Hernia Mesh Pain
Some people suffer chronic hernia mesh pain that interferes with their daily activities and can last from several months to years. Symptoms include a burning sensation at the surgery site, swelling and pain during intercourse, and the pain may be caused by nerve damage or a reaction to the mesh. Treatment for chronic pain includes painkillers, mesh removal and nerve removal surgery.
Pain is one of the most common complications after hernia repair surgery with mesh — a medical device made of polypropylene plastic that supports weakened or damaged tissue. As with most surgeries, some pain after hernia repair resolves after the incision and tissues heal.
But hernia mesh can cause an inflammatory response that causes pain for three to six months after surgery, according to researchers Kristoffer Andresen and Jacob Rosenberg at the University of Copenhagen in Denmark.
But some people may suffer chronic, long-term pain that lasts years, according to Dr. Robert Bendavid, a surgeon specializing in hernia repair at the Shouldice Hospital in Ontario, Canada.
“People should be concerned about hernia mesh pain long before they decide to have hernia surgery. If a patient has had a mesh inserted already, the average time it takes for half of them to become a pain problem is about 5 years but can last as long as 17 years,” Bendavid told Drugwatch.
Conservative treatment for hernia mesh pain typically involves oral pain medications or pain-relieving injections. For more serious cases, doctors may recommend surgery to remove the mesh or the nerve causing the pain.
What Are the Symptoms?
Symptoms vary from person to person and depend on the location of the surgery, type of surgery, type of mesh and any preexisting pain a patient may have had.
If postoperative pain gets in the way of daily activities and remains severe after six months, the patient may be suffering from chronic hernia mesh pain. Patients who have pain for longer than three months should speak to their surgeons about treatment options.
- Burning sensation around surgery site
- Feeling like there is something strange in the body
- Inflammation or swelling
- Pain when walking, sitting or sleeping
- Painful ejaculation
- Painful sexual intercourse
- Pins-and-needles sensation
- Radiating or spreading pain
- Shooting pains
- Testicle pain
- Tugging or pulling sensation when moving
Researchers aren’t sure how many people actually suffer from chronic hernia mesh pain because there isn’t one consistent definition of pain.
“Hernia mesh pain will vary in incidence depending on the definition of the pain,” Bendavid said. “The European Hernia Society and HerniaSurge have defined it as pain severe enough to interfere with daily activities.” He said the incidence of pain fitting this definition ranges from 13 to 15 percent.
According to the Shouldice Hospital, rates of “pain severe enough to bring a change in lifestyle, to cause a severe handicap in ordinary activities, or make life unbearable” were found by some studies to be as high as 60 percent.
Causes of Pain
Injury to skin, muscles and nerves during the operation are common causes of postoperative abdominal pain after hernia mesh surgery. The length and extent of the surgery may make the pain more intense. This type of pain may lessen as the body heals, but patients should always keep their health care providers informed of their pain levels.
Bendavid says mesh pain is less about the surgical procedure and more about the properties of mesh implants.
“The most common cause of mesh pain is the mesh itself. Polypropylene mesh has a tendency to erode into adjacent tissues,” he said. “A fact that most studies ignore simply because the articles are written by so called ‘collaborative surgeons’ who are known to cooperate with the industry.
We still essentially do not know what goes into the makeup of these meshes. Each one is different and is chemically just as different. Originally, the mesh was never intended for humans.”
“The most common cause of mesh pain is the mesh itself. Polypropylene mesh has a tendency to erode into adjacent tissues.”
Mesh manufacturers have downplayed the risks, said Bendavid. He points out that hernia mesh lawsuits in U.S. courts have revealed this evidence even if the industry has tried to hide it.
Other studies disagree. For example, a 2012 review published by Dr. Jeffrey B. Mazin of Scripps Mercy Hospital in California in Practical Pain Management cited a study of 55,000 hernia operations in Finland. The study found that “the causes for pain included general anesthesia, lengthy surgery, wound infection, and hemorrhage. Operations removing the mesh and orchiectomies did not abolish the pain.”
Researchers further concluded “that mesh did not increase the rate of chronic pain.”
General surgeon Dr. David Krpata told Cleveland Clinic that the most common causes of pain after mesh hernia repairs are an inflammatory reaction to the mesh and nerve entrapment.
Reactions to Mesh
Inflammation or irritation from mesh may lead to pain. This happens because the body reacts to the mesh by treating it as a foreign object. Mesh can also rub against nerves or muscles and cause irritation.
One 2019 study by Felix Heymann and colleagues from University Hospital Aachen in Germany and published in JCI Insight found that polypropylene meshes used for hernia repair triggered foreign body reactions.
In his interview with Cleveland Clinic, Krpata said there are three major nerves in the abdominal area. Surgical sutures or mesh can entrap these nerves during surgery and cause chronic groin pain.
Nerves can also become entrapped if they grow into the mesh, according to Shouldice Hospital. Mesh shrinks up to 40 percent in the first 5 years, becomes a hard mass and pulls on the nerves.
Mesh Erosion and Migration
Painful ejaculation (dysejaculation), pain in the testes and pain with intercourse can occur when mesh migrates or penetrates the spermatic cord and vas deferens — a duct that transports sperm to the ejaculatory ducts.
“Since the general adoption of mesh in the 1990s, the incidence of dysejaculation has risen to 3.1 percent, a 7,750 percent increase from when natural-tissue repairs were the standard of care,” according to Shouldice Hospital.
Mesh may also penetrate the intestines, bladder and other vascular structures.
Options for treating chronic hernia mesh pain range from oral medications to surgery.
Some health care providers will recommend watchful waiting in the beginning. Watchful waiting involves examining the patient and managing pain with oral pain relievers. In some patients, the pain will decrease with time, according to the Andresen and Rosenberg article.
If the pain doesn’t go away in a few months, providers may try stronger pain medications.
Medications for Hernia Mesh Pain
- Nonsteroidal anti-inflammatory drugs
- Tricyclic antidepressants
- Selective serotonin reuptake inhibitor/serotonin–norepinephrine reuptake inhibitor
- Conventional analgesic
- Pain injections
Other options for nerve-based pain include plasma-rich protein (PRP) injections and nerve ablation. PRP injections can promote healing and ease nerve pain. Nerve ablation is a minimally invasive procedure that uses electrical currents to lessen pain.
If medications and noninvasive treatments don’t work, the next step is surgery. Depending on the source and cause of the pain, providers may recommend mesh removal, a neurectomy to remove all or part of the nerve, or both.
Bendavid and other surgeons recommend removing mesh, but it can be difficult and requires a great deal of skill.
“The only definitive answer is as thorough a removal of the mesh as possible,” he said. “Certainly the best results have been obtained by mesh removal, but surgeons are loath to return to an area that has become scarred, has invaded adjacent tissues and can be a tricky and dangerous dissection.”
Patients who decide to remove their mesh should make sure their surgeon is experienced.
Tips for Decreasing Hernia Mesh Pain
According to University Hospitals, pain control techniques can help manage pain after surgery. Patients should get moving as soon as possible because it helps healing, but it’s important to take it slow. Holding a pillow against the incision can also decrease pain.
Relaxation techniques that take the mind off pain and decrease anxiety, such as playing cards, visiting with family, listening to music, meditating and watching TV, can help.
Questions to Ask Your Doctor
If you are experiencing hernia mesh pain after surgery, it’s important to talk to your provider. Here are some questions that will help you and your doctor discuss your pain and develop a treatment plan.
- Where is the pain located? (Is it near the incision or does it move in your body?)
- On a scale of 0 to 10, where 0 is no pain and 10 is severe pain, where does your pain fall?
- What were you doing when the pain started?
- Does the pain come and go?
- Does the pain interfere with your sleep?
- Does coughing make the pain worse?
- Are there activities that make the pain worse?
- Does taking medicine, changing positions, resting or eating different foods lessen the pain?
- How does the pain feel? (tingling, burning, sharp, dull, pins-and-needles, crushing)
- Does doing normal activities cause you pain even after you’ve taken medicine?
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