Meralgia Paresthetica in Pregnant Women - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

Meralgia paresthetica is a neurological condition that occurs in most pregnant women. It is mainly caused by obesity or weight gain during pregnancy or by wearing uncomfortable or tight clothes. It is a non-serious and self-limiting condition.

What Is Meralgia Paresthetica?

Meralgia means pain in the thigh area, and paresthesia means numbness or a pricking sensation. So, meralgia paresthetica is pain associated with a tingling or burning sensation in the thigh. It happens when the lateral femoral nerve (the nerve that supplies the skin of the thigh in the anterior and lateral region up to the knee level) undergoes compression.

What Causes Meralgia Paresthetica?

Meralgia paresthetica causes nerve compression leading to a burning sensation, numbness, and pain in the thigh. In meralgia paresthetica, a nerve called the lateral femoral cutaneous passing through the inguinal ligament area or the anterior superior iliac spine region gets entangled or entrapped, leading to compression. This nerve causes sensations in the upper leg or thigh area, so pain and associated symptoms like numbness in the upper thigh occur due to compression. However, this condition only affects the sensations and does not affect motor activity or leg movements.

How Does Meralgia Paresthetica Occur in Pregnant Women?

In pregnant women, the growing fetus leads to weight gain in the uterine region. Sometimes, the weight of the growing fetus puts pressure on the groin area, thereby compressing the nerve, leading to this condition. Other reasons may be wearing belts or tight clothing, obesity, standing, running, or walking for longer duration.

Meralgia Paresthetica in Pregnancy:

Meralgia paresthetica occurs more commonly in pregnancy. The growing baby puts pressure on the groin area and pinches the nerve LFCN (lateral femoral cutaneous nerve). LFCN is a sensory nerve that sends signals to the brain. When the growing baby’s weight or the uterus presses this nerve, meralgia paresthetica causes symptoms such as thigh numbness, burning sensation in the thigh above the knee, and pain sensation.

What Are the Symptoms of Meralgia Paresthetica?

The symptoms of meralgia paresthetica usually occur on one side and affect the outer skin in the front of the thigh above the knee and not the muscles. A few of those symptoms are:

• A pricking or burning sensation, numbness, and pain in the thigh above the knee may be observed.

• The pain may extend to the outer side of the knee.

• The thigh skin becomes overly sensitive to hot or cold objects and even to soft touches.

• Pain while lying down on the affected side and in the groin area.

• These symptoms worsen during long periods of walking or standing.

How Long Does Meralgia Paresthetica Last?

The symptoms or condition can worsen throughout pregnancy, eventually resolving after delivery. However, in rare cases, the symptoms also prevail after delivery.

Is Meralgia Paresthesia a Dangerous Condition for Pregnant Women?

No, meralgia paresthesia is not dangerous for pregnant women and will not cause any complications. It will not harm the baby or the mother. Even though it can interfere with the individual's daily activities, it is a self-limiting condition. It will eventually resolve with or without any medical intervention or treatment.

What Is Femoral Nerve Pain?

Femoral nerve pain is the same as femoral neuropathy. Nerve pain or neuropathic pain occurs when the nerve that carries sensations to the brain gets affected. In femoral nerve pain, the nerve that runs from the pelvis to the thigh gets affected. This nerve is considered to be essential for moving one’s leg and for feeling sensations. This condition may cause sharp, stinging pain and may result in loss of muscle control.

How Is Meralgia Paresthetica Diagnosed?

To diagnose the condition, the doctor or healthcare professional will take the history to get a general idea about the symptoms and condition. The physician will inquire about the type of clothes worn regularly or to work, if belts are worn, etc. Next, the physician performs a physical examination requiring one to point out the area of numbness or pain in the region. A detailed description of the pain should be provided to the doctor. Some additional examinations will be done, including reflex and strength testing. The doctor might recommend further tests if the condition is not diagnosed by physical examination alone. Some of them include the following:

• Imaging Studies - X-rays (not preferred in pregnant women) or MRI (magnetic resonance imaging) will provide a detailed image of the internal structures. Even though imaging studies prove very little significance in diagnosing meralgia paresthetica, we can use them to rule out any existing disorders like tumors in the pelvic region or a herniated disc.

• Nerve Conduction Studies - Here, damaged nerves are detected via electrical stimulation. They are usually done on the affected and the non-affected parts and then compared.

• Electromyography - This technique measures the electrical activity and discharges produced by the surrounding muscles. A thin electrode is placed into the muscle to detect any signs of activity. This test is usually normal in meralgia paresthetica, but it is done to rule out other disorders.

• Nerve Blockade - An ultrasonic-guided injection containing an anesthetic agent and steroid is given to the thigh area where the lateral femoral nerve passes. Usually, the pain resolves almost immediately.

What Are the Treatment Options for Meralgia Paresthetica During Pregnancy?

• In most cases, the condition resolves independently without any medical intervention.

• The patient is reassured that the condition will resolve once the baby is born.

• Conservative treatment options are also suggested to ease the symptoms. Some include advising the patient not to wear any belts, wear loose-fitting clothes, and reduce standing or walking for a long period. Advise the patient to reduce any extra weight.

• Low-risk interventions like specific exercises are effective as they help ease discomfort and pain.

• In very rare conditions, surgery is advised. It usually happens in people with severe symptoms that do not resolve even with other treatment options.

How Can Pregnant Women With Meralgia Paresthetica Sleep Better?

Pregnant women should adequately follow meralgia paresthetica sleeping positions. Meralgia paresthetica sleeping positions include:

• The affected person should not sleep on the side where the feeling of discomfort is present.

• One should be using a pillow between the legs and avoid lying on the affected side. This will help ease discomfort, as pain might substantially increase while lying on the affected area.

• If a person sleeps on the back, a pillow or two should be kept below the legs.

Which Exercise Will Help Meralgia Paresthetica During Pregnancy?

There are a few meralgia paresthetica stretches or exercises that help with the symptoms. However, always consult the gynecologist and get their approval before attempting any stretches or exercises.

Hip Stretching Exercises:

• Start by being seated at the edge of the bed and gently lie down. Then, slowly raise the unaffected leg and bend the leg towards the chest, leaving the affected leg hanging down at the bed edge. Hold the leg for at least a few seconds before dropping them. Do this stretch a minimum of three times per day.

• Second, lie down on the unaffected leg on a flat surface and bend both knees. Place an elastic band on the affected ankle and pull the ankle close towards the buttock region. Remember to keep the back straight during this stretch. Hold the ankle for a few seconds and leave. Repeat this stretch a minimum of two to three times a day.

• Third, lie down on the back, keep the feet wide apart and flat, and bend the knees. Gently place the arm on the sides. Try engaging the core and pulling the tummy back to the spine, squeezing the bottom muscles, and lifting the bottom from the floor. Hold this position for about 10 seconds and gently lower the back down. Repeat this about ten times, three times a day.

Meralgia Paresthetica Exercises:

Meralgia paresthetica exercises help relieve meralgia paresthetica pain. These include:

Cat-Cow (Cat-Camel): In this type of exercise, one should get on hands and knees with hands shoulder-width apart, and knees should be over the hips. By inhaling deeply, one should curve the lower back and bring the head up by tilting the pelvis slightly up (cow or camel position). Then, exhaling, pull the stomach in and arch the spine with the head and pelvis down (cat position). This exercise should be repeated ten times.

Clamshell: In this exercise, one should lie on one’s left side with his and knees stacked, and the head should rest on the left arm. The stomach should be kept pulled in. Then, slowly, the right knee should be raised as much as possible. The left knee should be kept on the floor while raising the right knee. After raising the right knee apart, it should be kept on hold for a couple of seconds. Then, the right knee should be brought back to the same position.

Conclusion:

Meralgia paresthetica is self-limiting and is fairly common among pregnant women. Even though it is a neurological condition, it is not serious and can be easily managed with adequate care and appropriate lifestyle modifications.