When the ilioinguinal nerve is pinched, the innervation of the tissues and organs of the pelvis is disrupted, and pain of varying degrees of intensity occurs in the specified area. Neuralgia and neuritis in this localization develop mainly due to damage to local tissues. Since the signs of the disorder are similar to prostatitis, cystitis and other pelvic pathologies, the results of ultrasound and other diagnostic procedures are taken into account when selecting treatment tactics.
Anatomical structure
The inguinal nerve begins in the lumbar plexus and descends into the pelvic region through the iliac joint. It goes further:
- along the edge of the psoas major muscle;
- along the surface of the quadratus lumbar muscle;
- through the transverse abdominal muscle;
- through the opening of the inguinal canal.
Next, the nerves of the inguinal region are adjacent to the spermatic cord and round uterine ligament in men and women, respectively. In the former, these fibers end in the scrotum, in the latter, in the area of the labia majora.
The difference in the anatomical structure explains the difference in the symptoms of ilioinguinal neuralgia in people of different sexes. In men, these branches of the central nervous system innervate the scrotum, penis and pubic skin. In women, the ilioinguinal nerve transmits impulses to the upper part of the labia. Also, in people of both sexes, these branches innervate:
- exit site of the rectum;
- anal sphincter;
- bladder sphincter;
- skin in the groin area.
The functions of the ilioinguinal nerve are regulated by the autonomic part of the central nervous system.
These branches are responsible for the sensations that occur during defecation, sexual intercourse and urination. In addition, branches of the nerve provide innervation to the transverse and oblique muscles of the abdominal cavity, responsible for their motor activity.
Surgical intervention
If there is no effect from conservative therapy, surgical treatment is indicated. The doctor performs decompression surgery under general anesthesia. This eliminates pinching of the nerve by nearby tissues.
This operation effectively eliminates all unpleasant symptoms. However, the rehabilitation period can last several months. During this period, it is necessary to follow a gentle regimen: avoid physical activity and prolonged sitting.
It is important to remember that even after surgery, relapses of the disease are possible. When exposed to unfavorable factors, re-pinching of the inguinal nerve is possible. Therefore, preventive measures and recommendations of the attending physician should be followed.
Causes of pinching
Surgeries performed when the rectum prolapses into the abdominal cavity lead to a pinched nerve in the groin. It is possible that neuralgia will develop due to the prolonged development of a hernia: over time, nerve fibers grow into such a tumor, without damaging which it is impossible to remove the tumor.
Also, operations to remove appendicitis and an inflamed kidney lead to neuritis on the right or left side. Here, the inflammatory process or compression occurs as a result of the formation of a scar that compresses the nerve fibers.
The disease also develops due to:
- complications of pregnancy and childbirth;
- damage to the pelvic bones (usually fractures);
- anatomical abnormalities in the structure of the round ligament of the uterus;
- neoplasms in the groin area;
- varicose veins that lie in the area of the spermatic cord (varicocele in men);
- muscle hypertonicity;
- recurrence of herpes zoster localized in the groin area or lower back;
- displacement of the abdominal muscles caused by excessive physical exertion.
A pinched nerve in the groin on the right side is diagnosed extremely rarely. This is explained by the deep location of the branches of this section of the vegetative system.
Athletes, especially those involved in cycling or horseback riding, are at increased risk of developing inguinal neuropathy.
Pinched nerve in the groin
Pinched nerves and associated pain exist not only in the limbs, neck, chest, but also in the groin. After all, this area is innervated by many anterior branches of the lumbar plexus. Due to its anatomical structure, compression-ischemic neuropathies of this anatomical region are somewhat less common than in the area of extremities that move intensively. One thing to remember is that there is not one nerve in the groin. This area is “served” by many nerves derived from the lumbar and sacral plexus.
A little anatomy
The lumbar plexus is a fairly powerful bundle of nerves that lie in front of the lumbar vertebrae, deep in the psoas major muscle.
The variety of nerves of the lumbar plexus
All branches and nerves emerge from under the edges of this muscle, and some directly pierce it. These branches that can become damaged and cause symptoms of inguinal neuropathies are:
- decreased skin sensitivity in the groin, paresthesia, “crawling”, numbness;
- pain in the groin, of varying localization and strength.
- iliohypogastric nerve. It provides motor innervation to the abdominal muscles, gives sensitivity to the skin of the buttock above, and innervates the inguinal canal;
- ilioinguinal nerve. Innervates the labia majora, or scrotum, as well as the skin of the pubis.
Causes of inguinal neuropathies
The causes of inguinal neuropathies most often lie in the interaction of nerves with the structures of the inguinal hernia, and neuropathies are a consequence of surgery to eliminate the inguinal hernia.
As you know, any hernia consists of a hernial orifice, hernial contents and a hernial sac. During the operation, a loop of intestine is inserted from the hernial sac back into the abdominal cavity, and then the “weak spot” in the anterior abdominal wall is closed, performing plastic surgery. Just during suturing of the hernial orifice, the branches of the corresponding nerves may be damaged or pinched by scar tissue, which may form as a result of surgery. In this case, the nerve in the groin will be pinched, and complaints may arise immediately after the operation, or may appear several days later.
Most often, patients present complaints such as:
In case of damage to the hypogastric nerve, hypoesthesia (decreased sensitivity) occurs not in the groin, but in the suprapubic space and at the top of the buttock. If the inguinal nerve (more precisely, the ilio-inguinal) is pinched, then a decrease in sensitivity occurs in the area of the external genitalia, but all functions (erection, etc.) are preserved. Sometimes there is superficial soreness in these areas. In this case, the pain may change (weaken or intensified) when the position of the legs changes.
Obturator nerve
It is important that the pinched nerve and pain in the groin will always be on one side, since the innervation is ipsilateral, that is, one-sided. When diagnosing, one must take into account the possibility of other lesions, for example, the obturator nerve, the lateral cutaneous nerve of the thigh. In the presence of severe pain in the lower back, the discogenic nature of the disease cannot be ruled out.
Lateral cutaneous nerve of the thigh
Diagnosis, in addition to a clinical examination, questioning and examination by a neurologist, includes an electroneuromyographic examination, which, although it does not play a key and decisive role, nevertheless allows one to establish the localization of the lesion. Of course, ultrasound and MRI can be used, but only if compression of the nerves is suspected by retroperitoneal space-occupying formations, or tumors of the pelvis and abdominal cavity.
Characteristic symptoms
When the ilioinguinal nerve is pinched, the main symptom is burning pain localized in the perineal area. However, in the initial stages of the development of neuralgia, this phenomenon is episodic in nature and manifests itself weakly, so it is quite difficult to diagnose the disorder during its inception.
Symptoms also appear as:
- aching (pulling) pain in the pelvic area that constantly bothers you;
- problems with urination (urinary incontinence or difficulty emptying);
- discomfort in the anal area;
- frequent constipation;
- numbness, burning, tingling sensation in the perineum;
- numbness of the skin on the genitals;
- pain syndrome that occurs during sexual intercourse.
In women, when the inguinal nerve is pinched, a burning sensation occurs when urinating. The difficulty in making a diagnosis is explained by the similarity of symptoms with other diseases affecting the pelvic organs: cystitis, hemorrhoids and others. In this regard, patients often begin treatment for inflammatory pathologies on their own.
Complications and prognosis
In most cases, doctors are able to relieve compression of the ilioinguinal nerve. Treatment leads to the disappearance of pain and discomfort. However, a favorable prognosis is possible only if the patient consults a doctor in a timely manner. A complication of an advanced form of neuropathy is the chronicity of the process. In this case, persistent disorders of sexual function and frequent urinary incontinence occur. Patients suffer from chronic constipation. In such cases, surgical treatment of neuropathy is indicated, which requires long-term recovery after surgery.
Diagnostics
Since the symptoms of damage to the inguinal nerve are similar to other pelvic pathologies, a comprehensive examination of the patient will be required to identify the causes of neuropathy.
The basis of diagnostic measures is ultrasound. This examination allows you to identify disturbances in blood flow that occur during compression.
The doctor receives important diagnostic data from an external examination of the affected area and palpation of the area near the anterior superior iliac spine. The inguinal nerve runs through this part of the body. Also, during the examination, patients are asked to tense their abdominal muscles and move their lower limbs to the side. The appearance of pain indicates signs of this particular disease (in addition to other symptoms).
In the future, CT and MRI will be required (but only if pelvic pathologies are suspected). These techniques make it possible to identify the localization of the inflammatory process that caused compression of the inguinal nerve fibers.
Signs of inflammation of the sciatic nerve
Where is the sciatic nerve located? These are the 2 largest and longest nerves in the human body, which run from the left and right of the lower back to the toes. Usually, with inflammation, the patient is bothered by pain in only one of them, localized in the buttock, behind the thigh, behind the knee along the calf, reaching the foot.
With neuritis or pinching of the sciatic nerve, symptoms and pain are described by patients as burning, stabbing, sharp, cutting. They both appear and disappear suddenly, however, with severe inflammation they can be chronic, with periodic relapses.
An attack of inflammation usually begins after emotional or physical stress, especially in combination with hypothermia, and often begins at night. Along the course of the nerve, the sensitivity of the skin may be disrupted, or intensify - tingling, goosebumps, or, conversely, decrease - numbness. The pain initially extends along the back of the thigh, down to the lower leg and foot.
After an attack, pain remains between the 5th lumbar and 1st sacral vertebrae, as well as under the knee and in the center of the buttock. Due to severe pain, a person may faint, as well as autonomic disorders - increased sweating of the feet, swelling and redness of the skin. The pain intensifies with prolonged standing, walking, or sitting on a hard surface. During attacks of pain, a person takes a forced position of the body, leaning on a healthy leg; one of the signs of a pinched sciatic nerve is a disturbance in gait (see also causes of lower back pain radiating to the leg).
With severe inflammation of the sciatic nerve, the symptoms are expressed in a severe decrease or complete disruption of the function of the nerve. This may cause the gluteal, thigh, or calf muscles to become smaller. The patient may have difficulty trying to flex the lower leg due to temporary immobilization of the hamstring muscle, and the flexion of the toes and rotation of the foot are also impaired.
Drug treatment
If the inguinal nerve is pinched, drug therapy is indicated, the main goal of which is to relieve pain. For this purpose the following are assigned:
- analgesics (“Analgin”, “Pentalgin”);
- anticonvulsants and muscle relaxants that relieve muscle spasms (Mydocalm, Gabapentin);
- rectal (vaginal) suppositories with analgesic properties (“Diazepam”);
- compresses with Dimexide (relieve muscle spasms).
To restore nerve conduction, taking B vitamins (intramuscularly) is indicated. In severe cases, it is recommended to take steroid hormones (Dexamethasone) or install novocaine blockades, which suppress acute pain. At the initial stages of pathology development, Xefocam is used.
In the absence of effect from drug therapy, surgical intervention is recommended. Surgeries are necessarily carried out when neoplasms are detected in the pelvic area or severe fractures. In case of severe compression of nerve fibers, surgical intervention helps restore the innervation of the pelvic tissues. This procedure is dangerous for the patient, so this treatment is resorted to in extreme cases. In addition, long recovery is required after surgery.
Causes and treatment of a nerve in the groin when pinched
When the nerve of the inguinal canal is pinched, the supply of nerve cells to organs and tissues deteriorates. A painful syndrome occurs in the pelvic area, which can radiate to the back, buttocks or thighs. This phenomenon occurs due to injury or pathologies of internal organs. It is necessary to start timely treatment to avoid negative consequences.
Causes of pinching
The main cause of pinched nerve bundle on the right or left side is surgery to remove an inguinal hernia.
The carelessness of the surgeon can lead to damage to the branches of the nerves or their pinching by scar tissue. There are other provoking factors:
- increased tone of the piriformis muscle;
- oncological diseases;
- consequences of herpetic infection;
- spasm of the perineal muscles;
- inflammation of the pelvic organs.
If the nerve is pinched, the internal organs of the pelvis could be injured. Prolonged labor or prolonged cycling can lead to pinched nerve bundles. Another reason is diseases of the internal organs. These include: tuberculosis, cholelithiasis, rheumatic diseases, disorders of the cardiovascular system, varicose veins of the testicle (varicocele).
How to recognize symptoms
A pinched nerve in the groin can cause certain symptoms. They manifest themselves with varying intensities: from decreased sensitivity to acute pain in the groin area. It all depends on the progress of the process.
At the initial stage, patients complain of aching pain that intensifies at night. In women, the pain syndrome is felt acutely in a sitting position. The following symptoms are characteristic of this pathological condition:
- painful sensations intensify with pressure;
- there is itching and burning;
- there is a feeling of tingling, numbness in the groin area;
- there is discomfort in the anal area.
In some cases, sensitivity in the upper buttock, pubis (with pinched iliohypogastric nerve) or external genitalia (pinched ilioinguinal nerve) is reduced. Painful sensations always occur on the left or right.
If it lasts for a long time due to stress, urination becomes disordered and the process of bowel movement becomes difficult (constipation).
Therapeutic measures
To begin with, a diagnosis is made, taking into account the condition of the obturator nerve and the external cutaneous nerve. After the examination, the patient is prescribed complex treatment. Injection therapy is used to relieve pain. Drug blockades are injected into the affected area, which begin to act immediately. Other therapeutic measures are used:
- Make compresses with Dimexide. They help relieve spasms.
- Steroid hormones are prescribed. These include Dexamethasone.
- Anticonvulsants are used to relieve acute pain.
- B vitamins and antioxidants are prescribed. Vitamins are administered intramuscularly.
- Xefocam helps relieve inflammation in the initial stages.
- Rectal or vaginal suppositories with anesthetics are administered.
When acute manifestations are eliminated, physiotherapy is prescribed. This can be electrophoresis, ultrasound and manual therapy. Subsequently, therapeutic exercise will help improve muscle tone and prevent pinching. The muscles need to be compressed and relaxed in the hip area.
Due to vague symptoms, patients may not be aware of damage to the nerve bundle. The disease tends to develop into a chronic form and treatment may not be limited to medication. In more advanced stages, surgical intervention is used.
