2405 The Cult of the Occult Hernia and the Endometriosis Population

Abstract

Study Objective Endometriosis is a condition in which tissue similar to but not the same as the lining of the uterus is found throughout the pelvic cavity. Pelvic Physical Therapy is a sub specialty of physical therapy focused on the hip, lower abdomen, and pelvis from the bones, to the muscles, including the pelvic floor, to the nerves and fascia. Ongoing pelvic pain post excision of endometriosis by a gynecology specialist may be treated by a pelvic physical therapist. In one year, a pelvic physical therapy practice specializing in endometriosis issues, multiple patients were suspected to have occult, or no bulge, hernias as sources of pelvic pain. The objective of this study is to examine in a retrospective analysis the impact of occult female hernia on pelvic pain post excision of endometriosis. Design Retrospective Analysis. Setting Outpatient Private Physical Therapy Practice specializing in endometriosis. Patients or Participants 35 Interventions Patients were evaluated based on nerve mapping and then were sent for MRI with a General Surgeon confirming presence of defect in the pre-peritoneal space. Measurements and Main Results In a one year period in a private physical therapy practice specializing primarily in endometriosis, out of 35 patients with endometriosis were screened for occult hernia's, no bulge hernias not seen within the retro-peritoneal space during excision of endometriosis, 22 were positive for nerve compressions onto either the ilioinguinal or genitofemoral nerves. Conclusion Occult hernia may contribute to pain during sex, genital pain, groin pain, pelvic floor pain, increased lower abdominal pain during menstruation, perceived urinary pressure and leg pain. In the patient with endometriosis hernia may be missed during follow-up visits and surgery with the gynecologist. As a driver in pelvic pain, occult hernia should become more widely recognized as a source of pelvic pain.