Advertisement

Pudendal Nerve Neuralgia/Entrapment

  • Sung-Jung Yoon
  • Juan Gómez-Hoyos
  • William Henry Márquez-Arabia
  • Hal D. Martin
Chapter

Abstract

Pudendal neuralgia is a very disabling form of posterior hip and perineal pain. Neuropathic pain in the distribution of the pudendal nerve with sensations of burning, tearing, stabbing lightning-like, electrical, sharp shooting, and/or foreign body sensation is usually described. Pain is made worse with sitting, reduced with standing, and absence upon awakening and progressing through the day. The common historical etiologies that include childbirth, prolonged sitting, trauma, and cycling exercises have been thought as causative. The etiology of pudendal nerve entrapment requires further definition. However, suspicion of this pathology can be validated through a comprehensive history, physical examination, and appropriate ancillary tests, including injections. Surgical decompression has shown good outcomes in patients that fail to get relief after conservative measures.

Keywords

Pudendal nerve Neuralgia Entrapment Guided injections Nerve decompression 

References

  1. 1.
    Possover M, Forman A. Voiding dysfunction associated with pudendal nerve entrapment. Curr Bladder Dysfunct Rep. 2012;7:281–5.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Stav K, Dwyer PL, Roberts L. Pudendal neuralgia: fact or fiction? Obstet Gynecol Surv. 2009;64(3):190–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Elkins N, Hunt J, Scott KM. Neurogenic pelvic pain. Phys Med Rehabil Clin N Am. 2017;28(3):551–69.CrossRefPubMedGoogle Scholar
  4. 4.
    Robert R, Prat-Pradal D, Labat JJ, Bensignor M, Raoul S, Rebai R, Leborgne J. Anatomic basis of chronic perineal pain: role of the pudendal nerve. Surg Radiol Anat. 1998;20(2):93–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Thor KB, Donatucci C. Central nervous system control of the lower urinary tract: new pharmacological approaches to stress urinary incontinence in women. J Urol. 2004;172(1):27–33.CrossRefPubMedGoogle Scholar
  6. 6.
    Benson JT, Griffis K. Pudendal neuralgia, a severe pain syndrome. Am J Obstet Gynecol. 2005;192(5):1663–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Loukas M, Louis RG, Hallner B, Gupta AA, White D. Anatomical and surgical considerations of the sacrotuberous ligament and its relevance in pudendal nerve entrapment syndrome. Surg Radiol Anat. 2006;28:163–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Mahakkanukrauh P, Surin P, Vaidhayakarn P. Anatomical study of the pudendal nerve adjacent to the sacrospinous ligament. Clin Anat. 2005;18:200–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Bohrer JC, Walters MD, Park A, et al. Pelvic nerve injury following gynecologic surgery: a prospective cohort study. Am J Obstet Gynecol. 2009;201:531.e1–7.CrossRefGoogle Scholar
  10. 10.
    Antolak SJ, Hough DM, Pawlina W, et al. Anatomical basis of chronic pelvic pain syndrome: the ischial spine and pudendal nerve entrapment. Med Hypotheses. 2002;59:349–53.CrossRefPubMedGoogle Scholar
  11. 11.
    Alevizon SJ, Finan MA. Sacrospinous colpopexy: management of postoperative pudendal nerve entrapment. Obstet Gynecol. 1996;88:713–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Pailhe R, Chiron P, Reina N, et al. Pudendal nerve neuralgia after hip arthroscopy: retrospective study and literature review. Orthop Traumatol Surg Res. 2013;99:785–90.CrossRefPubMedGoogle Scholar
  13. 13.
    Leibovitch I, Mor Y. The vicious cycling: bicycling related urogenital disorders. Eur Urol. 2005;47:277–86.CrossRefPubMedGoogle Scholar
  14. 14.
    Elahi F, Callahan D, Greenlee J, et al. Pudendal entrapment neuropathy: a rare complication of pelvic radiation therapy. Pain Physician. 2013;16:E793–7.PubMedGoogle Scholar
  15. 15.
    Filler AG. Diagnosis and treatment of pudendal nerve entrapment syndrome subtypes: imaging, injections, and minimal access surgery. Neurosurg Focus. 2009;26:E9.CrossRefPubMedGoogle Scholar
  16. 16.
    Khoder W, Hale D. Pudendal neuralgia. Obstet Gynecol Clin N Am. 2014;41(3):443–52.CrossRefGoogle Scholar
  17. 17.
    Martin HD, Reddy M, Gómez-Hoyos J. Deep gluteal syndrome. J Hip Preserv Surg. 2015;2(2):99–107.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Amarenco G, Lanoe Y, Ghnassia RT, Goudal H, Perrigot M. Alcock’s canal syndrome and perineal neuralgia. Rev Neurol (Paris). 1988;144(8–9):523–6.Google Scholar
  19. 19.
    Labat J-J, Riant T, Robert R, Amarenco G, Lefaucheur J-P, Rigaud J. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourol Urodyn. 2008;27:306–10.CrossRefPubMedGoogle Scholar
  20. 20.
    Popeney C, Ansell V, Renney K. Pudendal entrapment as an etiology of chronic perineal pain: diagnosis and treatment. Neurourol Urodyn. 2007;26:820–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Olsen AL, Ross M, Stansfield RB, Kreiter C. Pelvic floor nerve conduction studies: establishing clinically relevant normative data. Am J Obstet Gynecol. 2003;189(4):1114–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Abbott JA, Jarvis SK, Lyons SD, Thomson A, Vancaille TG. Botulinum toxin type A for chronic pain and pelvic floor spasm in women: a randomized controlled trial. Obstet Gynecol. 2006;108(4):915–23.CrossRefPubMedGoogle Scholar
  23. 23.
    McDonald JS, Spigos DG. Computed tomography-guided pudendal block for treatment of pelvic pain due to pudendal neuropathy. Obstet Gynecol. 2000;95(2):306–9.PubMedGoogle Scholar
  24. 24.
    Calvillo O, Skaribas IM, Rockett C. Computed tomography-guided pudendal nerve block. A new diagnostic approach to long-term anoperineal pain: a report of two cases. Reg Anesth Pain Med. 2000;25(4):420–3.PubMedGoogle Scholar
  25. 25.
    Hibner M, Desai N, Robertson LJ, Nour M. Pudendal neuralgia. J Minim Invasive Gynecol. 2010;17(2):148–53.CrossRefPubMedGoogle Scholar
  26. 26.
    Shafik A. Endoscopic pudendal canal decompression for the treatment of fecal incontinence due to pudendal canal syndrome. J Laparoendosc Adv Surg Tech A. 1997;7:227–34.CrossRefPubMedGoogle Scholar
  27. 27.
    Shafik A. Pudendal canal syndrome as a cause of vulvodynia and its treatment by pudendal nerve decompression. Eur J Obstet Gynecol Reprod Biol. 1998;80(2):215–20.CrossRefPubMedGoogle Scholar
  28. 28.
    Beco J, Climov D, Bex M. Pudendal nerve decompression in perineology: a case series. BMC Surg. 2004;4:15.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Robert R, Labat JJ, Bensignor M, Glemain P, Deschamps C, Raoul S, Hamel O. Decompression and transposition of the pudendal nerve in pudendal neuralgia: a randomized controlled trial and long-term evaluation. Eur Urol. 2005;47(3):403–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Sung-Jung Yoon
    • 1
  • Juan Gómez-Hoyos
    • 2
    • 3
    • 4
  • William Henry Márquez-Arabia
    • 5
    • 6
  • Hal D. Martin
    • 7
  1. 1.Chonbuk National University Hospital, Department of Orthopedic SurgeryJeonjuSouth Korea
  2. 2.International Consultant, Hip Preservation Center / Baylor Scott and White Research InstituteBaylor University Medical CenterDallasUSA
  3. 3.Department of Orthopaedic Surgery - Health ProviderClínica Las Américas / Clínica del CampestreMedellinColombia
  4. 4.Professor - School of Medicine - Sports Medicine Program, Universidad de AntioquiaMedellínColombia
  5. 5.Clínica Las Americas, Orthopedic SurgeryMedellinColombia
  6. 6.Sports Medicine ProgramSchool of MedicineMedellinColombia
  7. 7.Medical and Research Director, Hip Preservation Center, Baylor University Medical CenterDallasUSA

Personalised recommendations