ILIOINGUINAL ENTRAPMENT NEUROPATHY
Overview
Small collections of nerve fibers called cutaneous nerves supply sensation to every section of our skin. These nerves allow us to sense temperature changes, light touch, pressure and pain. Occasionally, these nerves can get trapped in other tissues such as scars. When this happens, the patient may experience pain along the nerve. The most common entrapment neuropathy is carpal tunnel syndrome where the median nerve gets trapped in the soft tissues of the wrist. Another common site for nerve entrapment is the groin. Many sufferers have had previous low abdominal surgery such as C-sections or hernia repairs. These scars can lead to entrapment of two nerves called the ilioinguinal and hypogastric nerves causing low abdominal pain. Other risk factors for abdominal entrapment neuropathies include obesity and tight fitting clothing.
Diagnosis
In establishing a diagnosis, the doctor will rule out problems with the internal organs through a careful history and physical, and may order diagnostic studies such as blood work, urinalysis, X-rays, ultrasound, CAT scans or MRIs. Once all internal problems have been eliminated, the most likely diagnosis is an entrapped nerve. The next step is to have the nerve injected by an expert, usually a pain doctor. If the pain goes away temporarily with the injection of local anesthetic, the diagnosis is confirmed. Unfortunately there is no X-ray study that reveals the presence of an entrapment neuropathy. The X-rays are only useful to rule out problems with the internal organs.
Treatment
Obesity and tight fitting clothing are two conditions that contribute to entrapment neuropathies of the low abdomen. Therefore, obese patients should try to lose weight to relieve the nerve compression. Tight fitting jeans should be avoided. If the patient has severe pain, injections of the nerve with anti-inflammatory drugs can sometimes give long-term relief. In those cases where nerve blocks and weight reduction fail to relieve the discomfort, surgery can be performed to remove the nerve from the scar. This procedure is not always successful because the surgery can again result in more scar formation. Nonetheless, many patients report good long-term relief after surgery.
Prevention
- Maintain ideal body weight
- Appropriate fitting clothing
- Avoid smoking
- Proper diet