Chronic pelvic pain syndrome in women and men

Neuralgia causes severe pain and interferes with a full life. That is why it is important to recognize the disease in time and begin its treatment.

In this article we will talk about pelvic neuralgia (inflammation of the inguinal, pudendal, and pudendal nerves) in men and women, its symptoms, and treatment of hip joint pathology.

Causes of the disease

Neuralgia of any type is accompanied by pain, which can increase, decrease and even change location. It gets worse when the stress on the nerve increases. With pelvic neuralgia, due to the large number of nerve endings located there, in some cases there may be no pain, especially if the cause is pinched one of the nerves.

The following nerves are located in the pelvic area and can cause neuralgia:

• Femoral. Most often subject to attacks of neuralgia due to compression by nearby tissues. Muscle innervation occurs, manifested in limited leg mobility, severe pain when walking and running, numbness;
• Lateral cutaneous. The pain can be localized both outside the thigh and under the skin. An increase in pain is possible not only with movement, but also at rest;
• Pudendal nerve. Most often, the pain is caused by damage to nerve tissue during childbirth, but it can also be of a compressive nature if it is constantly compressed (for example, prolonged and frequent cycling);
• Obturator nerve. Neuralgia manifests itself in the form of spasms and weakness of the thigh muscles, decreased mobility and pain in the hip joint. The pain increases with tension in the leg;
• Sciatic nerve. The thickest nerve that runs throughout the leg. Neuralgia can appear anywhere, from the hip joint to the toes. There may be complete numbness in the leg, a change in gait, the leg stops bending at the knee, and the fingers stop moving;
• Upper gluteal. Responsible for the mobility of the gluteal muscles. With neuralgia, their atrophy is possible, which will make it difficult to straighten the body;
• Inferior gluteal nerve. This is the auxiliary nerve of the femoral muscles and hip joint, when damaged, movement is limited.

Important! The doctor can determine exactly which nerve is damaged by indirect signs: localization of pain or numbness, limited mobility, etc.

The main cause of any neuralgia is damage or detachment of the myelin sheath of the nerve, so the disease can affect any of them or area. It is also difficult to establish the correct diagnosis because phantom pain may appear in the abdominal area and even in the chest area. The disease can manifest itself in the form of partial numbness, burning, paresis, and impaired mobility.

Clinical picture of hip joint neuralgia

The most common symptom of hip neuralgia is acute pain in the femoral-gluteal area. The pain may radiate to the lower back and/or knee. It is characterized by high intensity and short duration: the pain takes the form of shooting pains when changing position or exertion and occurs sporadically. At the peak of the syndrome, the person is almost completely deprived of the ability to make any movements with the leg.

The pelvic area and hip joint are innervated by a large number of nerves, among which six main ones stand out:

• femoral;
• superior gluteal;
• inferior gluteal;
• obturator;
• sciatic;
• external cutaneous.

The location of the pain depends on which of these nerves is pinched. As a rule, there are no clearly defined time limits for the manifestation of pain; it can recede as suddenly as it arises.

Along with shooting pain and a sharp limitation of the motor amplitude of the hip joint, the symptomatic picture of hip neuralgia may include:

• Paresthesia is a burning and tingling sensation in the affected limb.
• Decreased sensitivity (numbness) at the site of a pinched nerve.
• Difficulty moving, lameness.
• A slight rise in body temperature, chills, increased sweating, weakness.

Irradiation of pain to the leg or back indicates pinching of the sciatic nerve. In this case, pain attacks a person when he tries to change his position: stand up, lie down, turn on his side.

In women, symptoms of pelvic neuralgia may occur during menstruation, especially in cases of dysmenorrhea (painful periods). Some gynecological diseases lead to poor circulation in the pelvic area, which can also trigger an attack of neuralgia in this area. In men, there are specific reasons that contribute to the exacerbation of hip neuralgia. These include urogenital infections and prostatitis: with these pathologies, the infiltration of pathogenic microorganisms into the tissues surrounding the nerve cords is not excluded.

Since hip neuralgia can occur simultaneously with pathologies of the OMT organs, patients sometimes mistake one for the other: men with these symptoms suspect urology, and women attribute neuralgic pain to gynecological diseases. Only a thorough diagnostic examination allows one to differentiate the causes of the illness.

Types of pelvic neuralgia

It is customary to distinguish the two most common types of pelvic neuralgia: the femoral nerve and the external cutaneous nerve.

With neuralgia of the femoral nerve, the pain intensifies with active physical activity: while walking, running, performing various physical exercises. The cause of the disease may be previous injuries, inflammation in the pelvic area, previous purulent diseases, or intervertebral hernia.

With neuralgia of the external cutaneous nerve of the thigh, increased pain occurs either while walking or at night when the body is at rest. Localization of pain is close to the surface of the skin, and not in the deep layers of muscle tissue.

Diagnostics

Diagnosis and treatment of pelvic neuralgia is the responsibility of a neurologist or general practitioner. Often, mistaking the symptoms for other diseases, patients go to a gynecologist or urologist, and after an examination that does not reveal any abnormalities in their health, they come to the conclusion that the pain will go away on its own. This cannot be done, because in this way the disease only gets worse over time.

Highly qualified urologists and gynecologists, in addition to standard examinations, offer a consultation with a neurologist in order to have a complete picture of the patient’s health status.

The main symptom of the disease is pain, so it is important to clarify its nature, duration, reasons that cause it, etc. After this, the doctor prescribes basic studies, with the help of which it is possible to determine which nerve is damaged and find out the causes of the pain. The main studies for pelvic neuralgia are:

• Radiography;
• Magnetic resonance imaging;
• electroneuromyography;
• ultrasound examination with Dopplerography.

All these studies make it possible to determine possible pinched nerves, its patency, muscle activity, and localization of the disease.

Diagnostic techniques

Diagnosis of hip neuritis, like any other disease, begins with a survey and external examination of the patient by a specialist. The neurologist asks about the time of onset and the nature of the pathological symptoms, palpates the limb to determine the localization of the pain syndrome, and checks the dynamic qualities of the hip joint. Establishing a preliminary diagnosis for hip neuritis is not difficult for an experienced specialist, since the disease has very clear symptoms. Then the patient is sent for examination to identify possible pathologies of the hip joint and other organs that have similar symptoms. When establishing the presence of concomitant pathologies, consultation with an orthopedic surgeon, neurosurgeon, gynecologist, urologist, or oncologist may be required.

Laboratory tests of blood and urine are necessary to identify the inflammatory process in the body. Complex instrumental examination techniques will help to establish the exact location and nature of nerve pinching in hip neuralgia:

• Magnetic resonance imaging (MRI).
• Computed tomography (CT).
• Electromyography is a technique that shows the activity of muscle fibers.
• Applying skin electrodes to test nerve patency.
• Ultrasound examination (ultrasound) of periarticular tissues.

Tracking the reaction of nerve fibers to irritation allows us to identify the presence of pathological symptoms in it and determine their cause. After clarifying the diagnosis, appropriate therapy is prescribed.

Methods for relieving pain in pelvic neuralgia

If you need to quickly relieve pain from pelvic neuralgia, you can use drugs that are designed to relieve heart pain (nitroglycerin, etc.). To reduce symptoms, it is possible to use anticonvulsants such as trileptal, carbamazeline, and antidepressants.

If the pain is severe, before making a final diagnosis, the doctor can carry out a novocoin blockade, but this is a temporary measure, after which full treatment is necessary.

Pelvic neuralgia in men

It is generally accepted that pain in the pelvic area in men is a sign of prostate, prostatitis or adenoma. In this case, inflammation of the nerves of the inguinal ligaments and pelvic muscles occurs, which causes acute pain in the perineum, rectum or radiates to the hip joint.

Important! The anatomical features of the male body are that the pelvic organs are in more cramped conditions than in women. Therefore, the diagnosis of neuralgia is complicated by the fact that with inflammation and tumor, the nerve is pinched, and the pain is much stronger.

With pelvic neuralgia in men, the main symptoms are pain during urination or ejaculation, burning and pain in the urethra, and the presence of blood in the seminal fluid. Since these symptoms are characteristic of many “male” diseases, diagnosis must be especially careful.

Pudendal neuropathy

The main symptom of pudendal neuropathy is pain in one or more areas innervated by the n. pudendus or its branches. These are the areas of the rectum, anus, urethra, perineum and genitals. One typical symptom is pain that worsens while sitting and progresses throughout the day. The causes of neuropathy are still debated, but the most well known is compression of the pudendal nerve in Alcock's canal. Other causes are: piriformis syndrome, damage to the pudendal nerve during childbirth, pelvic trauma and malignant neoplasms. Therefore, for any chronic pelvic pain, an MRI is advisable. The role of the herpes virus is also actively discussed - indirect evidence is the effectiveness of acyclovir and valacyclovir in some cases of PN.

There are so-called Nantes criteria for PN, which were developed by JJ Labat, R. Robert, G. Amarenco. Five main criteria have been identified:

1. pain in the area innervated by the pudendal nerve;
2. Predominant pain in the sitting position;
3. the pain does not cause sleep disturbance (i.e. does not cause the patient to wake up at night);
4. the pain does not cause serious sensory impairment;
5. blockade of the pudendal nerve relieves pain.

Typically, patients describe pain during PN as neuropathic, i.e. burning, paresthesia. Most often, the pain is localized on one side. The sensation of a foreign body in the rectum is very typical. A few words about the anatomy of n. Pudendus. The pudendal nerve contains both afferent and efferent fibers, which causes sensory and motor disorders of the corresponding organs. The pudendal nerve enters the pelvis at the level of S2-S4 and passes through f. piriformis, then through Alcock's canal and divides into 3 branches. It is hypothesized that pudendal nerve dysfunction may lead to symptoms of overactive bladder that are primarily sensory in origin, due to an increase in the number of C-fibers in the bladder, as well as through cross-sensitization, which we have already mentioned, in organs receiving the same innervation for the reason convergence of sensory pathways in the pelvis. Diagnosis of PN is based on the above Nantes criteria; in addition, it is necessary to palpate trigger points m. piriformis and m. obturatorius for the diagnosis of myofascial syndromes. Transvaginal ultrasound with assessment of blood flow in a. can help in diagnosing compression of the pudendal nerve in the Alcock canal. pudenda and v. pudenda, because when the nerve is compressed, these vessels are also compressed and the speed of blood flow on the affected side decreases.

Treatment of pudendal nerve neuropathy

Drug treatment usually includes pregabalin, starting at 75 mg twice daily and titrating up to 600 mg/day. To relax the muscles, vaginal suppositories with diazepam and injections of local anesthetics with glucocorticoids into the affected muscles are used. If the effect is positive, botulinum toxin is administered under EMG control. For diagnosis and treatment, blockade of the pudendal nerve is used under x-ray or ultrasound control. Typically, 5 ml of 0.5% bupivacaine with 80 mg of triamcinolone is administered - 3 injections. Surgical treatment is performed only when there is proven compression of the pudendal nerve that is resistant to drug therapy. Significant improvement is achieved only in 44% of cases. Other authors report 62% effectiveness (E. Botrand), 70% (R. Robert). Indications for decompression of the pudendal nerve and its technique require further discussion and study.

Pelvic neuralgia in women

As in men, the symptoms of pelvic neuralgia in women are similar to a number of symptoms of diseases of the genitourinary system. Pain in the perineum can be caused by dysmenorrhea, PMS, infectious and inflammatory diseases.

Important! Menstrual pain is most often the result of an existing pathology - endometriosis, abnormal structure of organs, etc., and is significantly different from neuralgic pain.

In women, diagnosis is easier because there is a connection with the menstrual cycle, and they can distinguish pain of a different nature on their own. As a rule, to make an accurate diagnosis, it is enough to exclude infections and a possible inflammatory process.

Pelvic neuralgia during pregnancy

Preparing a woman’s body for childbirth is directly related to the pelvic organs. A woman gains weight, and the load on her hip joints increases. As the fetus grows, pressure on the nerve endings increases and venous congestion appears.

The changes most clearly appear in the last trimester of pregnancy, when the fetus is already large and there is a sharp increase in weight. Women use special pillows to choose a sleeping position. But they are also a temporary measure, since the position of the body has to be changed frequently. Neuralgic pain and cramps during sleep are especially common in pregnant women. They can be associated both with a lack of calcium and with pressure exerted on the nerve endings.

Important! Treatment of neuralgia during this period is complicated by the fact that expectant mothers are prohibited from taking most medications, which means they have to wait out the pain.

Negative health effects of chronic pelvic pain syndrome

If pain in the pelvic area is associated with muscle-ligamentous tension, a special approach is required.
In this case, using conventional painkillers is not enough. Even if they relieve pain for a short time, they will not eliminate their cause - muscle spasms and asymmetric ligament tension. Firstly, musculo-ligamentous disorders play a negative role, worsening the functional health of the pelvic organs. First of all, they impede blood circulation. This leads to stagnation, against the background of which the risk of developing various gynecological, proctological and urological diseases sharply increases. Secondly, muscle spasms in the pelvic area do not occur on their own. In some cases, they are caused by mental trauma, in others by psycho-emotional disorders. If the consequences of these influences are not eliminated, they will have a destructive effect on the entire body.

Features of treatment

The main goal of treatment for pelvic neuralgia at the initial stage is pain relief. First of all, the doctor prescribes analgesics, and then, when the diagnosis is confirmed, it is possible to switch to topical medications - ointments, gels.

Important! If the pinched nerve resolves with complications, the doctor may additionally prescribe hormonal medications.

Warming, rubbing, and massage are effective in treating pelvic neuralgia. The doctor may prescribe physiotherapy: electrophoresis, phonophoresis, medicinal baths, etc.

If these methods do not help, the patient is referred for further examination, and based on the results obtained, surgical intervention may be required. Its purpose is to relieve pressure on the nerve or destroy the damaged area so that the pain signal does not enter the brain. For this, currents or a gamma knife are used.

Forecast

With timely consultation with a doctor and treatment, pelvic neuralgia goes away well and quickly. But if left untreated, the consequences for the body can be different: from limited joint mobility to frequent and severe attacks of pain, which can only be reduced with the help of a blockade.

With neuralgia, it is important to find out the genesis of the pain so as not to miss the onset of the development of a more serious disease, such as a tumor, which can later develop into a complex oncological disease.

We can say that neuralgia is a concomitant disease or a symptom that the body already has more serious problems that require timely treatment. That is why you should not wait until the disease goes away on its own.

Therapeutic measures

Treatment of inflammation of the nerve of the hip joint is complex. When completing the course, drug therapy is used, which includes the use of:

• Analgesics – Tempalgin, Analgin, Baralgin in the form of tablets and injections.
• Non-steroidal anti-inflammatory drugs (NSAIDs) to relieve acute pain syndromes - Diclofenac, Ortofen, Voltaren. These can be either injections or ointments for external use.
• Antispasmodics – Sirdaluda, Mydocalma, Baklosan.

The complex of physiotherapeutic treatment of hip neuritis includes massage, manual therapy, acupuncture, physical therapy, as well as mud, ozokerite, paraffin, and water procedures. Therapy for such a form of neuralgia as pelvic or lumbosacral plexitis, which occurs in the fair sex, depends on its etiology. For the infectious type, which is a complication of gynecological infections, treatment of pelvic plexitis in women includes antibiotics; for traumatic and compression plexitis that occurs after childbirth, surgical intervention is indicated to remove blood clots compressing the nerve plexuses in the pelvic area.

Traditional healers use hemlock tincture to treat hip neuralgia. To prepare the medicine, you need to take a glass jar and fill it tightly with fresh or dry shoots. Then fill the container to the top with sunflower oil and place it in the sun for a week. After this, the jar should be moved somewhere in a dark pantry and stored there for a month, shaking occasionally. At the end of the month, the oil must be filtered. Rub the resulting liquid into the skin of the sore spot until completely absorbed. Important: hemlock is a poisonous herb, so it should be handled with care. After preparing the herbal infusion, as well as after rubbing your hands, you should wash them thoroughly with soap.

Neuralgia of the hip joint is a rather unpleasant disease, but if you consult a doctor in a timely manner, it can be successfully treated and does not cause serious complications. A healthy lifestyle will help prevent the development of pathology. Both significant physical overload and physical inactivity, as well as frequent hypothermia and injuries should be avoided.