Pudendal Nerve Entrapment
Monday, 5 August 2013 | Admin
Market Harborough chiropractor on pudendal neuralgia
Written By firstname.lastname@example.org, On August 5, 2013
Pudendal nerve entrapment
Pudendal nerve entrapment (PNE), also known as Alcock canal syndrome, is an uncommon source of chronic pain, in which the pudendal nerve (located in the pelvis) is entrapped or compressed. Pain is positional and is worsened by sitting. Other symptoms include genital numbness, fecal incontinence and urinary incontinence.
The term pudendal neuralgia (PN) is used interchangeably with “pudendal nerve entrapment”, but a 2009 review study found both that “prevalence of PN is unknown and it seems to be a rare event” and that “there is no evidence to support equating the presence of this syndrome with a diagnosis of pudendal nerve entrapment,” meaning that it is possible to have all the symptoms of pudendal nerve entrapment without having an entrapped pudendal nerve
There are no specific clinical signs or complementary test results for this condition. The typical symptoms of PNE or PN are seen, for example, in male competitive cyclists (it is often called “cyclist syndrome), who can rarely develop recurrent numbness of the genitals after prolonged cycling, or an altered sensation of ejaculation, with disturbance of urination and reduced awareness of defecation.Nerve entrapment syndromes, presenting as genitalia numbness, are among the most common bicycling associated urogenital problems.
The pain is typically caused by sitting, relieved by standing, and is absent when lying down or sitting on a toilet seat
If the perineal pain is positional (changes with the patient’s position, for example sitting or standing), this suggests a tunnel syndrome sitting pain relieved by standing or sitting on a toilet seat is the most reliable diagnostic parameter.
Imaging studies using MR neurography may be useful.
PNE can be caused by pregancy, scarring due to surgery, accidents and surgical mishaps. Anatomic abnormalities can result in PNE due to the pudendal nerve being fused to different parts of the anatomy, or trapped between the sacrotuberous and sacrospinalis 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.
Optional treatments include behavioral modifications, physical therapy, analgesics and other medications, pudendal nerve block, and surgical nerve decompression.A newer form of treatment is pulsed radiofrequency.
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 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. There have been cases where doing stretches have helped bicyclists. A helpful stretch for some is bending over and touching your toes. However this is a bad exercise for people with low back pain.
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.
Chiropractic adjustments to the lower back have also helped some patients with pudendal nerve issues.
There are numerous pharmaceutical treatments for neuropathic pain associated with pudendal neuralgia.
Alcock 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.
Pulsed radiofrquency has been successful in treating a refractory case of PNE.
Decompression surgery is a “last resort”, according to surgeons who perform the operation.
The surgery is performed by a small number of surgeons in a limited number of countries. The validity of decompression surgery as a treatment and the existence of entrapment as a cause of pelvic pain are highly controversial.
While a few doctors will prescribe decompression surgery, most will not. Notably, in February 2003 the European Association of Urology in its Guidelines on Pelvic Pain said that expert centers in Europe have found no cases of PNE and that surgical success is rare:
Pudendal nerve neuropathy is likely to be a probable diagnosis if the pain is unilateral, has a burning quality and is exacerbated by unilateral rectal palpation of the ischial spine, with delayed pudendal motor latency on that side only. However, such cases account for only a small proportion of all those presenting with perineal pain.
Proof of diagnosis rests on pain relief following decompression of the nerve in Alcock’s canal and is rarely achieved. The value of the clinical neurophysiological investigations is debatable; some centres in Europe claim that the investigations have great sensitivity, while other centres, which also have a specialized interest in pelvic floor neurophysiology, have not identified any cases. Three types of surgery have been done to decompress the pudendal nerve: transperineal, transgluteal, and transichiorectal. A follow-up of patients of this surgery after 4 years found that 50% felt their pain had improved to various extents, although control patients were not followed up for comparison.
If surgery does bring relief of symptoms, patients will mostly experience it within 4 weeks of surgery.
If you would like to see if chiropractic treatment could help you please call either the chiropractic clinic in Melton Mowbray or Market Harborough