Causes of Chronic Pain Following Surgery in the Pelvic Area

Eric H. Williams MD
Specializing in reconstructive surgery and pain relief in the Greater Baltimore area.

The pelvic area, including the hip and groin, is home to many important organs. Consequently, it’s an area of the body that is often operated upon. You may have had a C-section, a hysterectomy, or a hernia repair, among other procedures.

(Actually, if you had a C-section, we should say the area was home to at least one very important person instead of an organ, but we digress.)

Typically, these procedures are conducted to either manage an emergency situation or address a cause of trouble, such as pain or abnormal bleeding. Unfortunately, sometimes an unintended consequence of the surgery itself can be its own cause of chronic pain.

When it comes to cases of continuing pain following any type of surgery within the pelvic region, we abide by the same recommended guidelines for surgeries in most other areas:

If your pain still persists after 6 months, and you have consulted with your primary care physician, surgeon, or specialists who have not discovered an underlying cause, you should certainly consider giving our office a call.

The reason that we might be able to help when other experts have not is that the source of your pain may lie in an injured or distressed nerve. Other medical professionals do not have extensive training in identifying such problems—and they should not be blamed for this oversight—but this is Dr. Williams’s area of expertise.

What Can Happen to a Nerve During Pelvic Surgery?

Whenever surgery is performed, there is always a risk that a nerve may be damaged. Again, this is typically not the fault of the surgeon performing the procedure. We take great cautions to attempt avoiding any negative consequences from surgeries, but the human body has so many nerves that at least a small amount of risk remains no matter how careful a doctor is.

For some surgeries in the pelvic area, the risks can be higher simply based on the size of the incision that must be made.

A Pfannenstiel incision, for example, is a common procedure that is often required for C-sections, hysterectomies, and other forms of interpelvic surgery. You might also hear this incision referred to as a Kerr incision, pubic incision, or even “bikini line incision.”

In general terms, a Pfannenstiel incision requires making a slightly curved cut just above where the main sections of the pubic bones meet. This provides access to the abdomen once the skin and subcutaneous fat are lifted off the rectus muscle fascia. The fascia is then typically cut vertically to reach areas beneath.

While it is a sound technique, nerves can still be at risk of consequences during or after the surgery, simply due to how large of an incision it can be.

Two nerves in particular that may be affected are the illioinguinal and illiohypogastric nerves. The ilionguinal nerve provides sensation to the groin area and sexual organs of both sexes. The iliohypogastric nerve supplies sensation to the lower abdominal and some of the groin area.

 

Damage or distress to either nerve—as well as others in the region—can be the cause of chronic pain in the area of the incision. Many patients feel this as a “burning” type of pain.

A nerve can be cut during the incision itself. However, it can also become entrapped against tissue once the incision is closed, or become stuck in scar tissue during recovery. Any of these situations can result in nerve-related pain.

According to a 2008 study of Pfannenstiel incision patients, about one-third still exhibited some pain at the incision 2 years following their procedure.

Finding Help for Post-Surgical Pelvic Pain

We have previously discussed a typical approach to diagnosis and treatment in our blog that centered specifically on pain after a hernia surgery.

We will test whether the source of your pain is nerve-related, potentially using a nerve block. This is a dose of local anesthetic injected near a targeted cluster of nerves. If this has a greatly positive effect on your pain and discomfort, we can be more confident that some part of the nerve is under distress.

Treatment for the problem might include either decompressing the nerve from being pinched or trapped, or removing a damaged nerve entirely. In some cases, this might lead to permanent numbness in a spot, although the size of this area tends to decrease over time. Most patients greatly prefer this feeling to the pain, as well.

Sexual performance is not typically affected, but we will be sure to discuss all potential pros and cons of a procedure with you beforehand.

In many cases, we can use the same incision to perform a procedure, keeping excess scarring to a minimum.

Your Baltimore-area Nerve Specialist

Once again, if your groin or pelvic pain has remained for at least 6 months and you have consulted with other experts on how to treat it to no avail, it’s time to contact our office.

If we determine the problem is related to your nerves, we will do all we can to help you find relief and comfort, and get you back to living your life as best as possible. We can unfortunately never guarantee a 100% recovery for every patient, but any potential improvement we can make for your life will be considered.

Schedule an appointment with us by calling (410) 709-3868. If you prefer to contact us electronically, please feel free to do so via our online contact form.

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