40 mark) is diagnostic of an occult inguinal hernia and demands further workup, such as imaging, to confirm the suggested diagnosis. We found that point tenderness at the internal ring is 88% specific for an occult inguinal hernia.

 

DIFFERENTIAL DIAGNOSIS OF INGUINAL HERNIA VS OTHER SOURCES OF PELVIC PAIN

What are the various causes of pelvic pain?

Pelvic pain can arise from the abdominal wall, pelvic floor, intestines, uterus, ovaries, hip, and spine.

How can you determine if an inguinal hernia is causing or contributing to a person’s pain?

There are two very specific findings you can elicit from the history of the person that will raise inguinal hernia high on your definition

   1. Activity-related pain

The symptoms of a hernia are often made worse with activities, similar to the symptoms of myofascial pelvic pain and unlike the symptoms of other pelvic pain (gynecologic, urologic, etc). Hernias are typically worse with activities that cause an increase in abdominal wall pressure. This includes pain with prolonged sitting, prolonged standing, bending, coughing, and laughing. This also includes pain with activities that involve engagement of the abdominal wall, such as getting in and out of a car or bed, pulling open a heavy door, lifting a heavy object/pet/child, and sexual orgasm. Not all patients have every single activity-related pain, but they usually have a series of them. It is uncommon to have constant unrelenting pain alone without exacerbation with activities. In these situations, the patient may have an incarcerated hernia or femoral hernia.

      2. Pain to the touch

Aside from myofascial pelvic pain, very few other causes of pelvic pain are reproducible to the touch. Patients with pelvic pain due to inguinal hernia will be able to point to you exactly where the pain is felt. If you know your anatomy, you will notice that their pain is at the inguinal canal. They will point at or above their groin crease in an area between their anterior superior iliac spine and their pubic tubercle. They may also have sensitivity to touch. They will report pain when leaning over a sink, such as to shave their face, wash dishes, or brush their teeth. They may be unable to wear belts, jeans, or constrictive underwear. Some patients come to my office wearing baggy sweatpants; the women tend to wear soft leggings or skirts. When examined, they may hunch over in pain and be hypersensitive to touch.

 

Can it be the Gastrointestinal?

It is not uncommon for patients with inguinal hernias to also be constipated, which likely contributed to the hernia in the first place. Also, they may have pain when their colon is full, just before a bowel movement. When straining, they may have lingering pain after a bowel movement. Some present with nausea and bloating. This is a manifestation of their pelvic pain and there is no actual intestinal involvement with their hernia. I have seen a lot of patients with hernias that had colonoscopies and full gastrointestinal testing as part of their workup, which was normal.

 

Can it be Gynecologic?

The female patient’s pain may increase during her menses. I see this in ¼ of my female patients. This has to do with the hormonal changes during that period. Unlike endometriosis, however, symptomatic hernias have no pain-free episode in between the menses. Also, with endometriosis, there should not be pain felt at the inguinal canal. In rare instances, there may be an endometrioma in the abdominal wall or endometriosis implant along the round ligament that may mimic symptoms of a hernia.

Inguinal hernias may cause pelvic pain during sexual intercourse. This is true among both men and women.

Pelvic floor disorders are related to inguinal hernias. In essence, all are some form of pelvic floor dysfunction, weakness, defect, and they share the same genetic and other risk factors. It is not uncommon to have an inguinal hernia among women who already have known cystocele, rectocele, or other pelvic floor weakness. The reverse is also true.

 

Can it be Orthopedic?

Patients with orthopedic issues, such as disorders of the hip, tend to limp, shift their weight to the other leg, and have pain with certain activities involving the hip, such as running and yoga. Hernias do not cause a limp and patients in general bear weight equally, though in extreme pain, they may wish to favor the contralateral side. In such situations, a hip exam can be diagnostic. This is done by placing the patient in supine position and passively flexing and then rotating the hip internally and externally to assess for pain and restriction in range of motion. Patients with hernias should not have pain or any restriction in motion.

 

Can it be Neurologic?

This is a tricky one. Hernias, especially the occult ones that present without a bulge, may have a neuropathic component as their primary complaint. This is typically pain in the genitofemoral distribution (upper inner thigh, scrotum, labia) as this nerve can travel through the inguinal canal and be impinged by the herniating content. Ilioinguinal neuralgia-type symptoms may also be experienced, especially in larger hernias, due to the anatomic proximity of the nerve overlying the internal ring with impingement by its contents. Sometimes patients undergo direct nerve blocks in the groin region to address this problem. In my experience, we see an increase in their pain if they have an inguinal hernia, and a decrease in their pain if there is a true neuropathic injury as the cause of their pain. I believe the reason for the increase in pain is that the addition of local anesthetic results in volume and added pressure to an area that is already under pressure from the herniated content. In this case, further nerve blocks and even nerve ablations, etc., will not help and may cause further damage to the patient. I see a large number of patients that are initially sent to a pain management to undergo medical and percutaneous ablative techniques to address neuralgia, whereas the cause of their pain was an occult inguinal hernia. Almost all of these patients also had tenderness on examination and activity-related pain. It is important to note that ilioinguinal and genitofemoral neuralgia do not occur spontaneously or de novo. That would be extremely rare. They usually occur due to direct injury either surgically or from a traumatic penetration. Without this history, an inguinal hernia is the most likely cause of ilioinguinal or genitofemoral neuralgia.

 

You are now armed with all of my secrets on how to diagnose inguinal hernias! If the inguinal hernia is symptomatic or increasing in size, address all risk factors for hernia formation and consider surgical repair as an option.

For more extensive details about this specific topic, I invite you to read my book, The SAGES Manual of Groin Pain.

If you have questions about hernias and their related issues, go to www.HerniaTalk.com. This is a free discussion board with surgeons who contribute to answer your questions.

 

Finally, if you would like to have a consultation with me, either online or in person, go to for contact information.

Best,

Shirin Towfigh, MD

Pro Head Shot TowfighRenowned hernia specialist Dr. Shirin Towfigh is the only surgeon in the Western United States whose work is entirely dedicated to treating all types of abdominal wall hernias and their complications. Her rare focus on using all technologies and surgical modalities available in treating this particular area has made her possibly the nation’s single most respected hernia doctor.

Dr. Towfigh’s received her Bachelor’s degree with College Honors from UCLA and her Medical Doctorate from UC San Diego. She completed her surgical training and research at UCLA in 2002 (ranked “Best in the West” for 24 straight years byUS News and World Report), and is board certified in General Surgery by the American Board of Surgery. As a respected medical professor, she has trained medical students, residents, and fellows in Minimally Invasive Surgery at the USC Keck School of Medicine, LA County + USC Hospital, and the Norris Cancer Center.

Comments

  1. I was recently diagnosed with an inguinal hernia, after months of tests to try and find the cause of my abdominal discomfort, including a CT scan. Four days prior to seeing the hernia surgeon in my area, an unplanned conception occured which cancelled the surgery to have the hernia repaired. Since before the diagnosis i have been having intense pain only at night after I get up to Urinate. Could this be related to the hernia? Im terrified about being pregnant with all of this going on.

      1. Recent MRI view of sciatic and obturator nerves 25% blocked by clips holding Marlex Mesh. Now experiencing burning pain from pubic bone to wall (one side) of vagina, as well as inner thigh. Physical therapy, pain meds, ………. not helping. Long wait times to see doctors. I question if perhaps undetected obturator hernia again, or neuropathy spreading from the injured S1 nerve, as well as some injury to obturator nerve, and maybe this is all because of impingement from clips/mesh.

  2. Now 71 yr old lady; suffered many years and through 5 surgeries (including hysterectomy) for endometriosis; then in 1990 surgery for Obturator Hernia. Came out of it with injury to S1 nerve, which has given me neuropathy and CRPS since then. Becoming more troublesome over last 3 years and now pain in the pelvic bone also (i.e into side of pelvis). Often weary of pain, especially the burning pain I sit on. Any comments or suggestions?

  3. Hi There, I am awaiting my appointment with a surgeon to confirm my inlingual hernia.

    I suspect this has been an ongoing injury that is being re-aggravated by exercises like jump squats.

    Is it common to have increased gas and bloating when the hernia is irritated?

    Thanks

    1. Author Dr. Shirin Towfigh says:

      Yes, for sure.
      Bloatedness is a common complaint with inguinal and umbilical hernias. Some also have nausea. These are seen even when only fat and not intestine is involved in the hernia. Also, these are seen regardless of the size of the hernia; i.e., even small hernias have such a symptom.

      S Towfigh

  4. I have had Mri and,ct scan which did not show anything. I had a hysterectomy and I still have pain two inches below my belly button with exercise that causes bloating and pain into my back . I look 3 months pregnant when it bothers me . I have had this for 13 years . I cannot have a colonoscopy I have a torturous colon . Any suggestions very discouraged.

    1. The only thing that makes it feel better is latex band that applies pressure to my belly. When I sleep at night I have to tuck a pillow under my belly

      1. Author Dr. Shirin Towfigh says:

        Usually, abdominal wall or groin hernias can cause pain that is made better when pressure is applied directly on them. Bloating and pain radiating to the back can also be a symptom of a hernia.
        That said, there is no hernia that naturally occurs 2 inches below the belly button. If there is an incision in that area, then it can be an incisional hernia. Alternatively, this may very well be referred pain from a belly button hernia or pain from a wide diastasis recti.
        MRI and CT scan are both good studies to evaluate the abdominal wall. I recommend having a second set of eyes look at the images themselves to confirm that the radiologist did not miss an abdominal wall pathology. You can seek a second opinion from a local radiologist, seek a second opinion from a general surgeon who reads their own imaging, or if you wish, I am happy to either see you in consultation or have you send me the images and your story via online consultation via my website.

        S Towfigh

  5. Hi Dr. I’m Diane, I have hernia in my intestine.Always feel bloating.Can i send to you my Endiscopy Result Test.I want you tell me.If this hernia i have can be treat.Without surgery.

  6. recently I have started having pelvic pain. I went to the doctor weeks ago when I had just got over a UTI, but I noticed this one was stuborn and lasted longer than any UTI I ever had. I noticed a bulge on both sides of my uretha, which she never commented on. I thought it might have been due to menopause because in June I spotted before and after a 3 day period. This month I have not had one. When I pee there is pain and it doesn’t seem to stop. Sometimes it is more or less painful. I have looked at different things online and will call her on monday, but if she has no answers for me I am going to someone else. I had urine tested, but no UTI. They took pictures, but everything seems normal, but the pain is getting worse and I think it maybe a hernia because the pain is sitting, walking, standing, and sex is out of the question.

  7. My daughter has been suffering from severe pain that shoots up her vagina, along with gastrointestinal problems to include constipation. She has had multiple CT scans, X rays, and the pill endoscopy. She is now schedule for a colonoscopy, and standard endoscopy. I suspected a hernia, but the surgeon insisted she did not have one, because he did not see a bulge. I mentioned an Occult or hidden hernia, and he said yes, but they are rare. This has gone on for over a year, with no answers. She does not respond to anything that is intended to treat IBS. She has not slept in her bed for over year, because in certain positions the pain is worse. She can not sit or stand for long periods without experiencing this severe pain. When urinating, she often experiences the pain shooting up her vagina as well. She wears loose clothing, because she says anything else causes discomfort. She is afraid to do anything that puts pressure in her lower pelvic region, including yoga. I had encouraged her to do yoga, but she is afraid the pain will be triggered. She is only 21 years old, and does not lead a normal life due to this problem. I can not find anyone qualified to test for an occult hernia. They rule it out immediately. I would love some help, and am willing to travel to have her seen.

  8. I have done my inguinal hernia repair on right side 5months back after my surgery am getting groin pain that goes from inner thigh to my knees. And also towards my right buttock n shooting pain in my labia.but am not sure why the groin pain goes to my right buttock? ?am 30yrs woman .

    1. Author Dr. Shirin Towfigh says:

      Upper inner thigh pain within months after surgery may be due to a) nerve entrapment due to scar or mesh, b) hernia recurrence.

      The same is true for shooting pain into the labia, though that is most likely due to ilioinguinal nerve entrapment.

      Buttock pain may be referred pain from a hernia recurrence or referred pain from any nerve entrapment.

  9. Dr Towfigh,
    Following a vagunal hysterectomy 5 yrs ago I could never sit after, 3 years after diagnosed with pudendal neuralgia, pelvic floor dysfunction, si joint, piriformis, etc. by Dr Hibner. I’ve been in therapy all 5 years, I get better & then worse. I noticed a bulge & today was diagnosed by a surgeon with ilinguinal hernia. He uses staples with mesh. He didn’t show too much interest in the pudendal issue. I would like to find a surgeon who has knowledge of pudendal condition in my are or state if possible. San Antonio Texas. How can I find a dr with your knowledge closer to me or I am willing to travel. Thank you

    1. Author Dr. Shirin Towfigh says:

      Your surgeon does not necessarily need to be done by a surgeon who treats pudendal neuralgia. However, it is helpful for the surgeon to help differentiate which of your symptoms are potentially related to your hernia as opposed to the pudendal neuralgia.

      Feel free to post on HerniaTalk.com and we can help you find a surgeon near you. Consider traveling if you cannot find someone.

  10. Hi,
    I am a male suffering with pelvic pain for a few years but only in the last 7 months has it become chronic , I am currently in PT with pelvic pain therapist . I have a small inguinal hernia that I got checked out by a hernia Dr because I thought it was the cause of my problem. In my case there in no lump that can bee seen. They found it on a cat scan. I do have pain at the location of the hernia and my pelvic pain I feel in penis, it’s like a pulling or the feeling of having to pee. This is all of the time. This is the crazy thing all activity that hurt my hernia also hurt my pelvic pain. This includes having sex/orgasm #1, squatting in the gym (don’t do anymore) , going to the bathroom 1 and 2, sitting for a long time and standing for long time. Walking and light jogging feels good. The Dr is willing to fix my hernia problem, do you think this could be my cause? Should I get the surgery?

    1. Author Dr. Shirin Towfigh says:

      Yes. The size of the hernia is not a determinant of which ones should be repaired.

      Hernias can cause chronic pelvic pain and spasm. Pain is worse with sex, orgasm, squats, prolonged standing, prolonged sitting.

    2. Hi Ralph and Dr Shirin, I have had pelvic pain for approx 10 years. I’ve also noticed a small lump to the right of my belly button. One doctor in NYC has noted that I have a belly button hernia as well as what he describes as weakness on my right side. He said he would not recommend me getting surgery. If this is the cause of my pelvic pain I would definitely get hernia surgery.
      I’m curious to see how Ralph is doing at this point? Also is there a doctor in NYC you would recommend? Any other recommendations?

      Tom

  11. I’m scheduled for surgery next month to repair my inguinal hernia. A few days ago, my hernia became incarcerated. I iced my groin and elevated my pelvis and was able to reduce it after about an hour. Does the chance of incarceration increase after it has already happened? I’m thinking about seeing if I can move my surgery date up.

    1. Author Dr. Shirin Towfigh says:

      Yes, once incarceration has occurred, the chances of re-occurrence increases. Can’t predict when it will reoccur. Usually we recommend surgery soon, often within 1-2 weeks.

  12. Hi
    I have been having pelvic pain from endometriosis and adhesions for years along with IC. I’ve had numerous surgeries and finally a total hysterectomy. I have been fairly ok with pelvic pain for the past 14 years. About 6 months ago I had a flare up of symptoms. Pulling pain on the right side especially after a BM. My doctor had put me on calcium carbonate twice a day to deal with osteoporosis along with Prolia. I normally don’t take vitamins because of the IC. Anyway, several days went by without a BM in spite of taking colace. When I finally went it caused the worst pain afterwards. I could barely stand up straight. I was told it was PFD and went for therapy. External Massaging made it worse. The pain was awful. I was put on soma and continued to do the home PT such and lunges and stretching that right tight area. I also did home massaging of that right painful area. It did not get better. The pain was debilitating. I have been on a 6 week quest to find out what this could be and finally got a diagnosis of a small femoral right hernia through a detailed MRI. I also have disc herniation and annular tear at L5-S1. This was finally addressed today with a caudal epidural to help with the sciatica pain.
    Can a small Femoral fatty hernia cause such pain? I have a slender frame -90 lbs – and this is been adding to IBS. I’m so confused. Is surgery the only way to treat. I she been resting and icing for weeks and the pain persists. It is always there. A deep pain in the right pelvic area that worsens as the day goes on and also spreads to the groin area and inner thigs to the inside of knee. It’s very difficult to find information on Femoral Hernias online. Thank you in advance for an information that you can share.

    1. Author Dr. Shirin Towfigh says:

      Yes. All of your symptoms sound like they are from a hernia. The reactions you have to massaging and PT are also supportive of a hernia diagnosis.

      Femoral hernias must be repaired. Laparoscopic with mesh is the gold standard.

      Go to my website http://www.beverlyhillsherniacenter.com or HerniaTalk.com for more information on this.

    1. Hi Charles,

      Please call Dr. Shirin Towfigh’s office at (310) 358-5020.

      Regards,
      Admin

  13. Thank you for an amazing information I know more about Hernia then before.
    Thanks u again

  14. I have been suffering for over two months now with pain on my left side on my pelvic bone. I when to the doctor and they said everything was find with my female parts. I’m still hurting. I’m 56 years old and I also have back problems. I notice it starts hurting when I bend a lot. Can you help me?

    1. Hi Lesa,

      It sounds like you may have a pelvic floor disorder. Unfortunately we cannot make specific recommendations without evaluating you. We would be happy to evaluate you in one of our locations or you can use our website to find a pelvic floor physical therapist in your area that can help.

      Regards,
      Admin

  15. Hello, I am 6 years post vaginal fibroidectomy followed by an abdominal myomectomy 2 weeks later. I woke from the abdominal myomectomy in extreme, searing, biting pain on my lower left side. I have had numerous tests in addition to a laproscopic hysterectomy, no conclusion. I am going for a third nerve block (no results from previous two). Pain Management doctor prescribes the usual “cocktail” of pain killers to relieve pain temporarily, in addition to Lyrica and Cymbalta. Today a general surgeon suggested physical therapy and to seek a psychologist, after an abdominal exam. The only “diagnosis” that I have received is neuropathy/chronic pelvic pain. I am so discouraged. May I beg of a suggestion, please. Thank you so much.

  16. Thank you very much for the expert information. I have had a fairly small right-side inguinal hernia for about six years. I am a little paranoid about surgery, so I am “watchfully waiting” while using common sense. I work on my feet all day, do a lot of hiking, run (jog) 30-45 minutes a day. So far I have only minor pain, and at my age, it would be strange if I didn’t have pain somewhere. Your information is very reassuring. Unless my hernia starts causing pain, I intend to live with it. After all, as my doctor pointed out, I’m not going to live forever anyway. Thanks again.

  17. I have had an inguinal hernia about 35 years ago on my left lower side and recently I have experienced a lot of pain in my pelvic area and across my groin area this just came on suddenly and they diagnose me with Osteo pubis but I still think I have a hernia in the incision area where I had my hernia before because it hurts so bad I can’t distinguish what is going on

  18. I’m afraid I have a reoccurence of a hernia. Pain in lower abdomen right in the same spot as my last one
    My biggest worry is I am on blood thinner after having pe after shoulder surgery. What can I do? Extremely worried

  19. I have a long history of “perineal” hernias and most recently a ventral hernia caused by temporary ostomy. Then another perineal hernia. Also discovered I have a “partial” levator avulsion which I believe has now become total avulsion. Please tell me this avulsion can be repaired. I’m in excruciating pain when sitting, feels like a ligament from back to front of my pelvic floor right side is pushing through into my bladder/vagina/anus. Had to wait 3 months to see a doctor. Upcoming end of July. Can you repair an avulsion of that levator muscle? Please give me hope. If you can fix it, I’ll fly from Eastern US to see you ASAP!!

    1. Author Dr. Shirin Towfigh says:

      Yes, perineal hernias can be repaired. I perform these robotically. The results are highly dependent on your tissue quality. It seems extremely unfortunate that you have so many tears. First, it is important to figure out why your tissues are so weak or at risk. Then repair can have the best outcome. Happy to see you.

  20. Hi Dr. Towfigh : I’m scheduled to have my left inguinal hernia repaired next month robodicly. Right before I’m about to have a bowel movement I have a painful lump where the hernia is located. After my bowel movement the pain and lump go away. Also I’ve been having more frequent bowel movements. Cat scan showed no obstructions. Have you’ve heard of this ? Thank you.

    1. Dr. Towfigh says:

      Sounds like a typical inguinal hernia. The bulging of the hernia can get worse if it is pushed out by the presence of an amount of stool in the pelvis. The hernia repair should address this. Good luck.

  21. Hello, i have an inguinal hernia measuring 2.2×2.4 .It hurts somewhat almost all day on a and off. feels like someones pushing a dull broomstick into me. I saw a surgeon and am scheduled for mid November. Is out possible between now and then that this hernia could just ‘explode’ and Ill be in big time trouble with incarceration or strangulation???/ Im just freaking out about this. Found your article very helpful, especially the part saying small hernias hurt more. I also have an umbilical 1.5x.8 . BTW both of these were missed at a visit to a urologist as i diode not present with any lumps. he ordered a ct to rule out kidney stones. A look under the hood revealed the inguinal. fat containing. Its only after i insisted the radiologist take another look at the umbilical did he come back with a revised narrative. Pleas comment. Also on most likely prognosis…the forecast is a lot of pain,,or is it less with small hernias. he’s doing one at time on two trips to the hospital. Thanks so much John O

  22. Had a CT, showed Inguinal hernia- surgery scheduled 4wks away. Can’t seem to do much of anything without pain, so sitting around a lot, which is causing my back to be sore. Leg pain on same side as hernia, all the way down sometimes. If it was femoral, it would have showed in CT, correct? Having open repair, seemed the better option, but, is it not the better option? I’ve had c-section (bikini). Just thought that incision would be better with open as opposed to laparoscopic? Not sure what to think? And, I keep seeing lawsuits about hernia mesh, this is scary. What questions should I ask surgeon to ensure safest possible repair. I have only seen this after visit to surgeon, I will of course ask them all of the above as well.
    Also, having some pain in other side around same area- should I be concerned?

    1. Author Dr. Shirin Towfigh says:

      Femoral hernia should be ruled out in all women who undergo inguinal hernia repair. This can be done with imaging and confirmed during the operation. Femoral hernias are usually seen on CT scan. I do offer open repair to my patients with Cesarean section, since the scar is more cosmetic—can usually use the Cesarean section scar and maybe extend it a little bit.

      The hernia questions you pose are quite complex and deserves one-on-one with your surgeon. For more information, I recommend reading posts on the discussion board, HerniaTalk.com. There are several tagged posts that go into details that are relevant to you.

  23. Are there any doctors in the U.K. who operate on hidden hernias please
    2 years on and no solution and severe pain

  24. I am a 39 yr old woman and I have been experiencing the exact same symptoms of inguinal hernia for the past 2 months. Scheduled for ultrasound soon but can this be repaired without surgery? Thank you for your time.

    1. Author Dr. Shirin Towfigh says:

      Inguinal hernias cannot be cured by any technique other than surgery. However, depending on the situation, some activities may help reduce symptoms related to the inguinal hernia. These include core abdominal muscle strengthening, reducing any straining or abdominal pressure such as with constipation or coughing and weight loss.

  25. I have been having a issue for a while now. I feel as if I have a lesion, or something pressing in from the outside between hip and vagina, into the right side of vagina midway about the level of the vaginal opening. Female exams are said to be normal, and saw a pelvic floor specialist who said no issues. I have significant discomfort along that line between hip and vaginal opening. Are there any hernias in this area? Thanks.

    1. Author Shirin Towfigh says:

      Inguinal hernia in women can present with pain into the vagina on that side. At times, this makes sexual intercourse painful. Pelvic examination may demonstrate some spasm. The inguinal canal lies in the line from the hip pelvis bone and the labia. So, I do recommend that investigation focus on inguinal hernia as a possible cause of the pain.

  26. I am a 51 year old male who had an inguinal hernia repaired with mesh about 19 years ago. I had no complications; but about a year ago, I started having pain in my hip when twisting at the waist or bending at the hip. It was mild at first but gradually got worse. I recently noticed that there seems to be a connection to the incision sit at my groin — for example, if I continue twisting at the waist after the pain begins, it radiates to the incision site. Any suggestion for relieving this pain?

    1. Hi Doug,

      It sounds like you may have a pelvic floor disorder. Unfortunately we cannot make specific recommendations without evaluating you. We would be happy to evaluate you in one of our locations or you can use our website to find a pelvic floor physical therapist in your area that can help.

      Regards,
      Admin

  27. Useful information! I’ve had a hernia problem and now I know more about it then before. Quality repair is essence of good recovery and please educate yourself especially if you are a parent!

  28. I have diastasis recti. it was pretty deep but it doesn’t feel as deep, still as wide. I was exercising pretty heavy when I figured it out, i was doing crossfit. I went to pt for a few months and it started to close. I haven’t been working out lately and I noticed that its back to 2 fingers wide. I have two little ones that i carry around. Lately, if i push to the right of my belly button and maybe 2.5 inches below it, its pretty tender. i have to push hard. could it be a hernia or related to the DR?

    1. Malinda Wright, DPT says:

      Thank you for your comment. It is possible the DR widen. I highly recommend you see your PT again and consult with you doctor. Your doctor will be able to screen for a hernia.
      Kindly,
      -Malinda

  29. I have had a lot of constipation which has encouraged me to push too much when deficating. I am a 76 years old woman and have had lots of illnesses, lime disease, very painful chronic herpes, and many other problems with my body. Now on 2 december 2017, I have had small points ofshooting pains in my upper groin, and been screaming and crying with pain for the last few days. I am urgently in need of finding exactly where the pains are coming from and until I can see my doctor on Monday, and I am just drinking healthy juices and teas until I can see him for a diagnosis, and some advice.
    I live in Portugal and hope I can quickly find a way to improve my situation.
    Look forward to your reply.
    Alice Frankel

    1. It sounds like you may have a pelvic floor disorder. Unfortunately we cannot make specific recommendations without evaluating you. We would be happy to evaluate you in one of our locations or you can use our website to find a pelvic floor physical therapist in your area that can help.

  30. I am another case study for how challenging it can be to get a diagnosis of hernia. Mine was showed no bulge and did not show on CT or ultrasound. I was sent for colonoscopy, X-rays, and physical therapy all while I kept insisting that hernia be considered. Finally, after two years, my primary doctor referred me for a “diagnostic laproscopy” after I began to have serious constipation concerns. At that time, he was favoring femoral hernia while I continued, based on my reading of Dr. Towfish’s work, that it was an inginual hernia. The surgeon went with the primary doctor and thought he would be looking for a femoral hernia. What he found, of course, was an inguinal hernia which he repaired. He commented after that he was “surprised” such a small hernia could cause such pain and other concerns! At least now there are two more physicians educated about the concern. I am recovering well. Two weeks post-op my digestive system is back on track and I am back to most activities!

  31. Hi I have pain and discomfort about and inch to the left of my belly button and an inch down from that towards my groin on my left side. My colon is in discomfort and I’m constipated, I’ve been experiencing shooting spazims and bloating in the area together pain in my groin and testicule on the same right side. When it flares up I also experience cramping and a numb tingling sensation in my arms and hands. Any feed back would be helpful. Thanks

    1. Hi Ty,

      It sounds like you may have a pelvic floor disorder. Unfortunately we cannot make specific recommendations without evaluating you. We would be happy to evaluate you in one of our locations or you can use our website to find a pelvic floor physical therapist in your area that can help.

      Regards,
      Admin

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