Genitofemoral nerve – Dr. Towfigh

[drtowfigh]

If your pain is 3 yrs after the hernia repair, chances are it’s not a nerve issue. May be a hernia recurrence or an abdominal strain. The other questions are best answered by your pain doctor who is doing the injections.

[katiebarns]

[USER=”1942″]NFG12[/USER] He’s doing a CT guided genital branch nerve block with some cortisone. My pain is like in the low rectus abdominis and pubic area / pubic bone.. I guess where the rectus abdominis and pubic bone attach too. All that area. I’m just now thinking maybe the ilioinguinal or iliohypogastric nerve would cause that pain more than the genitofemoral nerve (Genital branch)….
[USER=”935″]drtowfigh[/USER] do you have any insight on which nerve would make more sense for where I’m hurting? I trust your insight 100%!

[Unknown Member]

Ive never heard of a CT guided nerve block before but I know that what they usually do is an ultrasound guided nerve block. The Genitofemoral nerve splits into the genital branch and the femoral branch. The femoral branch is rare to get injured. They should do a nerve block of the genital branch first if that does not help then do a ilioinguinal nerve block. The area you describe sounds more of the genital branch and it is always usually negatively affected by mesh. Go on google and type in genital branch nerve and go to images. It will show you the area of each nerve and to where they provide feeling to. I wish you the best and hope you get some answers!

[katiebarns]

[USER=”2042″]Jnomesh[/USER] I’ve googled it and the pictures vary.. is there a picture in particular that would be good? I’m like in between 2 nerves.

[Jnomesh]

They are all groin nerves but have different course and therefor can cause pain or be felt in different areas in the groin/thigh.
A simple google search will illustrate the pathways and course of each nerve. There is a 4th groin nerve called the lateral femoral cutaneous nerve that can also sometimes be affected in laparoscopic places mesh but this nerve causes more issues in the front and outer thigh.

[katiebarns]

[USER=”1916″]Chaunce1234[/USER] I will! Do you know if those different nerves affect different areas? Or are they kind of all in the same area?

[Chaunce1234]

quote katiebarns:

Just the genitofemoral nerve. If this doesn’t work, I think I’m going to get the ilioinguinal nerve.

[USER=”1916″]Chaunce1234[/USER] Is all 3 at once better?

I would think the more precise you can get the better, since if you can isolate the pain to a particular nerve then that should be informative for many reasons. So I think your approach of direct targeting each nerve individually makes a lot of sense.

Please keep us updated on your case and progress, and any changes to symptoms.

[katiebarns]

Just the genitofemoral nerve. If this doesn’t work, I think I’m going to get the ilioinguinal nerve.

[USER=”1916″]Chaunce1234[/USER] Is all 3 at once better?

[Chaunce1234]

quote katiebarns:

[USER=”1916″]Chaunce1234[/USER] I have digestive issues so I don’t think the extended course of NSAID’s would work 🙁 also… I’m getting a CT guided nerve block this month.. is that what you mean by the ultrasound nerve block?

Perhaps talk with a doctor about the NSAID approach, they can certainly cause digestive issues though. It may be helpful to split the dose up and take each smaller dose with food, never on an empty stomach. Just a thought to consider.

A CT guided nerve block should be even more precise than ultrasound guided, so that could be informative. Do you know if they will be targeting the trio of primary groin nerves (genitofemoral, ilioinguinal, iliohypogastric), or just the genitofemoral?

Please let us know how it goes, and keep us updated on your progress!

[katiebarns]

[USER=”1916″]Chaunce1234[/USER] I have digestive issues so I don’t think the extended course of NSAID’s would work 🙁 also… I’m getting a CT guided nerve block this month.. is that what you mean by the ultrasound nerve block?

[Chaunce1234]

[USER=”2482″]katiebarns[/USER] I’m sorry you’re going through this.

I’m just a fellow patient, but here are a few ideas you may want to discuss with your doctor if you haven’t tried them yet:

– Extended course of strong prescription strength NSAID. Typically 40-60 consecutive days, assuming your health can tolerate the RX NSAID and that the doctor will supervise you on that regimen

– You may want to discuss having an ultrasound guided nerve block if the first attempt fails or is less than satisfactory, since sometimes it can be tricky to get the proper nerve(s) targeted. If there is any success at all, repeating the nerve block injection several times over several weeks (or months) can often be more helpful.

– Targeted physical therapy, aimed at strengthening and stretching the surrounding muscles

Best of luck and keep us updated on your case and progress.

[Good intentions]

Okay, sorry I took the negative approach. I know that the tissue around the mesh thickens and becomes stiffer, in all cases. So the normal swelling and healing response from your injury might be complicated by the inflexibility of the mesh area, pulling on areas it normally wouldn’t. Hopefully it will relax back to the state in which it was working for you. Good luck.

[katiebarns]

[USER=”2029″]Good intentions[/USER] I just didn’t have issues after my hernia surgery until I had an injury while working out. I had my surgery in 2015 and my injury was this past jan. So I think the mesh is okay because I had no issues for those 3 years.

[Good intentions]

quote katiebarns:

[USER=”935″]drtowfigh[/USER] My symptoms are achy and drawing pain in the same area as my inguinal hernia repair (pubic and pubic bone and rectus abdominis area kinda).

Hi Katie. I know that you’re looking for Dr. Towfigh’s advice but a couple of things that might be considered are that the mesh is often attached to the pubic bone, and the rectus abdominis. That’s what my surgeon reported and he used the main stream method. And as it shrinks it will pull on those areas. You mentioned a “drawing” pain. I don’t know/remember the details of your procedure.

Also, while much focus is placed the main branches of the nerves, I think because they are visible and can be manipulated, or cut, those branches extend out to smaller and smaller nerves. So it’s possible that localized pain can be due to local nerves. Focusing on the main branch is a way to suggest that the patient is having some sort of referred pain, not correlated to local damage. Pain and the “quality” of the mesh repair are often not connected. The mesh can look fine, placed where it’s instructed to be placed, and still cause pain. It’s not the technique, it’s the material and its interaction with the body tissues.

Sorry, I know it doesn’t help you find a solution but just knowing the cause can sometimes reduce some of the mental stress. Good luck.

[katiebarns]

[USER=”935″]drtowfigh[/USER] okay thank you. could I also ask one more question — if I had more low rectus abdominis and pubic / pubic bone area achy pain, would you say that could be more so genitofemoral, illioinguinal, and/or iliohypogastric nerve?

[Unknown Member]

The Genital branch of the Genitofemoral nerve is usually negatively affected by the mesh.

[drtowfigh]

First you need a diagnosis. Sounds like your workup hasn’t been complete yet. Find a hernia specialist you can trust and go through figuring out if it’s the repair, the nerve, inflammation, infection, or the mesh.

[katiebarns]

[USER=”935″]drtowfigh[/USER] if it doesn’t go away, do you have any suggestions as to what I should do or look for next? thank you for replying!

[drtowfigh]

Can be. A block of the nerve may help prove that theory. If the pain goes away with a nerve block then the nerve is typically the culprit.