Women With Severe Irritable Bowel and/or Ovarian Cyst Pain May Have Something Else – and a Test For It

I have seen 2 cases of severe intermittent lower abdominal pain (both more left sided) with a background of lesser pains seen by various doctors with out relief and pain relieved in 1 minute – by pushing their inguinal hernia back into abdomen.

Both cases has some things in common:

1) Emotional distress is universal and I suspect makes doctors suspect irritable bowel.

2) Pain generalizes to lower abdomen and is NOT over the inguinal canal area. One does not get a history of relief lying down.

3) Presents as a semi-acute abdomen. One lady had been to two medi-clinics and the hospital prior to seeing me with pain beyond her ability to cope. The other I thought initially to have acute diverticulitis and started on antibiotics.

4) Diagnosis was not possible on initial visit. Given the pain seemed no where near the inguinal canal, and there seemed to be significant abdominal wall triggers associated, I did not make diagnosis in either case on first visit. One lady had had attacks for years and had seen various doctors and specialists.

Tip off- each seemed distressed I tried a simple myofascial technique in attempt to relieve some of the surface pain – Put hand gently on lower  abdomen and push up – hold until you find a direction that seems to give a little and follow that direction to get a release. Paradoxically, though I seemed to be getting some response to the muscles, the patient found the pain worsened – and perhaps (maybe in my mind) more localized now to the left inguinal area.  In each case, I was left with a sense of confusion why this would make things worse – but also with a sense that there had to be more going on then it seemed. When I stood each of the subjects up and had them cough, I could feel a tender impulse. I could feel it in the mons pubis: – but higher than I thought

I could feel an impulse on coughing and when I lay patient down and pushed (and rub/vibrated) area – eventually all the pains remitted – even much higher up. One patient finds she has  to lie down,  put her fingers over the tender area hand hit fingers with other hand in order to get it to go in.

I cut a piece of Styrofoam in attempt to hold hernia in. There are hernia garments for women.

I found this was available from amazon:      here

Each case was a major surprise and a major relief for the patient. Now I am left to wonder how many poor souls are their out there having intermittent incarcerations of their inguinal hernia on top of baseline irritable bowel and having it missed.

Important point – one case had hypermobility syndrome – these cases have chronic widespread pain and a Fibromyalgia picture – but their collagen problems predispose to hernia development.

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3 Responses to Women With Severe Irritable Bowel and/or Ovarian Cyst Pain May Have Something Else – and a Test For It

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  2. Nicole says:

    I have EDS-3 and I think this is me!!! I can’t figure out what is causing the pain on the left side of my mons pubis EXACTLY where that image is. Let me know if you want more info. Also, should I even go to the doctor for it? From everything I’ve read anybody with symptoms like mine are checked for hernia, sent to a G.I. doctor, and then discharged with nothing discovered.

    Dear Nicole,
    With Ehlers-Danlos syndrome (EDS), you are much more prone to having an inguinal hernia. Your problem with a hernia diagnosis is similar to those who have it with sports – called the sports hernia. If it is a frank hernia, then and ultrasound to area can locate it 75 – 86% of the time. Sometimes it is just “weakness of the posterior inguinal wall” and this creates quite a conundrum.
    Differential Diagnostic Difficulties in Athletes with Chronic Groin Pain: A Multidisciplinary Concern
    Sam G. G. Smedberg and Harald P. Roos
    Sport Injuries 2015, Mahmut Nedim Doral, Jon Karlsson

    Some features suggesting it is a problem:
    first appearance pain – a sports hernia could be gradual chronic or acute after straining

    quality of pain type – “Insufficiency of the posterior wall of the inguinal canal often produces a dull pain with variations in intensity and with more acute elements during straining”

    provocation pain – “groin pain provoked by increased abdominal pressure by coughing or sneezing indicates posterior inguinal wall insufficiency”

    relief of pain – finding pain remits with lying down or pressure to area would be helpful; however irritation of nerve to area could mask that.

    Palpation – finding a bulge when straining and coughing would help but insufficiency site might be higher in groin then suspected

    Beyond that, they suggest diagnostic blocks to various structures of <3 mls to see which structure is incriminated.
    Block to nerves should be done a special way:
    "When entrapped nerves are blocked for diagnostic purposes, the drug should be administered proximal to the location of pain. For example, the ilioinguinal nerve should be blocked at the anterior
    superior iliac spine when the pain is located at the pubic tubercle. If the skin in the dermatome of the nerve becomes numb and the pain disappears, the block is diagnostic. If the skin becomes numb
    but the pain does not disappear, the cause of the pain is of another origin. If the skin does not become anesthetic, the block was unsuccessful."

    Herniography is an invasive technique where dye is injected into abdominal cavity and made to look for hernia.
    It is very sensitive test(near 100%) but 10% who were positive for test did not benefit from surgery.
    It has been recommended as an initial test in sports hernias:
    Robinson A, Light D, Kasim A et al
    A systematic review and meta-analysis of the role of radiology in the diagnosis of occult inguinal hernia.
    Surg Endosc 27:11, 2013
    “Based on this systematic review, herniography should be considered as the initial investigation for occult inguinal hernia where available. In centers where this is not available, ultrasound of the groin should be used with good clinical judgment. When there is still diagnostic uncertainty, further investigation with magnetic resonance imaging should be considered to exclude alternative pathology.”

    If you think hernia is a likely cause then its best to see a sports injury doctor who is used to dealing with sports hernias. An ultrasound needs doing. With hypermobililty syndromes pains from pubic joint and hip could confuse issue and injection into former might be needed. The last article mentioned – the abstract could be brought to your doctor as a way of persuading him/her to arrange a herniography though I think a sports doctor would be more likely know how to arrange it.
    Good luck


  3. Suzy says:

    My sister thinks I may have Ehler’s Danlos Syndrome as well, and inguinal hernia is what I asked the doctor about, but they couldn’t find anything. After feeling for lump and after CT scan.. they just told me to ‘use warm pack to encourage red blood cells’.. It started after I felt I tore something with heavy lifting and swelling lasted almost a week. That was 4 years ago, and now I still get pain when I overdue things, sometimes just from standing up. Especially after doing leg lifts to target core. I couldn’t tell if it felt like fascia muscle tear or blood vessel, but it’s definitely aggravated by coughing or vomiting. :(

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