Chronic Pelvic Pain Syndrome | CPPS

Common pelvic pain conditions caused by nerve damage

The possible combinations of nerve injuries are almost endless, but here are a few of the ones we see most commonly in our practice.

Chronic pain after hernia surgery
Inguinal and other types of hernia repair are very common surgical procedures. The nerves that innervate the lower abdominal wall, upper anterior thigh, and testicles/anterior scrotum in a man or mons pubis/labia in a woman can all be injured during hernia repairs or other surgical procedures. The nerves most commonly involved include the ilioinguinal, iliohypogastric, genitofemoral, and occasionally the lateral femoral cutaneous nerve. When these nerves are injured, the result is usually chronic groin pain. In the man, a common manifestation is often severe testicular pain on the affected side.

Chronic pain after C-section
The nerves of the lower abdominal wall, upper anterior thigh, and mons pubis can be damaged during a c-section, causing long-term chronic groin pain and chronic pelvic pain. Chronic pelvic pain caused by c-section is quite common, with as many as 9 percent of women who have delivered via cesarean section reporting pain long after giving birth.

Chronic pain after hysterectomy
Hysterectomies are the second most common surgical procedure performed on women in the United States. Unfortunately, many women suffer from chronic pelvic pain after a hysterectomy. If the lower abdominal nerves are damaged during the hysterectomy procedure, chronic pain in and around the pelvis region can result, including pain with intercourse, bladder pain and urgency, leg pain, and bowel pain.

Meralgia Paresthetica
One very common type of nerve injury is compression of the lateral femoral cutaneous nerve, also known as meralgia paresthetica. This nerve can become compressed due to an underlying metabolic disease such as diabetes, or it can be injured due to local surgery (such as anterior approach for hip replacement), direct pressure on the nerve secondary to wearing a heavy utility belt (common in policemen), or direct blunt trauma to the front or side of the thigh (such as an injury sustained in a car accident).

This type of nerve injury typically produces severe pain and sensory alterations over the lateral hip/buttock, as well as the front and side of the thigh down to about the level of the knee. Depending on the mechanism of injury involved, simply relieving pressure off the nerve may be adequate. In other cases, the nerve may need to be disconnected to achieve excellent pain relief.

Pudendal nerve injury/compression:
The pudenal nerve is the nerve that innervates the area of the rectum and around the anus. It also innervates the area between the legs and provides the primary source of sensation to the genitalia in both men and women. Injury to this nerve can cause loss of sensation and severe pain in these important areas. Blunt trauma to the buttocks or perineum (area between the legs), extensive cycling, or difficult childbirth involving a severe vaginal tear or even an episiotomy are common causes of pudendal nerve injury.

Femoral nerve injury/compression:
Not to be confused with the lateral femoral cutaneous nerve, the femoral nerve is a very important nerve that is responsible for flexion of the hip and extension of the knee. It also provides sensation to the skin over most of the front/inside part of the thigh and lower leg to about the ankle. Although injury to the femoral nerve is rare, procedures such as hip replacement surgery or cardiac catheterization can result in compression or even direct injury to the femoral nerve. This can cause severe pain down the inside of the thigh and lower leg and make walking extremely difficult.