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Pudendal nerve entrapment
- disabling form of genital pain resulting from inflammation, compression or entrapment of the pudendal nerve (S2,3,4)
- affecting 4% of patients presenting with CPP.
- It has been associated with
- Childbirth
- pelvic surgery
- intense cycling
- sacroiliac skeletal abnormalities
- age-related changes/Post-menopausal women – related to urogenital atrophy as a result of decreased oestrogen
- Symptoms
- pelvic pain with sitting which worsens throughout the day
- pain decreases with standing or lying down.
- Common in people have office jobs and make frequent, long journeys
- sexual dysfunction
- difficulty in urination and defaecation
- Nantes essential diagnostic criteria for pudendal nerve entrapment (all must be present).
- Pain is expressed in the anatomical territory of the pudendal nerve (S 2, 3 and 4 – from the anus to the clitoris)
- Pain is aggravated by sitting (Pain predominantly experienced on sitting)
- The patient does not wake up during the night due to the absence of nocturnal pain
- There is no objective sensory loss on clinical examination
- There is positive response to anaesthetic block of the pudendal nerve
- (Pain relieved by diagnostic pudendal nerve block)
- Diagnosis
- Management
- behavioural modifications
- pelvic floor physiotherapy
- analgesics
- pudendal nerve block (transacral block at S2-S4)
- botox injections (in case of muscle spasms)
- surgical decompression via the transperineal, transgluteal or transischiorectal approach
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