<\/span><\/h2>\nPudendal nerve entrapment syndrome is an unusual condition that arises from compression of the pudendal nerve (S2) and causes chronic<\/span> pain at saddle sites: the perineal<\/span>, perianal<\/span> and genital areas<\/p>\nIt is a form of vulvodynia (in women). Pudendal nerve entrapment syndrome can also affect men.<\/p>\n
Pudendal nerve entrapment syndrome is also called Alcock syndrome. <\/p>\n
<\/span>What causes pudendal nerve entrapment syndrome?<\/span><\/h2>\nPudendal nerve entrapment syndrome is caused by compression of the pudendal nerve as it exits or enters the pelvis in various tunnels created by adjacent<\/span> muscles, tendons or bone and ligament tissues.<\/p>\nIn this condition, the nerve is most often compressed in:<\/p>\n
\n- The space between the sacrotuberous and sacrospinous ligaments (~ 70% of cases)<\/li>\n
- Within Alcock's pudendal canal (~ 20% of cases)<\/li>\n
- While the falciform process of the sacrotubertal ligament extends through the pudendal nerve and its branches<\/li>\n
- Anywhere along the course of the pudendal nerve or its branches<\/li>\n<\/ul>\n
Changes in the shape and position of the ischial spine are believed to occur in young cyclists. This predisposes them to pudendal nerve entrapment in later years, especially if they continue to cycle for long periods.<\/p>\n
The most common causes of pudendal nerve entrapment syndrome include:<\/p>\n
\n- Repeated mechanical injuries (eg, sitting in bicycle seats for prolonged periods over many years or months)<\/li>\n
- \nTrauma<\/span> to the pelvic area, for example during childbirth<\/li>\n
- Damage to the nerve during surgical procedures in the pelvic or perineal regions.<\/li>\n
- Compression of lesions or tumors arising in the pelvis.<\/li>\n
- Any cause for the development of peripheral<\/span> neuropathy<\/span> (for example, diabetes or vasculitis<\/span>)<\/li>\n<\/ul>\n
\n
\n
\n
\n<\/div><\/div><\/div><\/div>\n
<\/span>What are the symptoms of pudendal nerve entrapment syndrome?<\/span><\/h2>\nThe symptoms of pudendal nerve entrapment syndrome arise from changes in nerve function and structural changes in the nerve that arise from the mechanical effects of compression. These changes result in neuropathic<\/span> pain or cutaneous<\/span> dysesthesia<\/span> at perineum<\/span>, genital and anorectal areas.<\/p>\nNeuropathic pain has many manifestations, most commonly spontaneous or evoked burning pain (also called "dysesthesia") with or without an acute (sudden, "electrical") pain component. Other manifestations of \u201cneuropathic pain\u201d include deep pain \/ pain sensation, increased appreciation of a sensation to any physical stimulus (\u201chyperesthesia\u201d), exaggerated sensation of pain for a given stimulus (\u201chyperalgesia\u201d), sensation of pain that occurs with stimulation that normally does not cause pain (\u201callodynia<\/span>") Or an unpleasant, exaggerated and prolonged response to pain (" hyperpathy ").<\/p>\nThe characteristic feature of pudendal nerve entrapment syndrome is an aggravation of symptoms when assuming a sitting position, often after a short session duration. Symptoms are usually relieved by standing and are generally absent when you lie down or sit on the toilet seat.<\/p>\n
In some cases, other symptoms may occur, for example, urinary hesitancy (difficulty starting the flow of urine), frequency (frequent need to urinate), urgency (sudden sensation of urination), constipation \/ painful bowel movements, decreased awareness of defecation (the evacuation process), sexual dysfunction<\/span>, recurrent<\/span> numbness of the penis and \/ or scrotum (or vulva<\/span> in women) after a prolonged cycle, impaired ejaculation sensation and impotence in men.<\/p>\nChronic pudendal neuralgia<\/span> is associated with generalized<\/span> pain syndromes<\/p>\n<\/span>How is pudendal nerve entrapment syndrome diagnosed?<\/span><\/h2>\nPudendal nerve entrapment syndrome is primarily a clinical diagnosis based on:<\/p>\n
\n- History<\/li>\n
- Characteristic symptoms and aggravating or relieving factors.<\/li>\n
- Typical location of symptoms.<\/li>\n<\/ul>\n
The 'skin roll test' can be a useful clinic sign<\/span>. In this test, a thick roll (or fold) of skin just below and side<\/span> he pinches his anus and then rolls forward. If pain is caused, this suggests that the pudendal nerve is compressed.<\/p>\nIt is important to exclude injuries to the pelvis that could compress the nerve by a ultrasound<\/span>, computed tomography<\/span> (Connecticut<\/span>) scan or magnetic resonance image<\/span> (Magnetic resonance<\/span>) Sometimes special studies of the nerves (electrophysiological studies) can be helpful. Local anesthetic<\/span> Pudendal nerve blocks can be helpful in confirming the diagnosis in some cases if it demonstrates complete abolition of symptoms after a nerve block.<\/p>\n<\/span>What is the treatment for pudendal nerve entrapment syndrome?<\/span><\/h2>\nThe condition can be amenable to treatment in a number of ways. General measures may include:<\/p>\n