Hernia

Although infrequent in the female population, the presence of an abdominal wall hernia in a patient with chronic pelvic pain should be included in the differential diagnoses.94 These include inguinal (indirect or direct), femoral, spigelian, incisional, and umbilical. Symptoms and signs include history of an abdominal or groin mass and pain or discomfort with an increase in intraabdominal pressure. Spigelian hernias result from a defect through the transversalis fascia, just lateral to rectus muscle at the level of the semicircular line of Douglas.95 Incisional hernias generally occur at fascial defects with vertical incisions. Other types of hernias include sciatic hernias secondary to atrophy of the piriformis muscle, which may include the ipsilateral ovary in its hernia sac, and vaginal hernias (cystocele, rectocele, and enter-ocele).96 Treatment of abdominal hernias includes surgical repair through the laparoscope or through a skin incision. Vaginal hernias are repaired surgically or a pessary may be used.

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