Hernias difficult to diagnose in women

Martine Ehrenclou, 51, first noticed her lower abdomen pain in January 2010. She experienced severe discomfort if she sat at her desk for even 15 minutes, when she drove her car or any time that she pitched forward. Ehrenclou, who lives in Brentwood, describes the pain as “brutal.”

“I would have stabbing, sharp pain right in the center of where my C[aesarean]-section scar is,” she said. “It would start right above the scar, and it felt like it went very deep internally, and once that would happen, it would kick off a spasm that would radiate to every part of my pelvic area.”

Eventually, she said, the spasms happened every day, and she finally visited her doctor. But instead of a straightforward diagnosis, the visit marked the beginning of what would prove to be a year-and-a-half-long search for a cure.

“I saw 12 doctors of differing specialties, I underwent 15 tests and procedures, and I was put on 22 medications,” Ehrenclou said of the grueling road to a diagnosis.

It wasn’t until reading a newspaper article that Ehrenclou finally realized what she might have: a hernia. “I could not believe what I was reading,” she said; the complications that the woman in the article described matched Ehrenclou’s almost precisely.

Armed with this new information, Ehrenclou made an appointment with Dr. Shirin Towfigh, a surgeon at Cedars-Sinai Medical Center who specializes in treating women with hernias. After performing an MRI, Towfigh gave Ehrenclou the final verdict: two small belly button hernias and another one protruding through a muscle tear at the site of her C-section. One was pinching a nerve, likely causing the majority of Ehrenclou’s excruciating pain.

Towfigh performed a simple surgery on Ehrenclou, which, she said, is the only surefire way to treat a hernia. Within a few days, Ehrenclou was back on her feet, feeling “elated and grateful” that the pain she had been living with for so long was finally gone.

But unfortunately, Ehrenclou’s story is not uncommon.

Hernias, which occur when part of an internal organ or fatty tissue pushes through a hole in a muscle, are far more common in men than in women. As a result, many doctors don’t consider a hernia diagnosis when faced with a female patient.

“Hernias in women are not on the radar for most doctors,” Towfigh said, “and so many don’t ask the right questions to narrow it down.”

Adding to the problem, the most common type of hernia is in the groin area, and their symptoms mirror other pelvic problems that tend to plague women.

“Women have many more organs in that region than men do,” Towfigh said. “So when they come in with lower groin pain, it’s often mistaken for pelvic pain.”

Women with hernias may be misdiagnosed as having ovary-related problems, such as cysts or ruptures; complications from prior pelvic surgeries, such as Caesarean sections; endometriosis; or fibroids.

In Ehrenclou’s case, her incorrect diagnoses included interstitial cystitis, fibroids and neuropathy. But worse than the frustration of not knowing what was wrong, she said, were the invasive and sometimes painful tests and treatments she endured in the name of the wrong problem.

One such treatment involved painful steroid injections to her pelvic area. Another required her to be put under general anesthesia, injected with needles in her lower back, and then brought out of the anesthesia to have them electronically stimulated in order to isolate the origination point of the pain. 

“All these doctors did not have hernia in their purview,” she said.

Adding to the difficulty of diagnosing hernias in women, Towfigh says, is that they are often smaller than those seen in men. When a man with a hernia lies down, for instance, the hernia can generally be seen in the form of a bulge. But because of the differences in women’s bodies, a hernia may not be as prominent or even visible at all.

“Women’s pelvises are broader, and so the distribution where the hernias occur and how they present is a little different,” Towfigh said. “In men it protrudes, but in women it’s not as large, so it’s not commonly felt as a bulge.”

Because of the likelihood of confusion and misdiagnoses, Towfigh adds that the more information a patient has and the more forthcoming the patient is with that information, the more easily the diagnosis can be made. With Ehrenclou, for instance, her symptoms lined up clearly with those of hernia.

“Women will commonly tell you that they’re doing daily activities, like washing dishes or brushing their teeth, and it hurts them,” Towfigh said, “or anything that closes off that area, like coughing, sneezing or bending over.”

For her part, Ehrenclou encourages other women in her situation to be tenacious in seeking a cure. As difficult as it was, she says, she never stopped pushing for a diagnosis. If she had given up halfway through, “I probably would still be in pain.”