According to the NIH, inguinal hernias are uncommon in women. In fact, men are 8-10 times more likely to develop an inguinal hernia—which is why most inguinal hernia repair research focuses on male patients.
However, the National Library of Medicine recently published its 2022 findings on post-operation pain in female patients. This is one of the first reports of its kind and shows that women are much more likely to develop chronic pain after inguinal hernia surgery. Nearly 20% of female patients had chronic pain severe enough to affect their daily activities, significantly higher than the men with post-op chronic pain.
What Is Chronic Pain?
As defined by Johns Hopkins Medicine, chronic pain is severe, persistent pain that lasts longer than the typical recovery period. Chronic pain affects patients’ ability to continue normal activities, whether it’s continuous or intermittent discomfort.
The recovery period after an inguinal hernia repair surgery is typically 1-2 weeks, and people can often return to strenuous activities after about a month. Any pain in or around the incisional area that continues after those few weeks can be considered chronic pain. However, some surgeons prefer to wait until 3-6 months post-operation to see if the pain results from lingering inflammation or is truly chronic.
Why Is Chronic Pain More Common in Female Inguinal Hernia Repair Patients?
Unfortunately, there’s no clear reason why women are disproportionately more likely to experience chronic pain after an inguinal hernia repair. Research is limited, considering only about 10% of inguinal hernia repair patients are women.
That said, there’s a simple explanation of why post-operative pain occurs in both men and women: The local nerves can become trapped in the mesh used in an anterior hernia repair.
An open anterior hernia repair involves the surgeon directly accessing the hernia by making an incision on the anterior (frontal) side of the body. The hernia repair specialist then pushes the hernia back into place and stitches the hole. They usually place a mesh on the outside of the hernia to support the area and prevent a recurrence.
The potential issue arises with the mesh placement, which is close to three nerves. In some situations, those nerves can become caught in a stitch or the piece of mesh, causing chronic post-op pain.
Preventative Approaches to Chronic Pain Management
Chronic pain after an inguinal hernia repair is not a normal outcome and can be avoided. Here are a few ways to ensure the most successful post-operative outcomes.
Look for an Experienced Hernia Repair Specialist
Put simply, the nerves should not become caught in the stitches or mesh. An experienced hernia repair specialist will be able to identify those nerves and ensure they are out of the way during the entire procedure. If needed, the specialist may remove portions of the nerves to ensure they don’t become trapped. This process will create a small area of numbness in the skin but will prevent chronic pain.
Ask About Minimally Invasive Surgical Options
After finding an expert surgeon, consult with them about different surgical procedures. Thanks to technological advances, several minimally invasive options eliminate the need for open surgery. One of the most common options is laparoscopy, where the surgeon inserts long, thin instruments into a few small incisions.
Robotic surgery is another option. Like a laparoscopy, robotic surgery involves several small incisions, but the surgeon inserts more advanced instruments that allow for increased precision.
An even better option is single-incision robotic surgery. Since the surgeon only makes one small incision, recovery is much quicker.
Ask About Posterior Repair Options
Keep in mind that minimally invasive surgical options are not always an option. With complex inguinal hernias or emergent situations, open surgery is often the best and safest option—even if it involves a longer recovery time.
Patients who need open surgery should ask about posterior repair options. Instead of the surgeon accessing the hernia from the outside (near the nerves), they repair it from the inside.
Express Concerns About Chronic Pain
An open anterior hernia repair is still the safest approach in many situations, especially when the patient has complex health concerns or a history of pelvic surgeries. During initial consultations, the patient should discuss chronic pain risks with the hernia repair specialist.
They should ask about the surgeon’s approach to protecting the nerves from becoming trapped in the stitches or mesh. If they don’t feel comfortable with the surgeon’s response, patients shouldn’t hesitate to consult with another hernia repair specialist.
Again, seeking an experienced hernia repair specialist is the best approach to avoiding post-operative pain.
Post-Operative Approaches to Chronic Pain Management
Women who have already had an inguinal hernia repair surgery are at a greater risk for chronic pain. However, that doesn’t mean they learn to live with that pain for the rest of their lives.
According to the NIH, there are several chronic pain management methods to help diminish or eliminate that pain after inguinal hernia surgery in Orange County.
Before implementing a pain management plan, surgeons will likely recommend waiting several months to see whether the pain slowly diminishes as the swelling subsides. Although the typical recovery timeline is just a few weeks, internal healing can take longer and cause pain to linger.
During this waiting period, the surgeon will likely recommend lifestyle changes to help diminish the pain. For example, they might recommend minted physical activities and plenty of rest.
If the pain continues after those first 3-6 months, the hernia specialist will likely recommend pharmacological intervention. There are several pharmacological options, depending on the patient and pain severity.
For example, specialists might recommend that women with chronic inguinal hernia repair pain apply topical analgesics, anti-inflammatory medicine, and possibly tricyclic antidepressants.
Another pain management option is local anesthetic injections. This approach can help relieve the pain and also diagnose which nerves are affected.
While not common, radiofrequency can provide short-term chronic pain relief. This process heats and blocks the nerves to alleviate the pain.
All of the aforementioned pain management options are ongoing approaches that require continual attention. In some cases, pain management is enough to let women continue with their everyday lives.
However, pain management is not a cure. Women struggling with post-operative chronic pain might prefer a more definitive solution like a secondary surgery to remove the mesh and potentially remove the portion of the nerves causing the continued pain.
Dealing with ongoing pain is challenging. Women with chronic pain after an inguinal hernia repair might struggle to participate in daily activities, which can take a toll on their physical and mental health.
To help combat depression, stress, and anxiety, patients should surround themselves with a support team that might include family, friends, counselors, and a support group. Through collaboration with the surgical team, mental health professionals, and primary care providers, patients can get the mental and psychological support they need.
Regarding physical health, women should talk to their surgical team about what activities and exercises are safe and which stretches can help alleviate some discomfort. They should closely follow activity restrictions to prevent further pain and prioritize rest.
Coping with Flare-Ups and Seeking Help
Even though women with chronic inguinal hernia repair pain may become used to the constant pain, they should carefully watch for any signs of worsening symptoms. If the pain suddenly worsens or the pain management strategies become ineffective, the patient should seek immediate medical assistance.
Even though women are much less likely to have inguinal hernias, they are at a higher risk for post-operative chronic pain. However, they don’t have to live with that pain forever.
If you are preparing for an inguinal hernia surgery in Orange County, express your concerns about chronic pain with your surgeon and ask about alternative surgery options. And if you’re currently dealing with continued pain, contact an experienced hernia repair specialist immediately. They can develop a pain management plan for you and discuss potential surgical options to eliminate the pain.
The important thing to remember is that living with pain is not the only option.
To find out if inguinal hernia repair surgery is right for you, Contact Orange County General Robotic Surgery at (714) 706-1257 for a consultation with Dr. Abtin H. Khosravi.