What is Pudendal Nerve Entrapment?

Pudendal Nerve Entrapment (PNE), also referred to as Alcock canal syndrome, is a condition that results from the compression or pinching of the pudendal nerve. This causes chronic pain on the saddle sites of the patient. These sites include the perianal, perineal and genital areas. While it’s common in women, PNE can also affect men.

What causes Pudendal Nerve Entrapment?

PNE occurs when the pudendal nerve is pinched or compressed as it enters or leaves the pelvis through the various tunnels in-between the adjacent muscles and tissues.

So, what leads to this compression of the pudendal nerve?

Common causes include:

Repetitive mechanical injury. It’s thought that the ischial spine in young cyclists could change in shape and position predisposing them to PNE later in their life, especially if they continue cycling for long periods. Sitting on bicycle seats for too long over months or years may result in PNE.

Childbirth. During childbirth, the pelvic area may be stressed, which can expose the mother to PNE and can often be labeled simply as post-partum pelvic pain

Surgery. If a surgical operation done in the pelvic region results in some damage to the pudendal nerve, the patient may be exposed to PNE.

Tumors or lesions in the pelvis could cause compression of the nerve.

Diabetes, vasculitis or any other condition that may trigger peripheral neuropathy.

What are the symptoms of Pudendal Nerve Entrapment (PNE)?

The symptoms of PNE result from nerve function and structural changes brought about by the mechanical effects of the compression. These changes cause neuropathic pain in the anorectal, perineum and genital areas.

The neuropathic pain can show itself in many different ways. Most commonly, the patient will experience a spontaneous burning pain (dysesthesia). Other ways the patient may experience neuropathic pain include deep pain; increased sensitivity to any physical stimulus, called hyperesthesia; exaggerated sensitivity to pain caused by certain stimuli, called hyperalgesia; or pain resulting from stimuli which don’t normally cause pain, called allodynia.

Usually, these symptoms are aggravated when the patient is in a sitting position, often after they sit for a short duration. They are relieved by standing and are absent when sitting on a toilet seat or lying down.

In some cases, other symptoms may indicate PNE: Urinary hesitancy, the patient has difficulty starting urinal flow; frequency of passing urine; sudden need to pass urine; painful bowel movements; sexual dysfunction; altered sensation of ejaculation in men (impotence may result); recurrent numbness of the vulva or penis and/or scrotum in men.

What’s the difference between PNE and Pudendal Neuralgia (PN)?

While there has been a lot of progress made in the treatment of PNE and PN over the past decade, there is still a lot of confusion about the difference between the two conditions. Granted, the two conditions are quite rare and not many practitioners actively focus on them.

This has led to misdiagnosis and eventually inappropriate courses of treatment such as unnecessary surgery. Some, even among pudendal nerve doctors in New York, still use PNE and PN interchangeably.

So, what’s the difference?

Pudendal Neuralgia (PN) is a condition characterized by pain in the pudendal nerve. While PN can be caused by other factors, PNE is the common cause. Other causes include childbirth, surgery, Pelvic Slings, trauma, and strain caused by bowel movements.

Exercises for PNE

PNE results in the contraction and shortening of the muscles lining and supporting the saddle sites of the body (i.e. the pelvic floor). The goal of exercise is to lengthen and loosen these muscles while avoiding too much stretching of the nerve. Before attempting any exercises, patients should seek advice from their healthcare provider.

toe touches to help pudendal nerve entrapmentUsually, any exercise that can increase the range of movement for the affected muscles will work. Toe touches, side leg raises and supine leg lifts are some of the beneficial exercises. During these exercises, the range of motion of the target muscles improves, lengthening them. Gently pulling the knee towards the chest while lying on the side can also help loosen tight buttock muscles. Swimming is also another great exercise as the water helps relieve pressure on the weight-bearing joints. This minimizes the pain.

Your doctor will most likely tell you to keep off Kegel exercises as they may aggravate the pain. The same goes for resistance training.

As with any other physical therapy, consistency will play a big part in helping you recover fully.

Make sure to contact a qualified pudendal nerve doctor for the best result and to avoid follow-up complications that may result from inappropriate treatment procedures.

Contact Pelvic Rehabilitation Medicine if you are suffering from similar symptoms. We develop individualized treatment plans for our patients always without surgical intervention. In the most severe cases a patient may go through a serious of ultrasound guided trigger point injections to help relieve severe nerve compression. Please contact our office today for an immediate consultation.

Meet Pelvic Rehabilitation Medicine

At Pelvic Rehabilitation Medicine, we treat whole human beings, not symptoms. In the body, everything is connected; and the pelvic region is the vital center of the body’s connected functioning. Our physicians take an innovative approach, combining traditional medicine with holistic modalities and restorative and regenerative medicine. We treat both male and female patients who experience core muscle and nerve problems; chronic pelvic pain; and pelvic floor muscle dysfunction. Learn More »

Relevant Publications/Citations

Shrikhande A, Ahmed T, Shrikhande G, Hill C. A Novel, Non-Opiod Based Treatment Approach to Men with Urologic Chronic Pelvic Pain Syndrome (UCPPS) Using Ultrasound Guided Nerve Hydrodissection and Pelvic Floor Musculature Trigger Point Injections. The International Continence Society. 2018 Aug. Link to Article.

Charity Hill, MD sits as a committee member of the Medical Education Committee for the International Pelvic Pain Society. Link to Medical Committee.

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