Disorders: Pelvic Pain and Pudendal Neuralgia
There are many causes of pain in the abdomen and pelvis – the place to start in any investigation is with your internist, general surgeon, urologist or gynecologist.
However, sometimes, the cause of pain and numbness in various areas of the pelvis remains a mystery. MR neurography has a proven track record for diagnosing pelvic pain problems that are due to problems with the nerves.
The nerves involved form a complex alphabet soup of different syndromes that many general doctors are just not familiar with. In the front of the groin area – the problem may be with ilioinguinal or genitofemoral nerves. In the inner thigh – it may be the obturator nerve. Buttock pains can come from the superior or inferior gluteal nerves, the cluneal nerves, or from the nerve to the obturator internus. When pain or numbness affects the area between the legs – the pudendal nerves may be involved.
The pudendal nerves travel a long complex course – they may be entrapped in the upper pelvis near the piriformis muscle, in the mid-pelvis near the Ischial spine, or in the low pelvis along the Alcock's canal that travels over the obturator internus muscle.
An MR neurography study can be the first step towards unraveling the knot and finding the source. Even these small nerves can demonstrate a tell-tale signal of injury or entrapment on an MR neurography study. Then, together with a physical exam by a pelvic nerve specialist and targeted injections and blocks you may finally be able to get a solid and treatable diagnosis.