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Pudendal Nerve Entrapment - Rapid Pain Relief
An effective treatment plan for the relief of pudendal nerve pain
Pudendal nerve entrapment (PNE), is a rare and debilitating condition of the lower hip, caused by entrapment, impingement or compression of the pudendal nerve. We say rare, but this still means that thousands of people suffer from this painful condition every day. Far too many are embarrassed to discuss it with their doctor, and to describe their symptoms fully, preferring instead to suffer in silence.
In reality, not much attention has been paid to this nerve in the past, so much so that often it is missing in anatomy books, gets zero mention in locator and surface anatomy books, physio books sometimes mention it as a side note to the obturator nerve, sciatic, or the gluteal nerve, but other than that, even surgeons admit they rarely have any involvement with this nerve. And yet, here we are now, someways down the line and the medical mainstream are taking more notice. Mainly because they want to 'block' it, rout it out, or cut the ligaments that surround it. Bless 'em, it's always all or nothing, isn't it?
What are some of the symptoms of Pudendal Neuralgia?
First of all a series of events has occurred to pinch, trap or compress the pudendal nerve between two very strong ligaments. This can radiate pain down into the perineum and the urino-genital area. Sexual dysfunction, genital or groin pain, burning or stabbing pain, numbness, erectile dysfunction (ED), frequent urination, sitting pain, chronic postural distortion, lower back pain, and the emotional impact of living with an (up to now) 'incurable' condition.
The pudendal nerve can become compressed or pinched at the piriformis muscle as it exits the sciatic foramen, or at the mid level at the ischial spine, or at the obturator foramen/membrane, and also at the extremity of the nerve as it innervates the anus, perineum, scrotum, penis, vagina and clitoris. The nerve becomes trapped or stretched between two broad, heavy ligaments; The sacro-spinous ligament (sacrum to ishium) and the sacro-tuberous ligament (sacrum to ishial tuberosity).
This entrapment can feel like stabbing, burning, throbbing or a deep, severe ache. Sometimes the pain is so bad, and goes on for so long, that you may find yourself thinking irrationally, reacting emotionally, or behaving abnormally. If you find you are at your wits end, or feel angry, depressed, agressive, frustrated, anxious or even in denial, please don't give up hope.
The pudendal nerve is formed from three branches of the sacral nerves at S2, S3 and S4. This nerve has 3 tails that carry sensation to the penis and clitoris, the rectum and the perineum. Feeling stuck in the cycle of pain, over and over, will bring you through several emotional states, such as those listed above. But eventually you will not look for a cure, you will look for realistic outcomes. This is when you can make progress, because one single event may not work for you, but when you combine several disciplines together, or different modalities over time, you often get a gradual response and solution.
Remember, unless the problem of your pudendal nerve pain was caused by catastrophic injury, it is likely it built up over a long time. Traumatic injury will involve more than just the pudendal nerve. You will be waiting for other body structures, such as bone, muscle, fascia and nerve to repair and heal, before the problem can be resolved. With time delayed onset, such as bad posture and pressure on a cycle saddle, distortion will build up over a long time, like rust on a hinge. The hip structures all work fine until they are stressed beyond their elastic limit and close off orifices, compress one tissue against another, or against bone, or go into spasm and strangle the nerve. Just like the rusty hinge, is is hard to get moving, it creaks and groans, and strains relentlessly against the screws holding it in place.
What are the possible causes of pudendal nerve neuropathy?
A fall on the coccyx. An impact injury to the spine or the pelvis, such as a motorbike or car accident. Strong osteopathic manipulation. Limb traction during surgery. Heavy lifting from a squatting position. Childbirth. Vaginal surgery. Cycling. Employment that involves long periods of sitting. Long car or plane journeys. Obturator or piriformis compression. Direct trauma to the genitalia. Polyneuropathy, such as that caused by diabetes.
But I've had this for years and been misdiagnosed for nearly all of this time.
Absolutely true. This is a newly recognized condition in medical terms, as it was often misdiagnosed as piriformis syndrome, sacro-iliac joint dysfunction, bursitis, vulvodynia or prostatitis. Difficulty of diagnosis is at the heart of mis-treatment or non-treatment up to now, with many patients even finding it difficult to convince doctors, urologists or gynaecologists that they have lower pelvic pain at all.
The condition creates restriction in normal living, as it is so difficult to sit for any lenth of time. Cycling is a definite no-no, at least for a while. When you resume cycling, make sure you have fitted a wider, more comfortable saddle.
Are there things I should avoid doing to increase my chances of success?
Yes. Try not to become constipated, and keep bowel movements regular. Avoid exercises like cycling, climbing, running, squatting, squats and heavy lifting, gym, cross trainer or elliptical trainer, heavy exercise like step aerobics, weights, sit-ups and piriformis stretches. Kegel exercises, designed to strengthen the pelvic floor, should be given a miss, at least for a while, as these are designed to strengthen the very muscles and ligaments that are causing the problem in the first place.
There are going to be many more things you will need to avoid, at least for the time being. Just remember, all stretch routines that involve the hams, quads, pelvis, pelvic floor muscles, gluteal muscles and lumbar muscles, will also stretch the pudendal nerve, probably triggering pain for several days. Just do what you can manage. Little and often is far better than overdoing it and paying for it with pain and stress.
Ok, so what can I do to help myself?
I'm guessing you've tried many of these already, but reaching down to your toes (not necessarily all the way, just in that direction). Lie on your back, bring legs up with bended knee, and open the legs very gently, using your hands on knees as support. Lie on side and lift one leg off the ground, hold briefly and relax. Swimming is very good for range of motion exercises. Most likely the main stroke to avoid would be breast-stroke, as you open your legs with a frog-leap action to propel yourself forward. This rapid movement would probably not be in your interests as it would irritate the pudendal nerve unduly via the gluteal muscles.
What therapy will you use to treat me?
Firstly I will use Spinal Touch. If you haven't had Spinal Touch before you can read more by clicking here. This will loosen the muscles and ligaments that are holding your pudendal nerve to ransom. Then other techniques, such as Trigger Point Therapy, Bio-Stress Relief, Neuromuscular Therapy, can be used to close in, identify and then treat associated problem areas, to bring relief to the pain of pudendal nerve entrapment.
I will likely give you one or two very simple exercises to do at home, either those above, or like those above. This is to complement your treatment and to create a degree of longevity into your treatment which means less time on the couch and more time doing the things you enjoy the most. All too often I find that exercises have been prescribed by well meaning physio's that are wholly inappropriate and actually increase pain symptoms.
Pudendal Nerve Entrapment. Please contact me if you want to find out about appointments and prices. I look forward to welcoming you soon. Phil.
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Important Note: DISCLAIMER: This information is not presented by a medical practitioner and is for educational and informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read.
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