Pudendal Nerve Entrapment (PNE)

Pudendal Nerve Entrapment or Pudendal Neuralgia

The basic idea here is that compression of the pudendal nerve in the Alcock’s canal (by impact trauma, an operation in the immediate area, or congenital malformations) can lead to a syndrome of pelvic pain.

pudendal nerve entrapment

Important warning: This is an extremely rare disorder. It was described by a 2010 paper as “an uncommon cause of pain in the pelvic floor”. Please read our in-depth warning about surgery offered for this condition. The surgery to alleviate it should not be entered into lightly. Many people who have “decompression of the pudendal nerve” surgery are still in great pain years later. Some are in worse pain than before the operation, and a significant percentage develop Sacroiliac Joint Dysfunction (SIJD) and pelvic instability due to the severing of the sacrotuberous and sacrospinous ligaments (leaving them unable to play sport, lift weights etc). Only a small handful of doctors in the world will do this operation. It is not mainstream medicine. The operation can cost tens of thousands of US dollars, and most insurances will not cover it. When the operation fails, as it usually does according to reports on our forum, patients are urged to submit to further operations. According to proponents of the theory, PNE can be identified if pain is relieved by anesthetic infiltration of the pudendal nerve. This is an essential criterion, they say, but it lacks specificity since pain related to any perineal disease may be relieved by pudendal nerve block. Our recommendation is that unless you have pain that comes on only when and immediately upon sitting, combined with episodes of penile numbness, and/or urinary or fecal incontinence, do not consider this option before thoroughly investigating the far more common causes of pelvic pain.

It is not unknown for men to be diagnosed with Pudendal Nerve Entrapment or Pudendal Neuralgia, and then end up getting treated (and cured!) with trigger point massage (only called something else such as “Active Release Technique”). Here’s an example.

In the unlikely case that a patient has PNE, he/she will also have some of these symptoms: positional pain worsened by sitting, genital numbness, fecal and/or urinary incontinence. Sitting pain relieved by standing or sitting on a toilet seat is the most reliable diagnostic parameter.

A review study in 2009 found that while some people do have the symptoms of pudendal neuralgia (which would include many people with IC and CPPS), “there is no evidence to support equating the presence of [these symptoms] with a diagnosis of pudendal nerve entrapment”.

Lastly, a 2015 paper from the University of Texas, a study of 13 normal female cadavers, found that the pudendal nerve is routinely “entrapped”, to the point where the authors suggest that there is no such thing as pudendal nerve entrapment, and that attachments (“entrapments”) are normal. This is an extract from the commentary section at the end:

An interesting finding of this study was the fixation of the pudendal nerve (PN) on the dorsal surface of the sacrospinous ligament (SSL). These connective tissue attachments were found not only on the dorsal surface of the SSL-ischial spine junction but within the pudendal canal. Whereas previous authors have noted that the PN is surrounded by a connective tissue sheath in the pudendal canal,(4,9) we found no specific descriptions or assessments of the mobility or connective tissue interactions of the PN on the dorsal surface of the SSL. This finding has potential implications in the surgical treatment of pudendal neuralgia, and it may be misleading to attribute pudendal neuralgia to nerve entrapment. Thus, procedures seeking to decompress the PN may not address the true etiology. In fact, these procedures may potentially result in significant complications, given the complexity of surrounding nerve and vascular anatomy.

Note that surgeons who perform PNE surgery claim that the pudendal nerve should “glide freely”. The above study clearly shows that this is not the case in most people, thus undermining the basis of the theory of pudendal nerve entrapment.

Another warning: there are various forums in the internet that promote this surgery, even to anonymous members whose symptoms are identical to CPPS and/or IC. If you disagree with the people who run the forums, you are quickly banned, without discussion or warning. We have information that leads us to believe that the forums may be funded by the surgeons promoting this unusual surgery. Our advice is to avoid these forums.

Throw out the antibiotics and try these….

Q-Urol

Q-Urol for prostatitis

Buy 1 get 1 FREE! Remember, use code 50UROL18. There is no better anti-prostatitis medication on the market, period. Q-UROL offers all of the benefits of Prosta-Q, but with time release technology and extra strength anti-inflammatory power. Published studies prove that both quercetin and pollen extract (also known as cernilton) calm CPPS symptoms. The combination is very effective for the majority of patients, and has been shown in published urological studies to help maintain prostate health and specifically target pelvic or genital discomfort.

BP-Qmax

BP-Qmax for prostatitis and BPH

Buy 1 get 1 FREE! Remember, use code 50QMAX19. BPH and Prostatitis share many symptoms. The proprietary blend of clinically proven all-natural ingredients found in BP-Qmax was developed in collaboration with leading urologists at major medical centers to assist men with prostate and urinary health issues and provide support for those seeking powerful, but natural, prostate health support. Contains optimum amounts of Beta-Sitosterol, Saw Palmetto, Flower Pollen and enzymes, as studied by academic urologists. Reduce nighttime urination and sleep through the night with BP-QMax™

TriverexMD and Trinoboost

trinoboost and triverex for libido repair

Buy 1 get 1 FREE! Remember, use code 30TRIN456. Trinoboost increases levels of nitric oxide (NO), vital for erections. TriverexMD contains Panax Ginseng, which has extensive clinical evidence (7 human clinical studies) proving effective for boosting male sexual health, especially erectile dysfunction. Try these natural remedies and avoid harmful ED drugs.

MultiRight

Multiright acide free vitamins

Buy 1 get 1 FREE! Remember, use code 2Multi3295. MultiRight is the only pH neutral, low acid multivitamin which means that it’s more bladder friendly than ever!  Most multivitamins are acidic (usually because of the cheap form of Vitamin C they contain) and can burn inflamed bladders, prostates and urethras. This product won’t do that. Kill the burn now!

Farr Labs

Buy 1 get 1 FREE! Remember, use code ??????. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Fusce rutrum vitae erat sit amet tempus. Nullam placerat arcu vel fermentum sodales. Proin dignissim condimentum imperdiet. Vivamus cursus eros nisi, et malesuada justo molestie vel. Pellentesque habitant morbi tristique senectus et netus et malesuada fames ac turpis egestas. Phasellus blandit tellus ac tortor sagittis, sit amet sagittis justo rutrum.

Farr Labs

Buy 1 get 1 FREE! Remember, use code ??????. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Fusce rutrum vitae erat sit amet tempus. Nullam placerat arcu vel fermentum sodales. Proin dignissim condimentum imperdiet. Vivamus cursus eros nisi, et malesuada justo molestie vel. Pellentesque habitant morbi tristique senectus et netus et malesuada fames ac turpis egestas. Phasellus blandit tellus ac tortor sagittis, sit amet sagittis justo rutrum.