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January 16, 2023

Hernias are often overlooked as the cause of chronic pelvic pain in women

Without a noticeable bulge, the condition can be difficult to accurately diagnose

Women's Health Chronic Pain
Hernias women Source/Image licensed from Ingram Image

About 15 to 20% of U.S. women, ages 18 to 50, experience chronic pelvic pain in their lifetimes, and though this type of pain is a common symptom of an inguinal hernia, it often is initially misdiagnosed.

Chronic pelvic pain is a common health issue for women, but a hernia is often overlooked as a potential cause.

About 15 to 20% of U.S. women, ages 18 to 50, experience chronic pelvic pain in their lifetimes, and though this type of pain is a common symptom of an inguinal hernia, it often is initially misdiagnosed.

The challenge in diagnosing hernias in women is that there are many conditions that can cause chronic pelvic pain including endometriosis, fibroids, ovarian cysts, pelvic adhesions, interstitial cystitis, ectopic pregnancy, urinary tract infections, irritable bowel syndrome, pelvic inflammatory disease, and sexually transmitted diseases. In rarer cases, a gynecological cancer may be the source.

An inguinal hernia occurs when tissue, usually part of the intestine, leaks out through a weak spot in the abdominal muscles, causing a bulge in the area on either side of the public bone. Some women will feel pain when they cough, bend over or lift something heavy, but others never experience any symptoms.

Besides groin pain, other possible symptoms include a burning or aching sensation at the bulge, a heavy or dragging sensation in the groin and a weakness or pressure in the groin. Men also can develop inguinal hernias.

An incisional hernia, which develops where a previous surgery occurred, and a femoral hernia, when the protrusion occurs in the upper part of the thigh, also can cause pelvic pain. Women are more likely than men to develop femoral hernias.

Hernias also can develop in the top part of the stomach – a hiatal hernia – and around the belly button, referred to as an umbilical hernia. Sometimes hernias run in families.

Without a noticeable bulge, hernias can be difficult to diagnose in women. Some hernias are deeper and hard to detect, even on ultrasound. Often, when a woman has chronic pelvic pain without the telltale bulge, her doctor will first consider other possible causes. Some women spend several years going from doctor to doctor before a hernia is correctly diagnosed.

How to prevent a hernia

There usually is not a clear cause of a hernia, so it is not an easy condition to prevent. Some hernias are present at birth while others develop later in life. 

Usually there isn't just one event that causes a hernia, but certain factors can increase the likelihood that a person will develop one, including chronic constipation, chronic cough, heavy lifting, obesity and straining to urinate. 

The best way to reduce the chance of hernia is to eat healthily, stay hydrated, avoid smoking and lose weight if necessary. Using proper lifting techniques also can lessen the strain on the abdominal muscles.

How to treat a hernia

Surgery is the only way to repair a hernia, but if it is small and not painful, doctors may recommend that a patient waits to see if it grows larger before taking action. These cases include patients who are at high risk of surgery complications due to other health issues, like obesity. Obese patients are often advised to lose weight before having hernia surgery because they are at greater risk of poor outcomes.

One serious risk of delaying surgery is the possibility of strangulation, which occurs when some of the protruding tissue gets stuck in the hole. When this happens, the tissue's blood supply is cut off, causing it to die. This prompts emergency surgery.

People are advised to seek immediate medical attention if they have hernias that turn another color, or develop a fever with pain, nausea and vomiting. The inability to have a bowel movement or pass gas also could be a sign of a strangulated hernia.

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