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underwent bilateral hernia surgery. Suffer from lower abdominal pain. No nausea or vomiting. What to do?

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Gastroenterologist, Surgical
Practicing since : 1984
Answered : 922 Questions
My grandfather is 80 Years old. He underwent a Bilateral Hernia Surgery about 5 years ago and the mesh was inserted.Hernia Surgery done with Groin Incision on both sides i.e bilateral as per the doctor who operated. Since then he is suffering from Lower Abdominal Pain. It was an open surgery and not through Laparoscopy. Pain on lower abdomen below the operation scar persists - more felt after meals and bowel evacuation. Constipation for many years past with hard stool and diverticulam of colon. No Blood or occult blood or mucus in stool. No nausea, vomiting

This has reduced his quality of life. We have consulted a lot of doctors but no one is able to diagnose the problem and just prescribe medicines like Isabgol, NSAIDs etc. but these medicines have proved to be of no help at all. I am attaching his Colonoscopy, CT Scan & Soft Tissue Ultrasound Reports.
Posted Mon, 5 Aug 2013 in Abdominal Pain
Answered by Dr. Ajit Naniksingh Kukreja 9 hours later

Thanks for writing in

Have gone through the history and the reports

Clinically from the information available it seems the pain is due to collitis and/or diverticullits

Considering the fact that he is grossly constipated the diverticullitis will be evident

I would suggest you add a lot of fiber and fluids to his daily routine

Also a probiotic will be of help

Constipation and straining can be instrumental in causing the hernia again

Another thing we need to rule out is neurological cause, in open surgery some twigs of the local innervating nerves get entangled in the sutures and patients keep on complaining of pain

If he has altered or reduced sensation in the operated area you should see your surgeon and ask him to prescribe medicines accordingly

Hope this helps
DO write back in case of concern
Wishing your Grandfather a healthy life ahead
Above answer was peer-reviewed by
Follow-up: underwent bilateral hernia surgery. Suffer from lower abdominal pain. No nausea or vomiting. What to do? 3 hours later
Thank you very much for your response and advise.

In the last 5 years, we have consulted a lot of doctors from all over the country but unfortunately did not get any relief.

Please advise on the following:

1) Please let us know if there is any test or tool to find out whether the problem is neurological and that some twigs of the local innervating nerves have got entangled in the sutures.

2) Can an enlarged prostate be one of the causes for the pain and will undergoing a prostate surgery will help relieving this pain? I am attaching the latest sonogrpahy reports for your reference.

3) Please prescribe a laxative to treat constipation that can taken for prolonged use as most laxatives have a warning that they are to be taken only for a short period. Isabgol etc. have not given favourable results in my grandfather' s case.

Thank you.
Answered by Dr. Ajit Naniksingh Kukreja 5 hours later

Thanks for writing in again

1] It is more of a clinical evaluation and not a laboratory test

2] The report shows very minimal residual urine so even if you get the enlarged prostate removed it may not work

3] Prescribing medicines without examining the patient is not permissible on the online forums, yet if I get a refractory constipaton patient I would advise to go for Cap Lubiprostone 24 mg for two weeks followed by 8 mg for two to three weeks - both twice a day

Fiber and fluids will additionally help

Hope this clears your doubts
Above answer was peer-reviewed by
Follow-up: underwent bilateral hernia surgery. Suffer from lower abdominal pain. No nausea or vomiting. What to do? 3 days later
Thank you for the response.

The President of the American Hernia Society - Dr. B. XXXXXXX Henniford has observed that about 30% of the patients who undergo Hernia Repair Surgery suffer from Chronic Pain. If the pain is not cured by analgesics and NSAIDs after 8-12 months, then another surgery needs to be done and this is due to the mesh inserted which irritates nerves etc.. Is is applicable to my Grandfather's case?

Thank you
Answered by Dr. Ajit Naniksingh Kukreja 6 minutes later

It is good you care so much for your Grandfather

Your R&D is also appreciable, but the above statement is variable on case to case basis

Explantation of the mesh is not frequently needed but as I would try using Gabapentine twice a day for two to three weeks before taking up removal of mesh

Hope this helps
Do write back in case of concern
Above answer was peer-reviewed by
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