Pudendal Neuralgia: carpal tunnel of the butt (part 1)

We have all heard of and understand what Carpal Tunnel Syndrome is. Patients experience tingling, pain, weakness and loss of function in their hands. We have all banged our “funny bones” and felt the temporary unpleasant feeling that follows. These two situations are examples of what happens when peripheral nerves get pissed off.

What you may not have known is that all nerves can get pissed off. Adverse neural tension, the actual term used to describe what occurs when nerves get pushed beyond their comfort zone, can occur temporarily (acutely), or chronically. Anyone who has experienced chronic nerve irritation will tell you the symptoms can be distressing and disabling enough to make you want to chew off a body part.

The pudendal nerve is a mixed nerve arising from sacral nerve roots at S2, 3, and 4. It travels a circuitous course through the pelvis, including and you guessed it, through a tunnel called Alcock’s Canal, innervating the majority of the skin of the genitals, the perineum and the anus. It also innervates the majority of the pelvic floor muscles, the distal 1/3 of the urethra and the distal portion of the rectum. As a mixed nerve, the pudendal nerve carries autonomic, sensory, and motor fibers. This is unusual for a peripheral nerve and can lead to a host of disabling problems when things go wrong.

When things go wrong with the pudendal nerve, as in Marina’s case, patients can experience urinary, bowel,
and sexual dysfunction as well as pelvic pain. The Society for Pudendal Neuralgia has defined this syndrome as a ‘burning, stabbing pain in the territory of the pudendal nerve’. Unfortunately, at present there are no accepted standard diagnostic tests to confirm this diagnosis; therefore, a diagnosis is made by subjective complaints together with a manual examination.

Because of the complexity of innervation of the pudendal nerve, patients commonly experience symptoms beyond simply a burning pelvis. In fact, pelvic floor dysfunction almost always co-exists with PN and therefore symptoms of patients with PN also have symptoms of myofascial pelvic pain syndrome (MPPS). Overlapping symptoms of PN and MPPS include: urinary hesitancy, frequency, urgency, constipation and pain before, during or after bowel movements, diminished or absent orgasm, pain with or after orgasm, clothing intolerance, genital hypersensitivity, and genital hyperaousal.

As if the symptoms described are not horrendous enough, the autonomic component of PN can also kick-in causing increased heart rate, shallow breathing, anxiety, sleep issues, and excessive sweating. If the pain and dysfunction itself doesn’t drive patients crazy this aspect can and does. Unfortunately, many patients suffering with PN feel like they are losing their minds and most medical professionals do not know how to help them.

By now you are probably holding your pudendal nerve and worrying about how to NOT get Carpal Tunnel in your Butt. Or perhaps you are reading this standing up because you actually have this syndrome and you need to know what to do for it. Or maybe you are reading this because you are on your way to recovery and are trying to support the cause. Regardless, more articles will follow to answer the questions that may be arising.