Sunday, January 6, 2013

Sudden, Painful, Abdominal Wall Bulge


I was practicing Yoga today, lifting myself up in a pose that uses arms, and lifts the legs up, so there is a lot of pressure in the abdominal muscles, suddenly I felt a sharp pain 2 centimeters to the right side, and one centimeter down of my solar plexus, I had to stop the pose, and touched what it felt like a bump, maybe a hernia, it was really painful, I put some pressure and it went down, but I still feel a little pain, and I'm concerned as to what that could be. I had to put a few days ago because the site wouldn't let me leave it at started today, but this, started today.

Gender: Female
How tall are you (feet and inches)?: 5'7
What is your weight in pounds?: 123
How old are you?: 43
How long has this been going on?: A few days

Describe associated symptoms not listed above: I had a really bad cold, was bedridden for almost 13 days, first 3 days I had a fever and chills, I was so tired, I got up on day 13, I'm still not strong enough, this was 4 days ago when I got up, I feel as though my body aches, which it does because I also teach Yoga and practice daily. I haven't been eating as much as I usually do, I'm a raw vegan, I'm very healthy, but I have some stress going on in my life now so I haven't been very diligent or disciplined when it comes to eating.

What have you done so far to remedy this condition? Please include tests and relevant studies here. Just happened today, pushed the bulge down.

Please list any chronic medical problems and also list any prior surgery (lacerations don't count!): I've had 2 myomectomies, 2 laparotomies to remove uterine fibroids, and a cyst in the right ovary. I've also torn L4 and L5 a year and a half ago.

Please list any medication allergies that you have : : None that i know.

Please list any medications you are currently taking (and dosage if known) :: I started taking Opti Gyn Formula from Eclectic Institute. I have uterine fibroids and don't want to get surgery yet again, besides they pressure my bladder so I cannot get over 4 hours of uninterrupted sleep, sometimes even less than that.

When was your last menstrual cycle?: 2 weeks ago
Are you currently using or do you have a history of tobacco use?: No
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Never

I'd like to know what this is and the steps I should take. I'd like to know whether I can shrink the fibroids without surgery and whether there is something I can take to stop going to the bathroom all night so I can sleep.


So I think it is fairly safe to say that you have given us the textbook definition of an abdominal wall hernia here in your question. The fact that it occurred suddenly during exertion and produced a  bulge in the abdominal wall is nearly diagnositic. 

Abdominal wall hernia's are not as common as umbilical hernias or inguinal hernias, but they do occur, and they do require repair by a surgeon. 

This link here might be helpful to you, I'm not sure, you seem to understand what a hernia is but I will provide it for your information.

Strangely, it is the small hernias that are the most dangerous. For this reason I think it is critical that you see a surgeon soon to get this looked at. Small hernias are prone to 'incarceration' which can lead to 'strangulation', where the herniated tissue becomes trapped and dies. This then can lead to rupture and peritonitis and then, instead of an elective repair of a small hernia defect, you face major surgery and days if not weeks in the hospital. 

My recommendation about your second question is simply that you consider a hysterectomy. At age 43 you are likely not thinking about having children, and I can only assume that the myomectomies were performed in an attempt to preserve fertility. There is no medicine that will allow for you to sleep through the night as the problem is mechanical, the fibroids are compressing the bladder. 

Interestingly, since it is likely you will need surgery for this hernia that we think you have, you might be able to get the hernia repair and a laparascopic or trans-vaginal hysterectomy done at the same time. This will require agreement between two surgeons (not an easy feat), but it's certainly something I would pursue if I were you. 

Finally, if you have not had your blood count checked lately you will want to do that. Uterine fibroids, with the chronic bleeding that often accompanies them, can cause ANEMIA, and it may be that you have anemia and are experiencing some of the common symptoms associated with it (link provided). 

If you have any questions about my answer please ask them in the comment section. Thanks for your question, and good luck!

1 comment:

space doc said...

I agree with MDSTAT ER DOC that this certainly sounds like an adominal hernia.

The fact that you could push the bulge and have it go down in size would indicate that it is not incarcerated or strangulated at this time--that would produce severe , persistent, pain--but it would definitely be important to see a surgeon asap.

The hernias can be repaired in different ways--the surgeon could advise you as to whether a laparoscopy approach would be possible.

As far as the uterine fibroids are concerned, there are some non-invasive approaches such as using gonadotropin-releasing hormone (Lupron & others). There are uses of heat or cold (myolosis or cryomyolosis).
A reltively new approach has been done with focused ultrasound surgery---using non-invasive, high energy, high frequency, sound waves.

You could ask your gynecologist whether any of these would be possible in your case.

I definitely agree that you should get a blood test to check for anemia.

I also think it would be good to check vitamin B-12 levels as well as possible decrease in your "good" HDL cholesterol, and a possible increase in your homocysteine levels (which can have a deleterious effect on your cardiovasvular system). These are sometimes found with raw veganism.

Good Luck!!
Space Doc