Chronic Pelvic Nerve Pain

Chronic pelvic pain is not only a woman’s disease: it can be caused by nerve damage as well. Men and women alike are prone to chronic pelvic nerve pain, usually resulting from damage to one of the following four nerves:

• The pudendal nerve
• The ilio-hypogastric nerve
• The ilio-inguinal nerve
• The genito-femoral nerve

These nerves are present either in the abdominal wall, in and around the pelvic cavity and in the groin and perineal area. Damage to any of these nerves can lead to chronic pelvic nerve pain.

What Causes Pelvic Nerve Damage?

Pelvic nerve pain is caused by damage or dysfunction to pelvic nerves, which can happen through:

• Diabetic neuropathy
• Excessive compression, such as prolonged sitting on a bicycle seat
• Nicks or cuts during abdominal surgeries
• Excessive stretching during surgical procedures
• Trauma to or around the nerves

Chronic pelvic nerve pain is pain caused by pelvic nerve damage or dysfunction that persists for longer than the expected healing time, or is present for 3-6 months.

Pelvic Nerve Pain Symptoms

Like other types of neuropathic pain, chronic pelvic nerve pain is often described as burning or stabbing. It may come and go, or it may be fairly steady. Certain activities, such as sitting or lying down, may increase symptoms.

Depending on the nerve involved, people with chronic pelvic nerve pain may experience any of the following symptoms:

• Pain when sitting, relieved when standing
• Pain that radiates to the external sexual organs
• Pain in the perineum (think of this as the area that touches a bicycle seat)
• Pain that radiates to the abdomen or the lower back
• Pain during intercourse
• Pain when urinating or having a bowel movement

Treating Pelvic Nerve Pain

Pelvic nerve pain can be treated with any of the following:

• Medications, such as Anti-convulsants or NSAIDs.
• Nerve blocks
• Spinal cord stimulation and sacral neuromodulation
• Cryotherapy
• Surgery (to reverse nerve entrapment)
• Steroid injections
• Pulsed radiofrequency (currently undergoing research)

Some types of pelvic nerve pain, such as genitofemoral neuropathy, have a good treatment success rate. Others, such as pudendal neuropathy, may be more difficult to accurately diagnose and treat.

Coping with Chronic Pelvic Nerve Pain

Coping with any chronic pain diagnoses can be difficult, but because pelvic nerve pain is often misunderstood and difficult to treat, finding ways to cope are vital to increasing your quality of life. Here are a few ideas to get you started:

• Keep a pain journal. Write down when your pain comes and goes, and what makes it worse. This can not only help your doctor with your diagnosis and treatment, but it can help you plan accordingly. You can also use your pain journal to write down your feelings instead of keeping them inside.
• Practice relaxation. Stress can intensify feelings of pain. Since stress is hardly avoidable in the real world, learn to relax your mind and body to reduce this response.
• Talk to Someone. If you don’t have a peer or a trusted friend who you feel comfortable sharing your feelings about your pain with, check out the chronic pain forum. Sometimes sharing your feelings in a safe environment can help you cope.

  _Sources:

  _{Hough David M, Wittenberg Keith H, Pawlina Wojciech et al. Chronic Perineal Pain Caused by Pudendal Nerve Entrapment: Anatomy and CT-Guided Perineural Injection Technique. American Journal of Roentgenology. 2003; 181:561-567}

  _{Mitra R, Zeighami A, Mackey S. Pulsed Radiofrequency for the Treatment of Chronic Ilioinguinal Neuropathy. Hernia. 2007 Aug;11(4):369-71}

  _{National Pain Foundation. Pelvic Pain: Causes. Accessed 8/21/09. http://www.nationalpainfoundation.org/articles/717/causes}

  _{University of Rochester Medical Center. Pudendal Neuralgia. Accessed 8/17/09. http://www.urmc.rochester.edu/smd/Rad/Pudendal.pdf}