I’m going to go out on a limb and say that probably one quarter to one third of my male patients have pelvic pain because of a hernia repair gone imperfect. (Don’t confuse that to my guess that 80-90% of my male patients have pelvic pain because of something related to a hernia.) When this happens, there are options out there. I have to honestly say that those patients who have pelvic pain because of a hernia repair only go so far with physical therapy treatment alone. They may improve a lot, a little or not at all until they get the right kind of medical management. I’m considering medical management to be care that I cannot provide as a physical therapist – something a physician might do.
According to the article that I reference often called : Current trends in the diagnosis of and management of post-herniorraphy chronic groin pain which can be found in the World Journal of Gastrointestinal Surgery (try googling it – the full length article is available)…there are a number of treatment options for those with pelvic pain after hernia repair.
There are surgical and non-surgical options. Let’s start with the non-surgical:
- Lifestyle modifications: This means that you just change things. Sit less. Avoid pain. Use heat or ice to calm the pain down. In general, I think this is a dumb idea (and so do the authors of the article, but they say this much more professionally). So, forget this option.
2. Use analgesics: Numb the pain with creams and gels. This is a Band-Aid and it isn’t a Band-Aid. It’s a Band-Aid because you are masking the pain to an extent, but you are not resolving the core issue of scarring, fibrosis, a lumpy mesh or nerve irritation. However, what you are doing is chilling out the constant painful signal to your brain. This might allow your fascia and muscles to calm down for a bit and for your brain to get a break. Constant pain signals to the brain actually change the brain and essentially make you more sensitive to less pain. It’s exhausting for your nervous system and it’s a downward spiral for your quality of life. So, in this respect, it isn’t a Band-Aid. Get it?
3. Physical therapy: Ya’ll, this article lumps physical therapy in with massage and acupuncture. Nothing against those that practice massage and acupuncture, but when you lump us all together, it tells me that the authors of this article have no clue what pelvic floor physical therapists do. It says that physical therapy can reduce the pain, but cannot prevent pain recurrence. I agree and disagree. It just depends on the reason one has pain after their hernia repair in the first place. We cannot treat all the symptoms with the same interventions. Cookie-cutter, cookie-cutter, cookie-cutter!
4. Nerve blocks: The article says that this can reduce the pain signal to the brain and there needs to be more research on nerve blocks for post-hernia repair pain. After what I’ve seen in my own practice, I think that it really depends on why one has post-hernia repair pain in the first place, who is doing your nerve block, which nerve the physician decides to block, how they block it and what combinations of nerve blocks (if they are doing more than one) they decide to do and what they are injecting into the nerve. Nothing is simple, everything is complex, but if the nerve is a big issue and there isn’t a neuroma growth and the nerve is purely just irritated and a patient gets the right kind of physical therapy from a therapist that doesn’t provide cookie-cutter treatment, then I believe that nerve blocks are a viable option to resolve some patients’ pain. It’s about why the patient has their post-hernia pain.
- Mesh removal: This article says that just removing the mesh alone won’t resolve the pain because an inflammatory process has taken place and nerves have become irritated. Because of this, many physicians will remove the mesh and then remove parts of the irritated nerve as well. Partial removal of the nerve is called a neurectomy. This can result in numbness.
2. Ablation: So they discuss radio-frequency ablation which is the use of heat to burn the nerve. This article looked at doing ablations for inguinal nerves at the spinal level and found that 4 out of 5 patients found that this completely resolved their pain months later. Now, don’t go thinking this is the golden ticket. Remember that patient selection is really important here, so after careful assessment of a patient the ablation was performed. When you do the right treatment for the right cause of symptoms, that’s when you get good results. In my next post, I will discuss cryoablation which is the use of cold to treat a nerve. Heat vs. cold. Cool, huh? <— Wait, I swear I didn’t write that intentionally, but will you look at that…”Cool” – I just kill myself! Ah…me.
So, that’s that. These are the options listed in ONE article about post-hernia repair pelvic pain. Again, I want to stress that for anything in medicine, you will only get better if you get treated for the root cause of your pain. Too many providers out there are throwing only apples at pelvic pain. Instead, they need to look at the pelvic pain and determine if that patient needs to be treated with an apple, banana, orange, kiwi or a cantaloupe. We cannot only have apples in our pockets because apples don’t really fit in a pocket to begin with.
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