Pudendal Nerve Entrapment (PNE or PN)

Pudendal Neuralgia (PN) is pain in the pudendal nerve area. The most common diagnosis of PN is Pudendal Nerve Entrapment (PNE). However, PN can also be the result of peripheral nerve damage or other conditions. These pages focus on PNE.

Some tests can be used to diagnose PNE, as described in Pudendal Neuralgia Diagnosis. However a large part of diagnosis relies on systematic study of the symptoms. This page is aimed at helping patients and doctors determine the strong possibility of PNE from the study of symptoms alone.
Most cases of PN are improperly diagnosed. Because early treatment will have the best chance for the most beneficial results, correct consideration of early symptoms is critical.

Possible Causes of PNE

Most of the time, pain has settled without one knowing, sometimes preceded by paraesthesia (numbness, lost of sensations) in the lower pelvic/buttock/genital/rectal/perineum area. Extended sitting at work and frequent long drives are among the causes of pudendal nerve compression. In younger people, sports involving the legs like heavy weight lifting, running and – most of all - cycling are the leading risk factor for the development of this condition. In the sports medicine community it is sometimes called the “cyclist syndrome”. Scar tissue from a previous surgery in the pelvic/rectal/genital area has played a part in developing PNE. Woman have developed PNE after a difficult childbirth or after having a hysterectomy. For many however, the cause remains unknown.
People who have PNE were most likely predisposed to get it and many people who are predisposed never develop the condition. For some, the pudendal nerve can follow an irregular path. One’s anatomy in this particular area of the body can lead to the compression of the nerve when performing certain movements or positions; such as bending, stooping, or sitting. Tight muscles and tendons can lead to constant friction with the nerve. Pressure, inflammation and scar tissue can possibly harm the nerve over time. Nerves fibers previously damage by a radicular lesion in the lower spine (L4-L5 or L5-S1) can result in an oversensitivity to the effects of a compression on its way.  
 
Many people however (1/3) recall one event in particular as the beginning of their symptoms. Some recall the feeling of a lightning electrical shock after a bad move. It is sometimes due to a direct shock like a fall on the buttock. Statistically, six out of ten subjects are woman and the beginning of the problem happens in average between 50 and 70 years old.

Symptoms

As most people develop this condition gradually, it is important to understand it’s symptoms to prevent further damage to the nerves. Here are the classic PNE symptoms:

The chief symptom is pain in the area innervated by the pudendal nerves. Sitting become intolerable.
The pain is lessened when laying or sitting on a toilet seat.
The pain can be delayed and stay long after one has identified the source of aggrevation (sat too long, walked too far, did too much, etc.)
Usually, the pain gradually increases during the day and is the worst at night. Many PNErs feel their best upon waking in the morning.

The most common type of pain is a burning sensation. Other type of pain often experienced are: twisting, pulling sensations, electric shock sensations, vague pains, stabbing pains, pin pricking, numbness and cold sensations. The pain level can vary from time to time but the nature of the pain is constant. The pain can move around to different areas.
PNE symptoms can also include:

Pain only on one side or on both sides of the perineum, buttock
Intolerance to tight pants.

Friction and inflammation feeling along the course of the nerve when walking for too long or running. However, walking reasonably helps to relax the muscles and reduce the pain for most people with PNE.

Pain at the standing position for 20% of the people with PNE.
Paraesthesia and eventually a lost of sensation in the territory of the pudendal nerve: penis, vagina, clitoris, perineum and buttock.

Rash on genital, or skin change - more rubbery - on the perineum, groin and lower buttock.
Bladder problems: dribbling, dysuria (difficulty or pain in discharging urine), difficulty to detect the feeling of urine when passing through the urethra; need to push to empty bladder, urgency.

Bowel problems: constipation (or inversely diarrhea), pain during or after bowel movement and frequent hemorrhoids.

Male sexual problems: some men complain of a diminution of sensations. Impotence is possible. Pain during or after ejaculation is frequent. Scrotum/Testicular pain is also common.
Female sexual problems: Pain during and after intercourse. Many woman cannot tolerate stimulation to the clitoris.

Buttock Sciatica: numbness, coldness, burning, sizzling sensation in legs, feet, buttock. This is more often due to a tightening reaction of the surrounding muscle to the pain in the pelvis region. It can be caused by “crosstalk” between the inflame pudendal nerve and the sciatic nerve.

Low back pain resulting from irradiation of the pain.

The symptoms can be unilateral or bilateral. If the entrapment is only on one side, the pain can also be reflected to the other side.

Over time, the evolution of symptoms without treatments worsen progressively starting from a small perineal discomfort to a more and more chronic and constant pain that is least decreased when standing and even lying down.

It can be frightening for the newcomer to read all these symptoms and can lead to self rationalization that he/she does not have this condition because it is not so bad at the moment. Remember that most people do not have all the classics symptoms at once, and for most of them the problem started with a small discomfort. Nerves can react in a variety of ways to entrapment.

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