Groin and Thigh Pain
There are many patients who experience persistent groin pain following surgery or trauma. It is fairly common for patients who have undergone hernia repair, caesarian section, or other abdominal and urologic procedures to experience persistent postoperative pain. This pain is typically due to direct damage to one of the many nerves in the lower abdomen, groin, or thigh. The damaged nerve, or neuroma, becomes irritated and sends a constant pain signal that makes it difficult to perform daily activities. Even scar tissue surrounding a nerve can cause indirect injury to the nerve in the form of nerve compression. The average patient with chronic groin pain at Florida Plastic Surgery Group describes numbness or burning in the lower abdominal wall, the pubic area, the inner thigh area, the scrotum/the testicles in men or the labia in women, and/or along the front and side of the thigh (known as meralgia paresthetica).
Preparing for Treatment
What are the non-surgical treatment options for my groin & thigh pain?
The first step in evaluating chronic groin pain is to schedule an appointment with a medical or surgical specialist interested in hernia, abdominal, urologic, or gynecologic surgery to rule out any underlying cause of your pain. They will examine you for possible causes including hernias or other intra-abdominal problems, infections, tumors, urinary blockage, cysts, or endometriosis. Your doctor may alter your physical activity, recommend physical therapy, or begin a trial of traditional pain and neuropathic medications. If your groin and thigh pain persists, a consultation with a pain management specialist may provide non-surgical options for pain relief.
Are there surgical treatment options for my chronic groin & thigh pain?
If there is no underlying medical condition causing your chronic groin/thigh pain, and conservative treatment for pain relief has failed, then you may be a surgical candidate. When the pain is due to a damaged nerve, or neuroma, one or more nerves are removed, leaving an area of numbness in the lower abdomen, pubic or inner thigh areas. If the pain and decreased sensation (e.g. the front and side of the thigh as in Meralgia Paresthetica) is due to a nerve compression, then the pressure on the nerve is released and the nerve is not cut (similar to carpal tunnel surgery).
Am I a candidate for groin denervation/thigh decompression surgery?
After ensuring there is no underlying medical reason for your persistent groin/thigh pain, our surgeons will perform a nerve block to identify the source of your pain. The nerve block is performed in the office setting, similar to a dental block performed by your dentist to alleviate your toothache. The nerve block targets the nerves sending pain signals to your groin, thigh, scrotum/testicle in men, and labia in women. If your pain is significantly relieved by the nerve block, then surgery can be up to 90% successful.
I have chronic groin/thigh pain, what is the next step?
Prior to the initial consultation:
- Complete our chronic groin/thigh pain questionnaire
- Obtain your records from prior treating physicians outlining previous treatment or diagnostic studies pertinent to your pain
What is done at the initial consultation?
The initial consultation steps:
- Our surgeons will review your history with you, perform a physical examination, and answer all your questions and concerns
- Our surgeons will perform a diagnostic nerve block to identify if your chronic groin/thigh pain is neural in origin and can be surgically treated
Surgery is performed under general anesthesia under supervision of a board certified anesthesiologist.
For most patients, surgery is performed on an outpatient basis (you go home the same day). Depending on the number of nerves treated, surgery takes 1 to 2 hours to perform.
What should I expect during my recovery?
Following surgery until the first visit (usually 7 days), we encourage patients to relax and not perform any strenuous activity. We recommend you use stool softeners to avoid straining and do not smoke as it can lead to coughing, both of which can increase your abdominal pressure and cause discomfort. A dressing is placed over the incision(s) and may be removed in 48 hours when you are able to shower. We may temporarily place a pain pump at the time of your surgery, which continually instills a local anesthetic to “numb” your surgical site. Activity is gradually increased and most patients are back to work within 2-3 weeks with a graduated lifting limit. You are not able to drive or operate heavy machinery while taking any postoperative narcotic pain medication.
While some patients experience immediate pain relief, the results of the procedure can take several months to take effect. If the groin was operated on, the groin will remain numb because nerves have been removed. If the front and side of the thigh was operated on, sensation should return as pain decreases.
What are the risks of surgery?
In addition to common surgical risks, the unique risks of chronic groin pain surgery include:
- Remaining areas of pain
- No change in the amount of pain
- Areas of numbness in the lower abdomen, groin, and thigh
- Residual burning in the front and side of thigh during nerve regeneration that can last for six months
- Unpredictable scar formation
- A require a second surgery to address an additional nerve causing persistent pain