The pudendal nerve, also known as the genital nerve, is a common cause of chronic pelvic pain in adults. The reason for this in most cases is a pinched nerve, which is called compressive neuropathy. The pudendal nerve is pinched more often in women. In men, this happens three times less often.
Anatomical features
The pudendal nerve is short in length. But this is a very important nerve of the last sacral plexus (if you move from the brain). It is located in the pelvic cavity and bypasses the ischium along the way. It then divides into three branches:
- Rectal.
- Cerineum.
- Dorsal nerve of the clitoris or penis.
What functions does it perform?
- Innervates the muscle that elevates the anus and sphincter.
- Innervates the urinary sphincter.
- Innervates the female clitoris and the cavernous bodies in men.
- Makes the skin of the anus and vulva sensitive.
From the above list it can be seen that the pudendal nerve plays a very important role both in the intimate life of a person and in defecation and urination. The composition of this nerve includes a large number of autonomic fibers that ensure the correct functioning of the sphincters without the use of conscious tension. After all, people never think, do not try to control and do not consciously squeeze their muscles so as not to urinate or defecate completely by accident at the wrong time. These functions are assigned to the autonomic fibers that enter the pudendal nerve.
Pinch: causes
Trouble can occur due to the piriformis muscle located in the pelvic cavity or due to pinching between a pair of ligaments.
In addition, the pudendal nerve can be damaged after unforeseen situations, which include a car accident, a fall from a height. In such situations, fracture of the pelvic bones can occur. Very often, the cause of chronic pain is nerve damage during childbirth or its involvement in the growth of a malignant tumor.
It is worth mentioning that some human activities can also lead to pinching of the pudendal nerve over time. This includes cycling or horseback riding.
Pudendal nerve: symptoms of neuropathy
As with any other pinching, the symptoms are pain, sensory disturbances,muscle weakness and disorders of the autonomic system.
When the pudendal nerve is pinched, the symptoms in women and men are similar:
- There is pain in the perineum.
- Pain has a burning tinge.
- There is discomfort in the genitals and anus.
- Incontinence of urine and feces, which may be incomplete, that is, manifest itself in the form of drip incontinence or fecal smearing.
- Skin sensitivity decreases in the indicated areas, a feeling of "goosebumps" appears.
- There may be an unpleasant presence of something foreign in the anus and urethra.
- Sexual disorders such as lack of orgasm and impotence may occur.
When the pudendal nerve is pinched, symptoms in women that should be treated immediately are observed in the lower part of the vagina. This causes great discomfort.
Severe pain may be felt during intercourse and walking - such, if the pudendal nerve is pinched, symptoms in men. Treatment is required immediately, as the pain becomes burning, and touching the skin acquires excruciatingly unpleasant consequences. Feelings can be described as the presence of a cold or hot foreign object or electric shock. In general, a pinched pudendal nerve entails a large number of unpleasant symptoms.
Pinch Diagnosis
With the above painful and unpleasant sensations, a person is simply not able to endure for a long time, becauseit is not the same pain as in the leg or arm. Most people with neuropathy go to either a neurologist or a proctologist if they have anal sphincter problems or problems with fecal and urinary incontinence.
In rare cases, patients may go to a sex therapist. But a good specialist, with the help of the simplest questions, should be able to identify organic disorders, and then refer the patient to the appropriate doctor. Pinching of the pudendal nerve is diagnosed with the following examinations and complaints:
- All the complaints listed above.
- Patients may notice that when something cold is applied to the perineum, temporary relief occurs and the burning pain begins to pass. This symptom suggests that nerve damage is neuropathic.
- When using a trial therapeutic and diagnostic blockade of the nerve with novocaine, the severity of symptoms decreases or completely eliminates all the pain for the duration of the painkiller, which lasts from 12 hours to 3 days.
- The nature of the pain indicates that a pinching has occurred (unpleasant sensations when touched and all kinds of itching, burning and feeling of "goosebumps").
- When performing ultrasound and Dopplerography of the small pelvis and perineum, in almost all cases, when the pudendal nerve is pinched, there is a slowdown in the speed of blood flow in the nearby pudendal artery. Since it passes through the same channel as the nerve, the narrowing of the artery indicates that it has also been compressed.
- Very importantThe criterion for diagnosis is an increase in pain in a person in a sitting position and a decrease when the patient lies on his back. For pinching of the pudendal nerve is also characterized by a lesion on one side only. It is on it that disorders are felt.
In addition to these diagnostic criteria, when probing the perineum, you can find characteristic areas that are pain points that reflect muscle spasm.
It is important that the pathology of the pudendal nerve is closely associated with the development of myofascial syndrome, which is much more difficult to treat due to the deep location of the muscles.
In addition, a pinched pudendal nerve greatly increases depression and anxiety, and people become more receptive to negative events.
Pudendal neuropathy treatment
As in other situations, the treatment of this disease should be comprehensive.
What are the basic principles of neuropathy treatment?
- Treat the characteristic pinching pattern of pain with gabapentin, which is part of the drugs.
- Regular nerve blocks with hormones and anesthetics.
- The use of centrally acting muscle relaxants, which allow the muscles to relax, resulting in a decrease in the tone of the piriformis muscle.
- The use of physiotherapy, which includes electrophoresis, phonophoresis.
- Intake of B vitamins, which are part of the blockade, as well as in the form of tablets.
Other procedures
Often, the treatment of a pinched pudendal nerve requires the support of a good psychologist who performs corrective therapy and prescribes antidepressants. You may need to prescribe vaginal or rectal suppositories, which include diazepam. The patient may be assigned to perform special physical exercises, the meaning of which is to slowly compress and relax the muscles located in the perineum.
In those situations where conservative methods of treatment do not have a positive effect, surgical operations of the decompressive type are performed. They are performed in specialized centers for the treatment of chronic pelvic pain.
Long-term treatment
It must be remembered that the treatment of pudendal neuropathy is a very long process, during which all the recommendations of the attending physician should be followed. The recovery period takes at least six months.
Treatment of the disease should be carried out only in a hospital, as this will allow doctors to take control of the recovery process, as well as successfully select a set of those means that will be used for proper treatment. After all, a person may be allergic to some products, which will only worsen the situation.
Results
Thus, it was considered what the pudendal nerve is, symptoms and treatment when it is pinched, diagnosis. In order to avoid this disease, it is recommended to be careful and not get injured, as well as lead an active lifestyle, exerciseexercise and have an active sex life. Well, if the trouble still happened, then you must strictly follow the recommendations of the doctors.
