Pudendal Nerve Block
The
pudendal nerve provides the majority sensations and functions
of the external genitals, the urethra, the anus, and perineum.
It also controls the external anal sphincter and the sphincter
muscles of the bladder. Image-guided pudendal nerve block
is the most important diagnostic test following history and
physical examination for patients with suspected
pudendal neuralgia. The nerve is blocked by a local anesthetic
to see if symptoms can be eliminated by numbing the nerve.
The block is done where
the nerve is passing between the two ligaments or in the Alcock's
canal.
Frequently
Asked Questions
- What
is Pudendal Nerve Entrapment?
Pudendal
nerve entrapment is a pain condition for no apparent reason
in the lower central pelvic areas. These are the anal
region, perineum, scrotum and penis or vulva. Pain
is worse upon sitting and less when standing or sitting
on a donut cushion
or toilet
seat. The pain could be stinging, burning, stabbing, aching,
knife-like, irritation,
cramping, spasm, tightness, crawling on the skin, twisting,
pins and needles, numbness, and hypersensitivity. The
pain is piercing and very comparable to a toothache. It often
starts in one place and progresses. Frequently there
is also urinary,
anal, or sexual dysfunction. The pain is often on both sides.
- What
causes pudendal nerve entrapment?
Pudendal nerve entrapment is caused by entrapment of the
pudendal nerve.
The initial constriction is often caused by pressure or
trauma. As the nerve swells it encounters a natural constraint.
Stretching or rubbing of the pudendal nerve can also cause pudendal
nerve entrapment.
- What
causes entrapment?
Pudendal nerve entrapment is usually
precipitated by prolonged sitting or trauma to the sitting
area, combined with a genetic
and developmental susceptibility.
Pudendal nerve entrapment is common in high mileage and
it is sometimes
called Cyclist's Syndrome.
- What
is Pudendal nerve entrapment frequently misdiagnosed as?
Prostatodynia, nonbacterial prostatitis, idiopathic
vulvodynia (idiopathic means unknown cause), idiopathic
orchialgia, idiopathic proctalgia, idiopathic penile pain
syndrome etc.
- What
are the most common symptoms of PNE?
The main symptom is pain with sitting. You feel great
in the AM until you sit for coffee, or drive to work.
You get better with lying down. The pain is in the distribution
of the pudendal nerve....genitalia, perineal or rectal. It
can be any combination of these areas depending on the part
of the nerve entrapped.
- What
are the treatment options?
1. Avoiding the offending factor that causes pain
2. Three sequential image-guided nerve
blocks, first with local anesthetics
and later
possibly combined with corticosteroids
3. Conservative medical treatment such as neurotin,
Elavil
4. Surgery with decompression of the nerves
is rarely done
- If
a patient suspects that they have pudendal what should
they do to
get help?
First, you need to make sure that
other possible conditions are ruled out. It is important
to have a complete workup.
Next is an image-guided nerve block and if
you get numb in the area of your pain and pain is gone you
have a good indication that you might
have pudendal neuralgia.
- Is
there a connection between pudendal neuralgia and spinal
disorders
and scoliosis?
No.
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