What is pudendal nerve entrapment (PNE)?
Pudendal neuralgia is a type of long-term (chronic) pelvic pain that originates from damage or irritation of the pudendal nerve.
The pudendal nerve is one of the main nerves in the pelvis, supplying areas such as the:
- Lower buttocks
- Area between the buttocks and genitals (perineum)
- Area around the back passage (rectum)
- Vulva, labia, and clitoris in women
- Scrotum and penis in men
Pudendal neuralgia can be very uncomfortable and distressing, but help is available and there are several treatments that can be tried.
How common is pudendal nerve entrapment (PNE)?
Pudendal nerve entrapment (PNE) is common. It commonly affects more females than males. It can affect patients at any age. It can be managed by reducing your risk factors. Please discuss with your doctor for further information.
What are the symptoms of pudendal nerve entrapment (PNE)?
The main symptom of pudendal neuralgia is pelvic pain. Any of the areas supplied by the pudendal nerve can be affected. The pain may:
- Feel like a burning, crushing, shooting or prickling sensation
- Develop gradually or suddenly
- Be constant – but worse at some times and better at others
- Be worse when sitting down and improve when standing or lying down
Other symptoms can include:
- Numbness and pins and needles in the pelvic area
- Increased sensitivity to pain – you may find just a light touch or wearing clothes uncomfortable
- Feeling as though there’s swelling or an object in your perineum – often described as feeling like a golf or tennis ball
- Needing to go the toilet frequently or suddenly
- Pain during sex, difficulty reaching orgasm, and erectile dysfunction in men
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
Contact your doctor immediately if you have persistent pelvic pain. Don’t delay seeking advice if the pain is causing problems. Pudendal neuralgia can continue to get worse if left untreated, and early treatment may be more effective. The stress of living with the condition can also have a significant impact on your physical and mental health if it’s not treated.
If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes pudendal nerve entrapment (PNE)?
Pudendal neuralgia can occur if the pudendal nerve is damaged, irritated or squashed (compressed). Possible causes include:
- Compression of the pudendal nerve by nearby muscles or tissue – sometimes called pudendal nerve entrapmentor alcock canal syndrome
- Prolonged sitting, cycling, horse riding or constipation (usually for months or years) – this can cause repeated minor damage to the pelvic area
- Previous surgery to the pelvic area
- A break in one of the bones in the pelvis
- Damage to the pudendal nerve during childbirth – this may improve after a few months
- A non-cancerous or cancerous growth (tumour) pressing on the pudendal nerve
In some cases, a specific cause isn’t identified.
What increases my risk for pudendal nerve entrapment (PNE)?
Below are some risk factors for the condition:
- Sitting for too long
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is pudendal nerve entrapment (PNE) diagnosed?
Your doctor will ask about your symptoms and may carry out an examination of the area to check for any obvious causes of your pain.
If they think you could have pudendal neuralgia, or they’re not sure what’s causing your pain, they may refer you to a specialist for further tests. These tests may include:
- A vaginal or rectal exam – to see if the pain occurs when your doctor applies pressure to the pudendal nerve with their finger
- A magnetic resonance imaging (mri) scan – to check for problems such as entrapment (compression) of the pudendal nerve and rule out other possible causes of your pain
- Nerve studies – a small device inserted into your rectum is used to stimulate nearby nerves with mild electrical impulses to check how well the nerves are working
- Nerve block injections – painkilling medication is injected around the pudendal nerve to see if your pain improves
How is pudendal nerve entrapment (PNE) treated?
Treatments for pudendal neuralgia include:
- Avoiding things that make the pain worse, such as cycling, constipation or prolonged sitting – it may help to use a special cushion with a gap down the middle when sitting and try constipation treatments
- Medications to alter the pain – these will normally be special medications for nerve pain, rather than ordinary painkillers like paracetamol
- Physiotherapy – a physiotherapist can teach you exercises to relax your pelvic floor muscles (muscles used to control urination) and other muscles that can irritate the pudendal nerve
- Painkilling injections – injections of local anaesthetic and steroid medication may relieve the pain for a few months at a time
- Decompression surgery – if something is pressing on the pudendal nerve, such as a piece of tissue, surgery to reposition it away from the nerve may help improve your pain
- Nerve stimulation – a special device is surgically implanted under the skin to deliver mild electrical impulses to the nerve and interrupt pain signals sent to the brain
Lifestyle changes & Home remedies
What are some lifestyle changes or home remedies that can help me manage pudendal nerve entrapment (PNE)?
The following lifestyles and home remedies might help you cope with pudendal nerve entrapment (PNE):
- Bowel and bladder management strategies: Try not to strain when emptying your bowels or passing urine, as this stretches the nerve. Avoid stimulant laxatives. Physiotherapy can help you develop a plan for good bladder and bowel habits that suit you.
- Sitting modification: Avoiding pressure on the perineum (the area inside your ‘sit bones’) helps to prevent the nerve compressing. You can buy special coccyx-cut-out memory foam cushions and modify them to remove the section under your perineum, so that when you sit you won’t take any weight there. Decreasing your sitting can also help – try standing at your desk for part of the day using a laptop on a box or a portable desk raiser.
- Avoiding physical activities that irritate the nerve: The biggest ones are spending hours on a pushbike and horse-riding. Other activities to minimise are trampoline jumping, bench pressing and excessive ‘core muscle’ exercises. Osteopathy and physiotherapy can help you identify movements specific to you that may need to be minimised for a period of time.
- Adapting your sex life: Some people find sex can flare their pain. There are many options to keep your sex life going while avoiding pain. Your clinician can help you with this.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Review Date: June 26, 2017 | Last Modified: June 26, 2017
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- Pudendal Neuralgia. http://www.whria.com.au/for-patients/pelvic-pain/pudendal-neuralgia/. Accessed 5 Jun 2017
- pudendal nerve entrapment https://www.dermnetnz.org/topics/pudendal-nerve-entrapment-syndrome. Accessed 5 Jun 2017
- Pudendal neuralgia. http://www.nhs.uk/conditions/pudendal-neuralgia/Pages/Introduction.aspx#symptoms. Accessed 5 Jun 2017