Excision Surgery: Occult Hernias, Bicornuate Uterus, and Birthday Cake
Hernia: protrusion of tissue through the wall of a body cavity in which it is normally contained, most often an opening or weakness in the muscular wall of the abdomen or pelvic area.
When my gynecologist first mentioned that my bilateral pain may be due to undetectable hernias, I almost wanted to laugh. Seriously, another problem that ultrasounds cannot find? In my ten-plus years of pelvic pain living, I have not once heard the word hernia mentioned. I was fighting tooth and nails to get the doctors to believe I had endometriosis, and here, I finally find a doc to say “Yup, it’s endo…” then she keeps going “but it’s also hernias.”
So, what even is an occult hernia? My husband and I were dumbfounded until we met with the general surgeon who was to remove/repair the hernias, if any were located during the laparoscopic surgery. He explained that an occult hernia is “a very small inguinal hernia which is difficult to diagnosis.”
Essentially, a hernia is a hole that typically develops in natural weaknesses in muscle or fascia or other natural holes. Over the last several years, articles have begun to emerge on hernias in women causing chronic pelvic pain. See “How Hernias Can Cause Pelvic Pain” (2016) and “Laparoscopic Inguinal Hernia Repair” (2009).
Inguinal hernias are seen in both male and female patients. Due to rather specific pain patterns, these hernias are typically diagnosed quickly in men. Because of the location, many women suffer from delayed diagnosis and treatment. The treatment for hernias is done by a general surgeon, in most cases, so many gynecologists may be hesitant to bring another party into the mix. However, the only known way to diagnosis an occult hernia is through laparoscopic surgery. Therefore, as my doctor did, a general surgeon should be consulted if pain consistent with a hernia is observed. This pain presents as tenderness over the internal ring with radiation of pain into the labia majora and anterior thigh.
I am extremely grateful that the endometriosis specialist I chose participates in a holistic approach to treatment and does not just spot treatment my endometriosis. She listened to my symptoms, performed a standard pelvic exam and ultrasound, and confidently proclaimed that my pain was consistent with endometriosis and occult hernias. Were it not for her mentioning the potential for hernias, the idea would never have crossed my mind. Who would have thought that my bilateral pain was caused by two occult hernias?! Many women do not have that luxury.
“On average, women go through four prior surgeries, and some a lot more than that, before the real cause of their pain is identified “- Dr. Deborah A. Metzger, a gynecologist in Los Altos, Calif., who specializes in chronic pelvic pain.
This is not something that should be happening in the 21st century. Physicians should not be “not thinking about hernias” when women complain of chronic pelvic pain and all other tests return normal. Proper training and education are key to preventing more senseless surgeries that build-up scar tissue, decrease the chances of fertility, and cause undue pain and suffering without any relief because the underlying problem has not even been diagnosed!
Ladies, it is up to us to educate ourselves, then. This is the only way we are going to place pressure on our medical system to care about women’s health and wellness. We are not complainers. We are not weak. We are not wimps. Heck, we deal with a crap-ton of pain! Yet it is on us to educate ourselves so that we may know the proper physicians to frequent, the correct questions to ask, and know the right procedures that need to be completed to properly diagnose our issues.
Let’s stand together – one day, pain-free.
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