Before reading this article, please be sure to have read ‘Marina’s story’ and carpel tunnel of the butt part 1. After reading Part 1 you now have a basic understanding of pudendal nerve anatomy, you understand Pudendal Neuralgia is a Myofascial Pelvic Pain Syndrome, and you are aware of the terrible symptoms associated with it.
So, how do people develop carpal tunnel of the butt and upset this nerve? Four generalized etiologic categories have been described. These are: stretch, compression, trauma, and surgical. Most patients discover they have a combination of these factors.
Examples of stretch injuries to the pudendal nerve include straining during bowel movements, vaginal deliveries, and deep squatting exercise with heavy weights. During each of these scenarios the nerve can be stretched out of its comfort zone and become inflamed.
Compression situations occur during bike riding, horseback riding, and prolonged sitting. During each of these scenarios the territory of the pudendal nerve is being deprived of blood flow and is vulnerable to friction. This can lead to inflammation.
Trauma can occur as it did in Marina’s case. Falls, car accidents, orthopedic injuries to the hip, low back or lower extremities are all examples of traumatic scenarios. In most cases the trauma will create sacro-iliac joint dysfunction, which will have biomechanical adverse affects on the pudendal nerve due to their close relationship.
Pudendal Neuralgia can also be an (uncommon) complication of pelvic surgeries. During hysterectomies, cyctocele, rectocele and other prolapse repairs, endometriosis removal, anal fissure repairs, and hemorrhoidectomies the nerve can get unintentionally nicked, stitched, compressed, or stretched, resulting in inflammation.
It is very important to note that many people can experience the above-mentioned scenarios and never even slightly annoy their pudendal nerves. People who develop myofascial pain syndromes usually, with help from a trained medical professional, identify other pre-disposing factors to pelvic pain before identifying ‘the straw that broke the camels pelvis’. The important thing to do is to pay attention to your body. Most syndromes start with an annoying symptom here or there and with this knowledge people can hopefully get to the right place for early intervention.
Not all patients are this fortunate. Accurate information on this topic is scarce and even less in number is the professionals qualified to treat pelvic pain, which is why Marina had to move to another state. The next article will describe effective multi-disciplinary treatment approaches for patients with Pudendal Neuralgia.
Comments
Great article. Thanks. I will be sure to pass it around. Do you think that medical massage therapy focused on releasing the accessible muscles along the nerve pathway could be an effective treatment for some patients, especially when nerve compression is occurring in the piriformis or other muscles in the gluteal region?
Thank-you for your comment Steve. As it sounds like you know, tight muscles and myofascial trigger points can both cause pain and irritate the pudendal nerve. Patients with tight muscles can definitely benefit from therapies to loosen the muscles and eliminate trigger points. Massage therapy is a great way to do treat the muscular component of the syndrome and is commonly included in multi-disciplinary treatment plans.
I am benefiting greatly from both physiotherapy and massage therapy. The physiotherapist I see (on a weekly basis) specializes in pelvic pain. In addition to PN, I have Interstitial Cystitis (IC), also known as Painful Bladder Syndrome. I don't know which started first.
I had hip sugergy about six months ago. As a result there was damage done to my pudenal nerve. For about 3 months after my penis and scrotum where totally numb, I was unable to have sex.Over the last 3 months feeling has began to return. I am wondering if the nerve will recover totally. My doctor says it will, but no one seems to know when.
Can PNE be cured completely? How many PT sessions can cure this? Or does the person have to see PT all life long?
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