Inguinal Hernias in Females

[covegirl15]

There is an interesting article in the NY Times today about hidden hernias in females and their relationship to supposed chronic pelvic pain. I figure it's worthy of a thread: http://www.nytimes.com/2011/05/17/health/17brody.html?_r=1&ref=health#

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[SLUser11]

Exercise that helps maintain healthy abdominal muscle tone can protect against hernias, she said, but “once you have the problem, exercise won’t correct it, though it may prevent it from getting worse.”

Her sorry tale could be repeated by countless women who, like Ms. Sweet, had hidden abdominal hernias, a condition that most doctors — including gynecologists and surgeons — rarely consider or know how to find.

The overwhelming majority of female patients with chronic pelvic pain do not have a hernia.

Anyway, that article is complete bulls@#t.

 

[maxheadroom]

The overwhelming majority of female patients with chronic pelvic pain do not have a hernia.

Anyway, that article is complete bulls@#t.

Agree, although it's something that often isn't investigated very well.

More importantly, the ****storm on the NYTimes in the past week over the editorial about physicians needing to be more professional in their interactions with nurses really pissed me off. Yes, there is a minority of physicians who are rude to nurses, but to characterize us as routinely dismissive undermines the progress that our generation of physicians has achieved in the realm of professionalism.

 

[droliver]

The overwhelming majority of female patients with chronic pelvic pain do not have a hernia.

Anyway, that article is complete bulls@#t.

I had the exact same though reading this. It sounded like a lot of those women with a "hernia" non-visible on CT scan who went on to surgery with preperitoneal mesh placement got a placebo effect. Also they describe a 4 hour laparoscopic ingunal hernia repair by the "women's hernia specialist" in that story. WTF?

BTW, I think women are particularly well suited to very small anterior open approaches for their inguinal/femoral hernias. Much easier then male hernias as you can kind of go commando as there's no cord to injure.

 

[tussy]

Why would it take 4 hours to laparoscopically repair 2 small inguinal hernias? Also, they mention that it took a vaginal exam to identify the hernias - WTF? i've never heard of that before in assessing for a hernia. Anyone else? I hope my patients don't read this article.

 

[Smurfette]

Agree with you, tussy. Would never use a vaginal exam as a method to diagnose a groin hernia. I suppose you *can* get an ovary in the canal, but you'd discover that in the OR, not reliably on bimanual exam....

The whole article is crap. Nothing like spreading misinformation out there so women with pelvic pain are convinced they have an undiagnosed hernia and think surgeons don't know how to diagnose a hernia.

 

[dpmd]

Maybe they misunderstood the way you have to invaginate the labia to assess for hernia (equivalent to doing so with the scrotum) as a vaginal exam?

 

[ESU_MD]

Its like that guy who does those bogus sports hernia sham operation

 

[droliver]

Its like that guy who does those bogus sports hernia sham operation

Sports hernias are clearly real, they're just not hernias. It's a combination of about three or four different types of muscle/tendinous injuries of the rectus mm., oblique mm, and hip adductors that's just gotten a lot more attention. They would have been called "groin pulls" or such in the past. Some of them will not heal despite conservative management and rest and require surgical repair. It's kind of analogous to a partial biceps or triceps tendon tear. A lot will heal by scarring together but some require repair.