Hernias Can Often Be Overlooked as Cause of Pelvic Pain in Women

Women suffering from chronic pelvic pain may be surprised to learn that the root cause of their discomfort stems not from their reproductive organs, but rather a hernia.

Chronic pelvic pain is a constant or sporadic pain that a woman experiences in her lower abdomen for six months or longer. It’s a health concern that affects a significant portion of females each year. In fact, according to the National Institutes of Health (NIH), about 10 percent of appointments made with gynecologists is to discuss chronic pelvic pain.

Chronic pelvic pain is caused by a variety of conditions in different areas including a woman’s reproductive organs, urinary tract or bowels. In some cases, however, the cause of pelvic pain may not be found. But according to the Society of Laparoendoscopic Surgeons, the cause for the pain might go undiagnosed because a hernia is often not considered. 

Hidden Hernias

Hernias affect both men and women, but women often experience a delay in diagnosis because their hernia pain is located in the pelvic area, which can be attributed to many other causes, the society says.

“Pelvic pain in a woman can be a hernia that is not easily found during a physical exam and even on an imaging study,” says James de Caestecker, DO, a general surgeon with Gem City Surgical Hernia Center. “A woman may have been to her family physician about the pain and then referred to her gynecologist. A hernia may be the cause, but if there are no physical evidence on exam – such as a noticeable bulge – then it will not be easily diagnosed.”

A hernia happens when part of an internal organ or tissue bulges through a weak area of muscle. Most hernias are located in a person’s abdomen. Common types of hernias include those around the belly button, from an incision or scar or due to a birth defect. Hernias are common and can affect anyone. A combination of muscle weakness and straining – such as lifting heavy objects – might contribute, the NIH says.

Hernias not easily diagnosed upon an exam may be referred to as hidden hernias. Such hernias are often only found by a general surgeon who is able to make an initial diagnosis by listening to a patient’s history – such as when the pain occurs, what triggers it and how it is relieved, Dr. de Caestecker says.

“A lot of times, it is a diagnosis of exclusion. If all other imaging and tests for pelvic pain come back normal, but their history is pretty consistent with what you would expect of a hernia you go to the next step and place a camera into the belly button and actually look at it,” he says. “More times than not, there is actually a hernia present that you just couldn’t feel on a physical exam.”

Improved Hernia Treatment

The inability to diagnose a hernia in a timely manner can often leave women with unexplained pelvic pain frustrated and uneasy over the unknown, Dr. de Caestecker says.

“I have had patients who have gone from doctor to doctor to doctor. They have suffered with the pain of a hernia for three to four years and it has progressed to a point where it affects their lifestyle,” he says. “I put a scope into many of these individuals, find a hernia, fix it, and they are extremely happy. The pain is gone and their quality of life has improved.”

Dr. de Caestecker says women need to know there is hope for their pain if its source is due to a hernia. Treatment options for hernias have drastically improved over the past decade to include methods that help return a person’s body back to its original anatomical state. As a result, recurrence rates for hernias have dropped and individuals are able to return to activities they had been able to enjoy since before their hernia appeared. If women have questions about hernias, they should first discuss with their primary care provider or Ob-Gyn physician.