Chronic Pelvic Pain Treatment

What is Chronic Pelvic Pain?

Chronic pelvic pain can be caused by a wide variety of issues in both men and women, many of which are related to damage to one of the many nerves in the pelvic region. Dr. Tollestrup and his staff can help you find the source of your chronic pelvic pain and address it, so you can get back to the quality of life you love again.

Damage to pelvic nerves can lead to long-term pain

The complex group of nerves in the groin and pelvis is loosely known as the lumbosacral plexus. These nerves all originate from the nerve roots of the lumbar and sacral spine. They travel through the abdominal wall and pelvis on their way to innervate the lower torso, pelvis, groin, and legs.

Like other peripheral nerves elsewhere in the body, the nerves of the pelvis and groin are susceptible to damage due to trauma caused by injuries or nearby surgical procedures. When one or more of the nerves of the pelvis is injured, chronic pain is often the end result.

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.

Nerve surgery for chronic pelvic pain

Fortunately for patients suffering with chronic pelvic pain, there are a number of treatments available for men and women who live with this debilitating pain every day. For patients whose pain does not respond to physical therapy, medicine or lifestyle changes, nerve surgery can help.

Peripheral nerve surgery can either decompress or disconnect the nerve or nerves that are sending pain messages to your brain. Peripheral nerve surgery can greatly decrease or eliminate the chronic pelvic pain that’s been disrupting your life. This surgery can take the form of altering the anatomical structures surrounding the nerve to relieve the pressure that’s causing your pain. Or it may take the form of disconnecting the damaged nerve altogether. Your doctor will discuss your options with you.

How is chronic pelvic pain diagnosed?

With so many common causes of chronic pelvic pain, it is critical to get an accurate diagnosis of the source of your pain in order to treat it effectively. Before your appointment, make a list of all of your symptoms to share with your doctor. Make sure to include:

Anything that aggravates or alleviates your symptoms
Frequency of your symptoms
Prior surgeries or procedures you’ve undergone in and around the pelvic region
Injuries or illnesses of the pelvic area
Births/pregnancies
Anything you can correlate your symptoms with, such as a menstrual cycle, sexual activity, diet, activities, etc.

At your appointment, our doctors will give you a full health exam and review your medical history. A discussion of your symptoms, surgeries, correlated conditions, and the list mentioned above will help your practitioner get a better insight into the cause of your chronic pelvic pain. You may also undergo a physical exam in which your doctor may press on areas of your pelvis and abdomen to look for tender spots and any abnormalities that may point to the origin of your pelvic pain.

More in-depth testing such as an MRI, CT scan or x-ray may be ordered to assist the doctor in diagnosing the source of your pain. In some cases, an invasive procedure called a laparoscopy may be necessary.

Common causes of chronic pelvic pain

There are a multitude of issues that can cause chronic pelvic pain in addition to nerve damage. Here are a few:

Trauma and injury
Sexually transmitted illnesses such as chlamydia and gonorrhea
Urinary tract infections
Interstitial cystitis
Endometriosis
Pelvic inflammatory disease
Fibroids
Kidney stones
Prostatitis
Hernia

At your appointment, your doctor will asses your symptoms and dive deep into finding the true source of your chronic pelvic pain. If your pain is caused by a condition outside of our specialty, we’ll be happy to refer you to another trusted specialist you can help you find the relief you deserve.

FAQs

Can weight gain cause pelvic pain?

Obesity has long been connected to chronic pelvic pain because of increased inflammation, excess strain on the pelvic floor, and hormonal changes that occur with obesity.

What does chronic pelvic pain feel like?

Does the occasional ache or pain qualify as chronic pelvic pain? If it’s recurring and ongoing, yes, it does. Because so many different types of conditions can cause pelvic pain, the question of “what does pelvic pain feel like” is difficult to answer. The pain may be localized, or it may engulf your entire pelvic region. It may be dull, sharp, or aching. If you have any type of pelvic pain that continues and disrupts your quality of life, please reach out and make an appointment. You don’t have to live with the pain!

Can sciatica cause pelvic pain?

Yes, sciatica can cause pelvic pain. Pain of the sciatic nerve that manifests as pelvic pain may cause chronic lower back pain as well as pain in the lower abdominal wall and deep pelvic area.

How is chronic pelvic pain diagnosed?

Getting the correct diagnosis for the source of your chronic pelvic pain is paramount to treating it. Your doctor will start with reviewing your medical history with you and performing a physical exam. Don’t forget to mention any surgeries, injuries, or other issues that could affect your pelvic region. Additional tests may be ordered to take a deeper look into your body to find the source of your pain, such as an MRI, CT-scan, or x-ray.

If my pelvic pain in not related to a damaged nerve, can Dr. Tollestrup still help me?

Dr. Tollestrup’s No. 1 goal is to help every patient that walks into this office achieve less pain and a better quality of life. If it turns out that the treatments our office offers aren’t right for you, we will be happy to refer you to a trusted specialist such as a gastroenterologist, gynecologist, or urologist that can help you treat the underlying symptoms causing your pelvic pain.