Pudendal nerve: Anatomy and treatment (exercises)

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Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine 

A pudendal neuralgia usually affects people between the ages of 50 and 70. It is more common in women than in men. Even if it causes pain that can be disabling, it has no impact on life expectancy. In this article, let's discover a little more about the world of pudendal nerve and its pathologies: what are the common causes, symptoms and treatments?

Pudendal Nerve Definition and Anatomy

Le pudendal nerve is formerly called " internal pudendal nerve ". Indeed, the word “pudendal” comes from the Latin “pudendus” which means “shameful”. Located in the lower part of the pelvis, this nerve is responsible for the innervation of the perineal region: the area between the anus and the genitals.

Le pudendal nerve consists of sensory, motor and vegetative nerve fibers. It originates at the level of the spinal cord in the firste, 3e and 4e nerve roots from the bottom of the sacrum. His journey consists of:

  • leave the pool through the large indentation sciatica (below the piriformis muscle);
  • pass around the sciatic spine;
  • penetrate the clamp composed of sacro-tuberal and sacrospinous ligaments;
  • enter the Alcock canal (fibrous canal).

When the pudendal nerve crosses the pelvis, it forms a branch and creates the rectal nerve. This ensures the innervation of the external sphincter of the anus. And, once arrived in the channel of Alcock, it is divided into two terminal branches.

On one side there is a lower branch formed by the perineal nerve which, in turn, also divides into two branches: superficial branch (innervation of the scrotum or labia majora) and deep branch (innervation of part of the ischiocavernosus and bulbocavernosus muscles, the medulla of the penis from the levator ani muscles).

On the other hand, there is a upper branch formed by the dorsal nerve which innervates the clitoris or the penis.

The pudendal nerve plays an important role in the mechanism of erection as well as in urinary and anal continence. It makes penile rigidity possible thanks to its nervous activity and transmits the sensation of urinating.

Causes of pudendal neuralgia

La pudendal neuralgia, also called pudendal pain or Alcock canal syndrome is a chronic neuropathy that results in compression of the pudendal nerve. In other words, it is a progressive condition that affects both the peripheral nervous system and the nerves of the autonomic nervous system in the region of the perineum.

Until now, the causes of this condition remain unknown. Nevertheless, there are risk factors that favor its appearance.

  • It can set in if you regularly practice activities such as cycling (Intergovernmental Panel on Climate Change) and the riding. This type of activity exposes you to the risk of micro-trauma at the level of the pudendal nerve which can seriously impede mobility.
  • It may be due to a anatomical origin. A narrowed Alcock canal, even a little, is more likely to get stuck.
  • It can follow a fall on the buttocks (trauma) or an prolonged sitting position and repeated, just as it may occur after a surgical intervention of an area crossed by the nerve.

What are the symptoms of pudendal neuralgia?

In general, symptoms of pudendal pain persist for months. They are mainly manifested by significant, even unbearable, chronic pain. They can be unilateral or bilateral.

The pain is more pronounced when sitting, but can be relieved at rest. They are usually perceived as an electric shock, pinching, twisting, burning, numbness...

The signs of pudendal neuralgia may vary from patient to patient. However, there are symptoms that are frequently present. These include urethral pain, difficult and frequent urination, constipation, sexual dysfunction and pain in the rectogenital region. These signs are sometimes associated with a sensation of a foreign body in the rectum or vagina.

It should be noted that the pains caused by this type of neuralgia subside during sleep. They have no impact on the latter and remain absent until waking up (morning). They appear especially from midday and worsen until the evening.

Treatments for pudendal neuralgia

Le diagnosis of pudendal neuralgia proves difficult because of its variable symptoms. In any case, it is difficult to establish a diagnosis with certainty.

The neurologist bases himself on the patient's history and carries out differential diagnoses to eliminate other diseases that can be confused with pudendal neuralgia, such as urological disorders. To this end, various examinations can be carried out such as an MRI, an ultrasound-Doppler, an electromyogram, a pudendal anesthetic block, etc.

Unblocking the pudendal nerve, is it possible?

It is not possible to " unblock » the pudendal nerve strictly speaking. the treatment of pudendal pain is primarily aimed at relieving symptoms and reducing compression or irritation of the nerve in question. First, it consists of taking medications such as:

  • antiepileptics;
  • analgesics;
  • antidepressants: pain caused by Alcock canal syndrome can lead to anxiety and depression.

The corticosteroid injections are not recommended, because not only is their effectiveness limited to 16%, but they can also cause long-term muscle necrosis. On the other hand, a spa treatment can accompany the drug treatment.

Pudendal nerve surgery

A pudendal nerve surgery should only be done as a last resort. It consists of freeing the nerve from the main points of compression and moving its path to prevent possible compression. Surgery is recommended for pain that persists beyond 6 months despite taking medication. The same is true for cases of recidivism.

According to studies, this operation can relieve pain in about 70% of cases.

Natural treatments for pudendal neuralgia

As natural treatments, patients often resort to physiotherapy or toosteopathy. This is explained by the fact that physiotherapy acts on the nerve through massage techniques to relieve pain due to compression of the nerve.

As for osteopathy, it makes it possible to establish a diagnosis on which the osteopath bases himself to treat pudendal neuralgia. To do this, the latter mobilizes different structures of the pelvis (muscular, bone, organic) to reduce tension. These manipulations can significantly reduce pain.

Other natural treatments can also be offered such asacupuncture, naturopathy...

Exercises to relieve the pudendal nerve

Several exercises allow relieve pudendal nerve pain. For good results, it is best to incorporate relaxation exercises into your routine. This helps to manage stress and relaxes the muscles of the pelvis to reduce tension on the sacrum. In this sense, meditation proves to be an effective ally against pain.

Ground support exercises are also recommended. In addition, bending the foot while climbing a step is ideal to soothe the pain associated with this nerve compression.

For this purpose, it is sometimes recommended to wear shoes with adapted soles to establish and maintain the balance of the foot and ankle. A podiatrist can help you determine which types of insoles to choose.

Movements performed while walking (and running when indicated) also help to fight against compression of the pudendal nerve. They mobilize different parts of the body: from the shoulders to the feet!

What about natural remedies?

Although they are not supported by solid scientific evidence, several natural products and home remedies are used to treat pain related to pudendal neuralgia, in particular for their anti-inflammatory power. It is essential to consult a doctor beforehand, mainly to avoid drug interactions and side effects.

Here is a non-exhaustive list of plants and essential oils that are effective in controlling pain and inflammation. The products are available on the site Country. Use promo code LOMBAFIT15 if you wish to obtain one of the following products, or any remedy aimed at relieving your symptoms and improving your quality of life:

  • Turmeric. Thanks to its antioxidant and anti-inflammatory powers very powerful, turmeric is one of the most used plants in a culinary and therapeutic context. The composition of turmeric is essentially made of essential oils, vitamins (B1, B2, B6, C, E, K) and trace elements. But it is to its composition rich in curcumin and curcuminoids that we owe them and calm skin of this spice.
  • Ginger. In addition to the special flavor it brings to the kitchen and its aphrodisiac properties, ginger is a root well known for its anti-inflammatory powers. the gingerol gives it its anti-inflammatory action. It is an active component acting on the inflammatory pain related to chronic joint inflammatory diseases, including rheumatoid arthritis, lupus, rheumatic diseases, etc. It has been proven that this active element is also effective in acting on the inflammation linked to arthritis and sciatica. Ginger also has other benefits thanks to its high potassium content and its richness in trace elements (calcium, magnesium, phosphorus, sodium) and vitamins (provitamin and vitamin B9).
  • Omega-3s. Omega-3s are polyunsaturated fatty acids that play a very important role in the functioning of our body. They are provided by food in three natural forms: docosahexaenoic acid (DHA), alpha linolenic acid (ALA) and eicosapentaenoic acid (EPA). Beyond their action on the brain and the cardiovascular system, omega-3s prove very effective against inflammation. Indeed, they have the ability to act on the inflammatory mechanisms in osteoarthritis by slowing down cartilage destruction, thus they reduce the intensity of osteoarthritis pain. Sciatica, being most often linked to an inflammation secondary to a herniated disc, it can also respond to omega-3 provided it is consumed regularly. 
  • Lemon eucalyptusEucalyptus is a plant most often used in the form of herbal tea or essential oil. She would have anti-inflammatory effects which give it the ability to act on the bone and joint pain in general and the pain of sciatica in particular.
  • wintergreen. Wintergreen is a shrub from which a very interesting essential oil is extracted. It is one of the most used essential oils in aromatherapy. This oil extracted from the shrub bearing the same name, is used in massage to relieve sciatica and act like a analgesic. Indeed, it provides a heating effect thanks to its ability toactivate blood circulation locally.

Remember that these products do not replace medical treatment. Do not hesitate to consult for support adapted to your condition.

References

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