What are the best management options for my hernia and severe stomach pain?

From the Guidelines

You should seek immediate medical evaluation for your hernia and severe stomach pain, as this combination could indicate a potentially serious condition like a strangulated hernia requiring urgent surgical intervention. While waiting to see a healthcare provider, avoid strenuous activities, don't attempt to push the hernia back in yourself, and take over-the-counter pain relievers like acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) for temporary pain relief, as suggested by recent studies 1. Avoid NSAIDs like ibuprofen as they may worsen gastrointestinal symptoms. Apply ice packs wrapped in cloth to the painful area for 15-20 minutes every hour to reduce swelling and discomfort.

Key Considerations

• For most hernias, especially those causing pain, surgical repair is the definitive treatment, either through open surgery or laparoscopic approaches, as indicated by the most recent guidelines 1.
• Non-surgical options like wearing a hernia belt or truss may provide temporary relief but aren't long-term solutions.
• The severe pain you're experiencing could indicate complications such as incarceration (hernia can't be pushed back) or strangulation (blood supply is cut off), which are surgical emergencies requiring immediate attention to prevent tissue death and serious complications, as highlighted in 1.
• Recent studies emphasize the importance of early diagnosis and treatment to reduce morbidity and mortality rates associated with complicated abdominal wall hernias 1.

Management Approach

• The management of complicated diaphragmatic hernia in the acute setting suggests that laparoscopic repair seems to be the best treatment option for stable patients, while open repair is considered necessary in the majority of unstable patients 1.
• CT scan of the chest and abdomen is the gold standard for diagnosing the diaphragmatic hernia, which can help in identifying the need for urgent surgical intervention 1.
• The use of prosthetic mesh may reduce the recurrence rate but may increase the risk of infections and other complications, as noted in 1.

Pain Management

• For visceral pain associated with hernias, neuromodulators including tricyclic antidepressants (TCAs) and serotonin norepinephrine reuptake inhibitors (SNRIs) can reduce perception of pain, as discussed in 1.
• Opioid analgesics should not be used to manage chronic visceral abdominal pain due to the risk of delaying gastric emptying, narcotic bowel syndrome, and potential for addiction, tolerance, and overdose, as warned against in 1.

From the Research

Management Options for Hernia and Severe Stomach Pain

• The best management options for hernia and severe stomach pain include surgical interventions, such as laparoscopic repair, which is associated with shorter recovery time, earlier resumption of activities of daily living, less pain, and lower recurrence rates than open repair 2.
• Watchful waiting is a reasonable and safe option in men with asymptomatic or minimally symptomatic inguinal hernias, but it is not recommended in patients with symptomatic hernias or in nonpregnant women 2.
• Ultrasound-guided Transversus Abdominis Plane (TAP) block has been shown to be effective in reducing postoperative pain and inflammation in inguinal hernia surgery, and it also has immunomodulatory effects by decreasing the levels of proinflammatory cytokines such as TNF-α and IL-1β 3.

Pain Management

• Non-steroidal anti-inflammatory drugs (NSAIDs) can be used to reduce pain and inflammation, but their use should be carefully evaluated due to the risk of organ damage, including gastrointestinal, cardiovascular, hepatic, renal, cerebral, and pulmonary complications 4.
• The use of NSAIDs should be limited to the lowest effective dose and duration to minimize the risk of adverse effects 4.
• Alternative pain management options, such as the TAP block, should be considered to reduce the need for NSAIDs and minimize the risk of organ damage 3.

Diagnostic Imaging

• Ultrasonography is a useful diagnostic tool for inguinal hernias, especially in women, and it can also be used to diagnose recurrent hernias, surgical complications, and other causes of groin pain 2.
• Magnetic resonance imaging (MRI) has higher sensitivity and specificity than ultrasonography and can be used to diagnose occult hernias if clinical suspicion is high despite negative ultrasound findings 2.