Diagnosed with indirect inguinal hernia, and previously, gastritis, lots of questions
Posted , 5 users are following.
So I was recently diagnosed with indirect inguinal hernia. First off, a little about me. I'm early 40's Asian, and I consider myself very fit, as I've been running marathons and usually log in 2000+ miles a year. I get regular health screenings (cholesterol / blood pressure / glucose) and those numbers usually come back perfectly normal. My problem began a few weeks ago after what I thought was a routine workout at the gym, and the next day it felt like I strained my groin. The pain didn't go away after a couple weeks, so I went to a clinic. I told the doctor that though I felt pain, I couldn't pinpoint exactly where it was, only that it was to the right of my groin. After doing some tests to make sure it was not muscular, the doctor felt around and had me cough, and after that he determined I had an indirect inguinal hernia, albeit a very small one, right around where I said my pain was located. I have no visible bumps, and personally, I'm not able to feel the location of the hernia, so I'm trusting that the doctor is competent and knows what he felt.
He told me to go back to see him after a week (last week) to see if it gets better on its own, and it actually did, to the point where I felt totally fine. But this week, I've bounced around from "I can feel it but it doesn't hurt" to "uncomfortable / sore". Today has been worse than the other days, as I've actually had to stop mid-run because I felt like the hernia was getting worse.
Here's where it gets complicated. Back in April, I had intense heartburn and stomach pains, and after a bunch of tests and eventually getting an endoscopy, it was determined I had mild gastritis (if what I had was "mild", I don't want to know what full blown gastritis feels like). Eventually, after weeks of taking Nexium, my symptoms mostly disappeared. (Incidentally, initially I took Prilosec, which didn't alleviate the pain at all). Since then, I would still get occasional days of my stomach not feeling quite right, but I never got the burning throat sensation again, until tonight. Just an hour ago (and hours after the aforementioned run), I had a wave of nausea and burning throat. I couldn't eat dinner as I felt I couldn't hold anything down. In other words, it felt exactly like my gastritis from April.
So here's all my questions:
1) Is there a possibility that the inguinal hernia and gastritis are related, or are compounding / conflating each other? I want to say it's too much of a coincidence that my gastritis is striking back just as my hernia symptoms are getting worse. But I acknowledge it really could be just a coincidence.
2) My doctor was hoping that the hernia symptoms would go away on its own (and it actually did for a week), but he did acknowledge that surgery would be a possibility. Everything I read online is that hernias can't repair itself. Is this true? Once you have a hernia, unless you get surgery, will you always have that hernia?
3) Regarding surgery, he seemed to suggest that because it's quite small, most likely a surgeon would suggest a laparoscopic surgery with simple stitching (ie no mesh). Does this sound right to you? After hours of reading online, I can't determine whether the mesh or no mesh approach is better (depending on which article you read, they're both superior to the other). What say you?
4) I'm going to ask for a referral for a surgeon, but I want to know what questions should I be asking the surgeon? What are the signs that he will take good care of me, and what are the red flags?
5) How likely is it the doctor misdiagnosed my indirect inguinal hernia, and that it's actually something else completely different?
6) My doctor also said that smaller hernias like mine are also more at risk for strangulation. From what I read online, it's quite serious, but what I'm unsure about is how great is this risk? And also, what are the definitive symptoms that I may have it? They say "acute pain", but not where. At the sight of the hernia? Elsewhere? Could (and this is me being paranoid), the symptoms I'm feeling now that I think are gastritis-related be actually nothing to do with gastritis but everything to do with the hernia?
7) Can indirect inguinal hernia pain radiate outward, to, say, inner thigh? I'm feeling a bit of soreness there right now, and I don't know if it's to do with my hernia or simply due to running (ie, typical soreness).I may also just be feeling general weakness due to gastritis, but I really don't know.
Thanks in advance for any answers!
0 likes, 18 replies
patricia43624 unpossible
Posted
Sorry to hear you are experiencing so much discomfort and I am not going to be of much help. I have recently had keyhole surgery for a Spigelian hernia( which was diagnosed at the beginning of this year. ) For three years from first finding the small lump I suffered from terrible digestive problems , gas etc diagnosed with various things including fructose malabsorption. There were lots of foods that I couldn't eat including things like porridge, bread, potatoes. Since I have had the surgery and beginning to eat I am finding that my digestive problems have improved and I am eating things that I have been unable to eat. Don't know if there is a link. Hope all goes well for you.
jonah30439 unpossible
Posted
Hey there. First and for most take your time and don't rush into anything. Do your research and get at least a few opinions from different surgeons. An MRI in the hands of expert can help detect small or hidden hernias and can also rule out other issues-hip issues strains tears etc.
If your surgeon is rx laparoscopic surgery this will use mesh and I would research as much as you can regarding mesh. I had a laparoscopic hernia repair with mesh and it turned out to be a nightmare. It ended up folding up and become rock hard and the ordeal was an utter nightmare. I had to have it removed and it was a 3 1/2 surgery . It is mean to be permanent in your body and there are only a few surgeon in the US who can attempt to confidently remove it. It had to be peeled off my bladder and spermatic cord and was also in some dangerous arteries. I'm not saying this will happen to you but to do your research and ask tons of questions.
If you do have a small hernia it can be repaired the old fashion way unfortunately there are very few doctors who specialize in doing these repairs and you have to seek them out-if you are interested through my research I have found a few if you are interested I can share.
You may also have what's called a sports hernia look that up and research it.
And yes there can be a correlation between hernias and stomach/digestion issues as part of the bowel can be involved in the actual hernia.
I've heard the opposite that strangulation is very rare and
More common with larger hernias
And yes hernia can cause radiation pain Bc there are three nerves located in the ground region that can cause radiating pain or burning to the leg, hip, back and obviously the groin.
But this can also be common with hip issues that can also radiate to the groin
There is an excellent site called herniatalk.com where people ask questions. It is run by dr. Shirwin Towfigh and she answers questions. She is also an expert in reading MRI's.
Good luck. I'd lay off the running and weight lifting for a good amount of time as these can exasperate things.
You said the pain was more lateral to the groin where specifically. On the outside of the thigh/groin crease (more in the upper thigh) or on the inside of the crease.
Btw stay away from anything that can increase intrabdominal pressure i.e. squats jumping, coughing a lot and constipation i.e. Straining to make a bowel movement
unpossible jonah30439
Posted
Thanks for the advice. I do intend to do as much research as possible. Over the weekend I've read a ton on mesh vs. no mesh, and I'm frightened by the number of horror stories I've read, like yours. On one hand, people with problems are more likely to post about it (my observation on the Internet in general... people report the negative and not the positive). But on the other hand, even if the chances of something going wrong is low, are those odds really worth it considering how bad it can get?
As I replied to someone else, I'm hoping to see someone who would offer both mesh & non-mesh surgeries, but from what you said, those are probably rare. I did find a clinic fairly close to me (northern California) who specializes in sports hernia and avoids mesh surgeries altogether. So he's probably someone I want to have a chat with.
Also, regarding sports hernia, though I am quite active, my *guess* is that I don't have a sports hernia, since from what I read, it's caused by a lot of twisting motion. My running involves a lot of straight line motion and very little twisting. BUT, I'm not ruling it out either.
After a full day of no activity, all the radiating pain (and gastritis) has subsided, and I'm back to the general dull to barely perceptible ache in my groin. As I said in my initial post, the pain is actually fairly hard for me to pinpoint exactly where. But according to my doc, it is right on the inguinal canal on my right side, just to the right of my scrotum. I would say it's more on the inside of the crease. I can't feel the bump, or maybe I just don't know what I'm feeling. Doc did say it was quite small.
And yeah. the doctor did mention all the things you said to avoid, like squats / jumping / and straining the bowels.
I'll definitely take some of my questions to herniatalk.com. Thanks!
jonah30439 unpossible
Posted
You are fortunate you are in CA. There is Shirwin Towfigh in CA who is a expert in hernia repair and I heard she is developing a laparoscopic procedure with no mesh where she stitches the defect using a pure tissue repair . She does this for small hernias and people who are thin.
There is also doctor wiiloam brown in San Fran who is an expert in hernias and sports hernias and does not use mesh-specializes in tissues repiars. So you have some great options.
My advice whatever route you take mesh vs no mesh is that you get and expert to do the surgery someone who only specializes in hernias not a genera surgeon who says he/she does a lot of these surgeries.
Even if you have to travel.
The majority of people do well with mesh but there are no long term studies say 20 or 30 years down the line.
Again without debating whether mesh is good or bad the big issue is if something should go wrong it is a nightmare beyond comprehension to deal with. You will be sent off to pain management and then you will be in your own to figure out what to do.
If you go the mesh route I rx seeing a surgeon who also specializes in removing mesh should something go wrong. Dr. Towfigh does this.
But I would definitely lean towards getting a non mesh tissue repair since the hernia is small if there is indeed one. For a non mesh tissue repair dr. Brown is the guy since you are in CA.
Otherwise there is andoctor Tomas in FL who does a non mesh tissue repair called the desarda repair and there is a doctor Kevin Peterson in Las Vegas who also does these repairs and that's about it for the specialists for pure tissue repairs.
Again whichever path you take make sure to see an expert who only does hernia repairs
unpossible jonah30439
Posted
Thanks for the advice.
I've scheduled a consultation with Dr. Brown for this Thursday. From our brief talk over the phone, he seemed inclined to do non-mesh surgery, but he does mesh also. So I'm definitely going to poke his brain at my best option (provided of course he determines I actually do have a hernia... in theory, it still could be something else). But I won't make a decision until I talk with other doctors as well.
Again, thanks for your opinion!
Jeannie74 unpossible
Posted
Dear unpossible,
I will address your concerns in the order presented.
1) I do not think your gastritis and groin pain are related except in the sense that you are anxious and your body is reacting with increased acidity in your stomach area.
2) The doctor is right in that hernias do not reduce on their own. They generally continue to get worse over time. They will also get worse if you continue to engage in strenuous activity.
3) With surgery as your recourse and the apparent size of the hernia, I would just say that procedure and use of mesh would depend on surgeon's personal choice. I will say definitely that the sooner you get this done the less invasive the surgery and the better off you will be.
4)I think the questions you have asked in this forum is the place to start; is it a hernia, is it small and easily treatable, will it progress if I do nothing, what are the risks if I do nothing, if surgery is indicated what procedure will you use and will you use mesh? Also, make sure the surgeon is Board Certified which gives him/ her greater credibility. You will be asked to sign consent form if you decide to proceed but before signing, be sure all your questions are answered and you UNDERSTAND what has been told you. If possible, take a friend or family member with you who can also listen to explanation and help you remember what was said. Also, take written questions with you and do not hesitate to speak up if there is anything that you do not understand.
5) Misdiagnosis is always possible which is why a surgical consultation will give you a correct diagnosis and peace of mind.
6) Hernia strangulation is a reality and can be quite serious. Acute persistent pain is your indicator. While you are waiting for appointment I would suggest no lifting and no strenuous activity.
7) It is quite possible for pain to radiate. Additionally, if you are probing the area yourself , that can also increase soreness and pain in addition to lifting and physical activity that are both strenuous.
I hope this information is useful and your problem is taken care of soon.
God bless
unpossible Jeannie74
Posted
Thanks for the answers.
Yeah, I realized that perhaps stress from worrying about hernia may have triggered my bout of gastritis (which is much better this morning). I remember previously my doctor asking me if I was stressed when diagnosing my stomach issues.
I definitely want to take care of the hernia while it's still small and before it gets any worse. I've read about people who live with hernias and never need surgery, but with my active lifestyle, I don't think that's possible, if only because I'll be constantly worried about doing something that makes it worse. Even if it doesn't get any worse, this on-again off-again feeling of discomfort is rather annoying.
GRWriter unpossible
Posted
My thought is that the two matters are separate. A hernia cannot self-repair, as far as I know. A section of bowel is poking through the muscular wall and, given time, this could be dangerous and lead to a piece of the bowel dying through lack of blood circulation.
If you can have a stitched repair, that would be my choice. - mesh has messed around with me and it appears I have to live with it, as do many others. BUT, do not accept only 'amateur' advice here - do see specialists for each problem. Best of luck!!
unpossible GRWriter
Posted
Thanks. I'm hoping the two matters are indeed separate.
I recall my doctor saying "stitching" when it came to repair, because my hernia is so small. I'm hoping for that too. I spent hours last night reading about mesh vs. no mesh, and what I read has scared me into hoping not to have anything inserted in me. But I've also read that stitching is a short term repair because the surrounding tissue is also weak so more likely to tear again. So I don't know. I'm hoping I get referred to a surgeon who offers both approaches and not just one or the other.
jonah30439 unpossible
Posted
A pure tissue repair (non mesh) in the hands of someone who specializes in doing these isn't a short term fix. Surgeons are always reporting that mesh is superior to the old fashioned method in regards to recurrence rates. However, the shouldice hospital in Canada that only does a pure tisuue technique called the shouldice technique reports recurrence rates of less than 1% (you can google this) where mesh recurrence rates are around 3%. The problems is obviously finding a surgeon who specializes in tissue repairs as they are a dwindling breed.
Furthermore the introduction of mesh was to reduce recurrence rates but little thought was given to the pain issues mesh can cause in the body. As pure tissue repairs dwindles and mesh repairs increased there have been more reports of chronic pain caused by mesh as high as 20%. Most mesh is made out of plastic the same kind as used to make a tic tax box. It can fold, migrate, curl up, attach to vital organs, and the groin nerves can become embedded in them causing sever pain. Furthermore some people can have allergic reactions and some can have infections.
However the big issue wit mesh is if should something go wrong-whether the odds are high or low- and it could be one, five, 10 years down the line-the big issue is the mesh is meant to be permanent your tissue gets incorporated into it like a scaffolding. So removing it is extremely difficult with no guarantee that symptoms will subside.
There are about 4-10 doctors out of about 10,000 hernia surgeons in the US who can try and successfully remove the mesh and you will ha r to travel to find them and most likely have to pay a good amount of money to have the mesh removed.
Also the odds are that if you do experience issues with the mesh you implanting surgeon will tell you to wait and give it time and if pain persists will send you off to pain management. Most will tell you the mesh can't be removed etc.
So you are left with a life full of pain. Then the onus is on you to do the research to find out how to get it removed and then have to make a very difficult decision on weather tonactually get it removed.
So again do your research ask a lot of questions i.e. What if something goes wrong can the mesh be removed? See what your surgeon says.
The pride of mesh they out in during laparoscopic surgery is the size of a small plate. Most people are surprised when they find this out. It is usually 4" x 6"
Which is very large for a small hernia.
If you indeed do have a hernia I'd consider getting non mesh repair by a specialist.
Jeannie74 unpossible
Posted
I am not a doctor but I am a registered professional nurse with 45 years experience in most every field of nursing.
However, my response is based solely on my opinion which is based on my education and experience. As a disclaimer , I am not answering you with my professional credentials.
unpossible
Posted
So a bit of a followup:
I saw Dr. William Brown (Fremont, CA), on the recommendation of @jonah30439 and from reading about how he's one of the few who would do non-mesh hernia repairs. He could not find signs of the indirect inguinal hernia, but he did find a small abdominal tear maybe an inch or two above where my original doctor thought there was a hernia. Dr. Brown said the tear was common among long-distance runners (but not sprinters, weirdly enough), and that it's still up in the air if I need the surgery or not. But he wanted me to get an ultrasound just to double check.
It just so happens the clinic he referred me to had an opening that same day, so I went in for that ultrasound. The technician could not find either the inguinal hernia OR the abdominal tear. She finally called in the radiologist, who took over the ultrasound. After having me switch to various positions and scanning for awhile, he was finally able to find a bulge where Dr. Brown said there was a tear. The radiologist said there was no actual tear, but it was a weak part of the abdominal wall where my bowels were pressing up against.
I asked the radiologist on his opinion of surgery, and he thinks it's too early to say that I need it. He said I could actually strengthen that area with exercise, mainly focusing on oblique muscles. He said he'll forward his findings to Dr. Brown, and that Dr. Brown will get back to me. He hasn't thus far, but I intend to call him on Monday.
In short, three different medical professionals have given me three different diagnosis -- indirect inguinal hernia, abdominal tear, no abdominal tear but weakened wall. At this point I'm not sure who to believe. There is definitely something wrong because I continue to feel discomfort, bordering on -- but not quite -- painful. I would not be surprised if I went to another doctor and got yet another diagnosis.
I have a friend in the medical field, and he feels that ultrasounds are unreliable when it come to finding small abdominal tears, and it greatly depends on the skill of the technician or radiologist performing the ultrasound. He believes an MRI will be definitive in this case and recommends I try to get a referral for one. So I think that will be my next step after I hear back from Dr. Brown.
unpossible
Posted
One additional issue:
Something I didn't mention because I didn't think it was related, but since this all started, I've had on-again off-again discomfort in my left testicle (so opposite side of where the possible hernia / tear is). At first, I thought it was because I was wearing boxer briefs on a daily basis, on the recommendation of my first doctor for added support. I usually wear boxers, so perhaps my briefs were too tight, and my testicles were feeling squeezed. But this past week, I've gone back to boxers, and the feeling of discomfort has returned. It's not painful per se, but it feels tender and uncomfortable. I have no other symptoms that I'm aware of, like urination or ejaculation problems, or hardness / unusual lumps. The hernia surgeon (Dr. Brown) doesn't seem overly concerned about it, but I'm not sure. He also doesn't think it's related to the tear since it's on the opposite side.
Do you guys think this issue is related to the hernia/tear? Is there anything I should really watch out for to determine if this is a serious issue or not? Incidentally, my first doctor did do a urine test before he discovered the hernia, and that test came back all clear. But this was before I had any testicular discomfort to speak of. Is it possible something has happened since then?
jonah30439 unpossible
Posted
Just curious how did dr. Brown diagnose a muscle tear? I'd think you need a MRI of the pelvis and abdomen to see what's going on.
I will tell you I had a nagging dull pain in my left testicle and it got misdiagnosed as a veriocele and then later Cat scan revealed I had a hernia on my right side . After this was repaired the pain went away. So it could be possible a hernia on the opposite side could have referred pain. I don't think an ultrasound is the best test. I'd get a MRI.
unpossible jonah30439
Posted
So at first, I was lying down Dr. Brown felt all along the inguinal canal and didn't feel anything. Then he felt about 1-2 inches above (still in the pubic hair region) and pressed down and felt the tear (or at least a weakness). He could more easily feel it when I was standing up. He had me feel it there and feel the opposite area, but to be perfectly honest, I couldn't feel the difference. This was also the case when my initial doctor had me feel the inguinal hernia he detected, where I couldn't feel the bulge or tear.
As I said, the ultrasound didn't detect a tear, only a bulge, and only after extensive scanning.
My friend who's in radiology thinks I really should get an MRI to get to the bottom of it, but even he admits that MRIs are not fullproof, but it should be better and more accurate than an ultrasound.
I'm almost positive my left testicle pain has to be related to the tear (or hernia) on my right side. I'm actually thinking of contacting this other doctor, Dr. Marc M Zare, who also seems to have knowledge with sports hernias.
jonah30439 unpossible
Posted
Wow. I wouldn't think someone could feel a tear just on a examination. Best to get an MRI and if it doesn't show anything there is dr. Shirwin Towfigh that specializes in reading MRI's for hernias. It might be worth sending it to her. There is dr. Igor Belyanski who removed my mesh and is really an expert in this area-I think he specializes more in reading Cat scans for hernias but you can check. I know this is frustrating. I had groin swelling and burning for over 13 months and during this time saw two surgeons and had a MRI and a cat scan that didn't show anything. Finally it was diagnosed 13 months later maybe Bc it was small and then got large enough. Who knows.
If it's a true sports hernia it should go away if you stop the physical activity-of it doesn't it's probably a hernia. The crazy thing is when I eventually had my surgery the surgeon found both a direct and indirect hernia when he got in there. So I had 2 hernias which makes sense because if all the pain I was in.
Anyways there are experts out there who can interpret these scans if your not get any answer or at least they can rule it out.
The hip is also close to the groin and should be ruled out Bc pain can radiate to the groin. Best of luck!