Pudendal nerve entrapment (PNE) is a source of chronic pain, in which the pudendal nerve (located in the pelvis) is entrapped or compressed. Pain is worsened by sitting, and can include prickling, stabbing, burning, numbness, and the sense of a foreign object in the urethra, vagina, or rectum. In addition to pain, symptoms can include sexual dysfunction, impotence, anal and urinary incontinence. Chronic pain was originally defined as pain that has lasted 6 months or longer. ... The pudendal nerve is responsible for orgasm, urination, and defecation in both sexes. ... The pelvis (pl. ... In anatomy, the urethra is a tube which connects the urinary bladder to the outside of the body. ... The vagina, (from Latin, literally sheath or scabbard ) is the tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. ... The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. ... The term symptom (from the Greek syn = con/plus and pipto = fall, together meaning co-exist) has two similar meanings in the context of physical and mental health: Strictly, a symptom is a sensation or change in health function experienced by a patient. ... Sexual dysfunction or sexual malfunction (see also sexual function) is difficulty during any stage of the sexual act (which includes desire, arousal, orgasm, and resolution) that prevents the individual or couple from enjoying sexual activity. ...

Causes

PNE can be caused by pregnancy, scarring due to surgery and accidents. Anatomic abnormalities can result in PNE due to the pudendal nerve being fused to different parts of the anatomy, or trapped between the aforementioned ligaments. Heavy and prolonged bicycling, especially if an inappropriately shaped or incorrectly positioned bicycle seat is used, may eventually thicken the sacrotuberous and/or sacrospinous ligaments and trap the nerve between them, resulting in PNE. The term trimester redirects here. ... A cardiothoracic surgeon performs a mitral valve replacement at the Fitzsimons Army Medical Center. ... A ligament is a short band of tough fibrous connective tissue composed mainly of long, stringy collagen fibres. ... Police officer on a bicycle Cycling is a recreation, a sport and a means of transport across land. ...

Treatment

Physical Therapy

There are stretches and exercises which have provided reduced levels of pain for some people. There are different sources of pain for people since there are so many ligament, muscles and nerves in the area. Sometimes women do pelvic floor exercises for compression after childbirth. However, there have been cases where the wrong stretches make the constant pain worse. Some people need to strengthen the muscles, others should stretch, while for some people it is purely neurological. There have been cases where doing stretches have helped bicyclists. A helpful stretch for some is bending over and touching your toes. Another stretch includes bringing your knee to your chest on the compressed side while laying on your back. One more possibly helpful stretch for bicyclists include sitting in the lotus position and moving your head to the ground supporting yourself with your hands and keeping your buttocks up. Stretches should not be held long (about 8 seconds) and be spreadout through the day. Acupuncture has helped decrease painlevels for some people. Chiropractic adjustments to the lower back have also helped some patients with pudendal nerve issues. Neurology is a branch of medicine dealing with disorders of the central and peripheral nervous systems. ... Acupuncture (from Lat. ...

Corticoids treatment

Alcok canal infiltration with corticosteroids is a minimally invasive technique which allows for pain relief and could be tried when physical therapy has failed and before surgery.

Surgical

Decompression surgery is done primarily in Nantes, France, Aix-en-Provence, France, Pheonix, Arizona, Lake Elmo, Minnesota, Baltimore, MD, Santa Monica, CA, Houston, Texas, Switzerland, Belgium, Nashua, NH and in Egypt. The validity of decompression surgery as a treatment and the existence of entrapment as a cause of pelvic pain are controversial. While certain doctors will prescribe decompression surgery, others will not. Notably, in February 2003 the European Association of Urology in its Guidelines on Pelvic Pain said: For a place in Brazil, see Nantes, Brazil Nantes (Breton: Naoned) is a city in western France, near the Atlantic coast. ... Coordinates Administration Country France Region Provence-Alpes-Côte dAzur Department Bouches-du-Rhône (sous-préfecture) Arrondissement Aix-en-Provence Canton Chief town of 3 cantons Intercommunality Communauté dagglomération du Pays dAix Mayor Maryse Joissains-Masini  (UMP) (2001 - 2008) Statistics Land area¹ 186. ... Nickname: Valley of the Sun Official website: http://www. ... Lake Elmo is a city located in Washington County, Minnesota. ... This article is about the city in the US state of Maryland. ... Santa Monica Pier Santa Monica is a coastal city located in Los Angeles County, California USA, by the Pacific Ocean, south of Pacific Palisades and Brentwood, west of Westwood, Los Angeles, and north of Venice. ... Nickname: Space City Location in the state of Texas Coordinates: Country United States State Texas Counties Harris County Fort Bend County Montgomery County Incorporated June 5, 1837  - Mayor Bill White Area    - City  601. ... Nashua is a city located in Hillsborough County, New Hampshire. ...

the reality is that pudendal nerve neuropathy is probably only a likely diagnosis if the pain is unilateral, has a burning quality and is exacerbated by unilateral rectal palpation of the ischial spine, and the pudendal motor latency is delayed on that side only. However, such cases account for only a small proportion of all those presenting with perineal pain and the proof of the diagnosis resting on relief of pain following decompression of the nerve in Alcock's canal is rarely achieved. The value of the clinical neurophysiological investigations is debatable; some centres in Europe claim that the investigations have great sensitivity (1,2), while other centres, which also have a specialized interest in pelvic floor neurophysiology, have not positively identified any cases.[1]

Three types of surgery can be done to decompress the pudendal nerve: transperineal, transgluteal and transichiorectal. The results on pain are very similar (around 60% of cure). Impotence, anal and urinary incontinence can also be cured by these procedures.

External links

• TIPNA.org: Forum based website to go for information on PNE.
• Contains the statement of Dr. Rodney Anderson, Professor of Urology at Stanford University
• Consists of the European Association of Urology GUIDELINES ON CHRONIC PELVIC PAIN, including the quoted Section 7.2
• Website about the pudendal canal syndrome
• Society for pudendal neuralgia
• Pudendal.info: Forum based website for further information on PNE

References

• Am J Phys Med Rehabil. 2003 Jun;82(6):479-84. (PMID 12820792)
• Eur Urol. 2005 Mar;47(3):277-86 (PMID 15716187)
• Clin Exp Neurol. 1991;28:191-6. (PMID 1821826)
• BMC Surg 2004, 4(1):15 full text