Treating Pain After Mesh Hernia Repair
Your mesh hernia repair has left you with pain. You are not alone. If you’re like many people who’ve had a hernia repaired with mesh, then you’re looking for options and next steps so that you can get back to “normal.”
First and Foremost, a Word of Hope
Pain associated with mesh hernia repair often will lessen as time goes by. If the pain is manageable, Dr. William Brown suggests that you wait at least six months, and preferably a year, before considering surgery as a treatment for pain after mesh hernia repair. Nerve blocks, steroids, heat, and rest can offer relief during this frustrating, yet highly recommended, waiting period.
Next, If Pain Continues to Affect Your Life
Many patients immediately want imaging tests such as a CAT scan or MRI ordered. Unfortunately, rarely do the imaging tests identify the problem. A detailed history and careful physical examination are much more informative.
Recurrent Hernia, Nerve Injury, Scarring of the Mesh, and damage of the Spermatic Cord are the most common causes of chronic pain.
A new tear or hernia can be the source of your pain. This might be the case if:
- The pain is minimal when you are resting.
- Long periods of standing and sitting aggravates the pain.
- The pain is usually not severe.
- There will often be a bulge, which disappears when you lie on your back.
A recurrent hernia can usually be identified during the physical examination, and an ultrasound can be helpful. The treatment is to repair the hernia.
Injury to a nerve is another possible source of your pain, especially if:
- There is usually some pain all the time.
- The pain will suddenly worsen with even slight movement or pressure.
- The pain is often debilitating.
- The pain is usually in the area of skin normally innervated by the nerve.
- On examination, there is often allodynia in the area of skin innervated by the nerve.
- Direct pressure on the nerve will often reproduce the pain (Tinel’s Sign).
Imaging tests and nerve conduction tests are usually not helpful in determining nerve injury. What Dr. Brown has found to be most helpful are diagnostic nerve blocks. For example, if you have pain in the distribution of the ilioinguinal nerve, then Dr. Brown anesthetizes the ilioinguinal nerve with local anesthetic. If this provides significant relief, then that is strong evidence that the ilioinguinal nerve is the source of the problem.
There are several treatment options. Pain will sometimes improve if a steroid is injected around the nerve. Often a second or third injection is required. But each injection usually lasts a longer period of time.
Oral medications such as gabapentin or pregabalin can be tried, but Dr. Brown has noticed that they seldom are helpful and most patients do not like the side effects.
TENS units are occasionally helpful, as they use an electric current to confuse the nerve, which alleviates pain.
Nerve ablation is a procedure that involves placing the tip of a needle near the nerve. A radio frequency current then heats and destroys the nerve. But it can be difficult to see the nerve with ultrasound, and thus getting the needle in the right place can be challenging.
If conservative measures fail, then the damaged nerve can be excised. The nerve should be cut as high as possible and the nerve should be removed as far distally as possible. This will leave an area of skin numbness that decreases with time. Most of the nerves are purely sensory, so that there is no muscle weakness after neurectomy. Also, in men, the neurectomy does not affect the penile sensation nor erectile function and women will still have normal sensation of the clitoris and of the vagina; so intercourse will not be affected. Most patients report that sex is enjoyable again after surgery, because they can do it without worrying about pain.
Mesh used to repair the hernia is often a source of pain. This might be the source of your pain if:
- The pain is usually constant and worsens with exercise.
- The pain is often difficult to localize.
- The pain is usually not debilitating.
If you are thin, the mesh can often be palpated (felt) and it will be hard. Imaging tests are usually not helpful in determining whether or not the mesh is the pain source. To help with the diagnosis, Dr. Brown often will inject the mesh with a local anesthetic such as lidocaine. If you experience significant relief, then that confirms that mesh is a component of the pain.
Steroids injected around the mesh will sometimes provide long-term relief, but repeated injections are usually required.
If conservative measures fail, then the mesh should be removed.
The spermatic cord can become scarred to the mesh. Within the spermatic cord there are multiple, very important and sensitive structures: the genital nerve that innervates the testicle, the genital artery and veins that supply blood for the testicle, the vas deferens that transports the sperm, and the cremasteric muscle that retracts the testicle.
If the genital nerve is injured or damaged, you will have pain in the testicle (not the scrotum), and:
- The pain is constant and gets worse with activity or pressure.
- The pain can be debilitating, and sex is often impossible.
- There is severe pain in the testicle.
If the blood supply to the testicle is damaged:
- There is severe pain in the testicle.
- The patient is debilitated
- The testicle slowly shrinks and dies.
- An ultrasound can help confirm the diagnosis.
- The testicle may have to be removed.
If the vas deferens is damaged, then sperm cannot get out of the testicle. There will be:
- An ache and a swelling of the testicle.
- Intercourse is painful.
- The sperm count may be low.
- A steroid injection may help.
If the cremaster muscles become attached to the mesh, then the testicle will no longer retract upward in response to cold and sex. Surgery can help.
Learn more about Dr. Brown’s approach to hernia repair without mesh. Contact Dr. Brown today.