Pudendal nerve entrapment
What is Pudendal nerve entrapment?
Pudendal nerve entrapment syndrome is a long-term pelvic pain condition that results from damage, irritation or compression of one of the main nerves in the pelvis, called the pudendal nerve.
The pudendal nerve runs from your lower back, along the pelvic floor muscles to your perineum (the area of skin between your vagina and anus), where it branches off to the clitoris, vulva and rectum. This can cause a great deal of pain and discomfort and in some cases may significantly impact quality of life.
What causes pudendal nerve entrapment?
Pudendal nerve entrapment syndrome may be caused by:
- repeated minor damage from prolonged (months or years) sitting, cycling, or horse riding
- straining related to chronic constipation
- trauma to the nerve through childbirth, although this often resolves itself
- trauma to the pelvic area from a broken pelvic bone
- nerve damage through surgical procedures in the pelvic or perineal regions
- lesions or growths (cancerous or benign) pressing on the pudendal nerve
- peripheral neuropathy associated with diabetes or other vascular conditions
Symptoms of pudendal nerve entrapment
The most common symptom is pain when sitting, which gets worse the longer you sit. This pain may be burning, shooting, aching, itching or like an electric shock. You may feel it in your clitoris, labia, vagina, urethra, anus or rectum.
You may also experience:
- bladder and/or bowel irritation
- feeling you need to go to the toilet frequently
- having trouble starting the flow of urine
- feeling as if you have a bladder infection
- feeling an urgent need to have a bowel movement
- extra sensitivity to pain (eg wearing light clothes may be uncomfortable)
- numbness or pins-and-needles in the pelvic area, including the vulva
- a feeling of swelling in your perineum — like a golf ball or tennis ball
- pain during sex or difficulty reaching orgasm
How is pudendal nerve entrapment diagnosed
Diagnosing pudendal nerve entrapment syndrome is usually done via a clinical examination and some other tests. Your doctor will ask about your medical history, your symptoms and the location of symptoms. If your doctor suspects your pudendal nerve is involved, they will probably arrange for some other tests which may include:
- Vaginal or rectal examination — your doctor will apply pressure to the pudendal nerve to check for pain or other symptoms
- MRI or CT scans — these scans of the joints, ligaments and muscles of your pelvis check for physical abnormalities, tumours around the nerve or other possible causes of the pain
- Nerve studies — these stimulate nearby nerves with mild electrical impulses to check how they react
- Pudendal nerve block — the pudendal nerve is numbed with anaesthetic to check if symptoms disappear. If they do it indicates the pudendal nerve is contributing to your pain
Treating and managing pudendal nerve entrapment
There is no ‘cure’ for pudendal nerve entrapment. Rather, treatment aims to manage and reduce symptoms. This is usually done through a combination of approaches including lifestyle changes, physiotherapy and medical treatment.
Medical treatment
Managing pudendal nerve entrapment through medication is similar to managing other chronic pain syndromes. It may involve:
- Tricyclic antidepressants such as amitriptyline
- Anticonvulsants such as carbamazepine and sodium valproate
- Nerve stabilisers such as gabapentin and pregabalin
Injections of local anaesthetic or steroid medication may also provide relief for up to a few months at a time.
Surgery
If your nerve pain is due to compression from a lesion or growth, surgery can be effective in improving your pain. However, in some cases the effects of prolonged compression can still affect nerve function so eliminating all symptoms may not be realistic.
Neurostimulation may also help manage symptoms. This involves surgically implanting a small device under your skin, which delivers mild electrical impulses to the nerve to block pain signals from reaching the brain.
Risks and complications
Pudendal nerve entrapment can have a significant impact on your life. The condition can cause ongoing pain and discomfort and interfere with the ability to enjoy every-day activities. The condition can also lead to:
- sexual dysfunction including painful sex
- urinary problems including frequency and urgency
- difficulty opening your bowels
- high levels of stress
- depression and anxiety