What are other Names for this Condition? (Also known as/Synonyms)

• Entrapment of the Pudendal Nerve
• Pudendal Nerve Entrapment Syndrome
• Pudendal Neuralgia

What is Pudendal Nerve Entrapment? (Definition/Background Information)

• Pudendal Nerve Entrapment (PNE) is a painful neurological condition that arises from damage of the pudendal nerve, a main nerve of the perineum (space between the anus and vulva in females; between the anus and scrotum in males), which is responsible for external genitalia sensation and control of pelvic floor muscles
• The condition is a form of isolated nerve dysfunction (IND) and is also known as Pudendal Neuralgia. The most common causes include trauma/compression pressure to the region or nerve entrapment due to the presence of a tumor. This can lead to severe localized neuropathic pain on sitting, decreased sensation, painful sexual intercourse, and urine and bowel movement issues
• The treatment for Pudendal Nerve Entrapment includes treating/managing the underlying cause, physical therapy, administration of medications for symptom control, and surgery, if needed. The prognosis is generally good for mild cases with appropriate treatment; severe cases may cause irreversible nerve damage and associated complications

Who gets Pudendal Nerve Entrapment? (Age and Sex Distribution)

• Pudendal Nerve Entrapment may be seen in individuals of any age group
• Per medical literature, the incidence of the condition is 1 in 100,000. However, it is reported that the condition is frequently misdiagnosed or may remain underdiagnosed
• Both male and female genders are affected
• Worldwide, there is no racial or ethnic group preference observed

What are the Risk Factors for Pudendal Nerve Entrapment? (Predisposing Factors)

The risk factors for Pudendal Nerve Entrapment are wide-ranging and may include:

• Prolonged sitting (including excessive cycling)
• Direct trauma to the region, from a variety of factors including accidents, fall injuries, fractures, and surgical injuries (pelvic surgery)
• Participation in sports activities; bike riding professionals and cyclists have an increased risk for pudendal nerve injury. Hence, the condition is sometimes referred to as Cyclist's Syndrome
• Childbirth
• Obesity
• Chronic constipation

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others. 

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Pudendal Nerve Entrapment? (Etiology)

Any damage to the pudendal nerve can adversely affect the perineal region (pelvic floor and genitals), resulting in a set of related signs and symptoms. This is known as Pudendal Nerve Entrapment. Commonly, the damage occurs from direct injury, prolonged sitting (nerve compression), stretching, or poor blood supply to the affected region.

What are the Signs and Symptoms of Pudendal Nerve Entrapment?

The signs and symptoms of Pudendal Nerve Entrapment may generally include:

• Sharp pain that may be burning-like or stabbing-like or piercing, especially while sitting on any hard surface; the pain involves the rectal and genital region
• The pain decreases on standing or lying down; the pain also reduces while sitting on the toilet seat
• Loss of reflexes
• Foreign body sensation in the perineal region
• Reduced sensation; numbness in the region
• Pins and needles sensation
• Touch hypersensitivity
• Muscle cramping and tightness
• Anal and urinary dysfunction (mild to severe)

How is Pudendal Nerve Entrapment Diagnosed?

The diagnosis of Pudendal Nerve Entrapment by a healthcare professional may involve the following tests and exams:

• Complete physical examination and medical history evaluation
• Blood tests, as needed
• Nerve conduction velocity studies
• Electromyography (EMG): A diagnostic procedure to help detect neuromuscular abnormalities
• Some possible tests for sensation such as temperature, touch, and vibration, to assess how well an individual feels or responds to stimuli
• Radiological imaging studies, such as X-rays, Doppler ultrasound, CT, and MRI scans of the affected region, as necessary
• Lumbar puncture or spinal tap test; analysis of the cerebrospinal fluid (CSF)
• Tests and procedures to diagnose an underlying condition/disorder, if any present
• Biopsy of the nerve, if needed: A tissue biopsy of the affected nerve is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

The condition may be misdiagnosed, and hence, it is important to exclude the following conditions that show similar signs and symptoms:

• Complex regional pain syndrome
• Idiopathic orchialgia
• Idiopathic penile pain syndrome
• Idiopathic proctalgia
• Idiopathic vulvodynia
• Non-bacterial prostatitis
• Presence of tumors in the region
• Prostatodynia

Many clinical conditions can have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Pudendal Nerve Entrapment?

The complications of Pudendal Nerve Entrapment depend on the involved nerve, the body region/organs affected, severity and type of underlying condition, and lack of appropriate treatment. It may include:

• Debilitating chronic pain; severe penile pain
• Constant tingling and numbness in the area surrounding the affected nerves
• Permanent loss of sensation in the affected region; this can result in repeat injury from lack of touch sensation
• Painful sex
• Erectile dysfunction and impotence in males
• Inability to participate in sports activities such as cycling
• In severe cases, urinary and fecal incontinence
• Decreased quality of life
• Treatment complications such as from nerve block procedure

How is Pudendal Nerve Entrapment Treated?

The treatment options for Pudendal Nerve Entrapment vary depending on the nerve location and extent of nerve damage and symptom severity. It also depends on the underlying cause. Where possible, stopping or avoiding the activity that resulted in the nerve dysfunction is important.

• Mild cases of the nerve dysfunction may be treated using cold/heat compressions, adequate rest, anti-inflammatory agents, physical therapy (pelvic floor muscle therapy), and stretching exercises, as needed
• Severe cases of nerve dysfunction may be treated with surgery based on the cause. Typically, the surgery will be performed for releasing the nerve pressure
• Pudendal nerve block procedure, if necessary
• Neuromodulation, including pulsed radiofrequency
• Lipofilling procedure (injection of adipose tissue and stem cells into the pudendal canal region)
• Limiting activities to prevent injury from a loss of sensation

In some individuals, the condition may heal spontaneously even in the absence of any treatment.

How can Pudendal Nerve Entrapment be Prevented?

It may not be possible to effectively prevent Pudendal Nerve Entrapment in some cases. However, the following steps may be considered:

• Undertaking appropriate treatment of any underlying condition that places one at higher risk for pudendal nerve injury is helpful
• Avoiding any traumatic/repetitive injury that can increase the risk for the condition
• Avoiding cycling or motorbike riding for a period of time until the pain subsides, and healing is noted
• Obese individuals should maintain proper diet control and adequate physical exercise

What is the Prognosis of Pudendal Nerve Entrapment? (Outcomes/Resolutions)

The prognosis for Pudendal Nerve Entrapment is normally dependent on the cause and extent of the nerve damage. In many cases, nerve pain and associated presentations that may last for a long period, can significantly affect the quality of one’s life.

• If the damage is very severe, there may be permanent nerve damage leading to some form of paralysis in the region involved
• However, if the damage is mild, then with proper treatment the condition should resolve within a short period and full recovery may be ensured

Additional and Relevant Useful Information for Pudendal Nerve Entrapment:

Any injury to the nerves can lead to long term damage if not treated immediately and properly.