Sexual neuropathy. Inflammation of the pudendal nerve in women symptoms How does the femoral pudendal nerve hurt

The pudendal nerve is a paired structure, which is formed on both sides of the body by paired branches of the spinal nerves. The main purpose is to ensure the innervation of organs that are available in both men and women: the perineal region, the muscle that raises the anus, the sphincters of the rectum and bladder. Further, there are some differences in the structure - for example, in men it provides sensitivity, as well as the autonomics of the scrotum, cavernous bodies, and in women - the same functions in relation to the clitoris, large and small labia. It is customary to call a pinched pudendal nerve a pathology that can bring a lot of discomfort, most often the cause is compression neuropathy.

Consider the symptoms and methods of treatment of this pathology.

Reasons for development

The main etiological factor that can provoke sexual neuropathy is the pinching of the pudendal nerve, which occurs in the Alcock canal. It is in connection with this that experts refer to the disease as “Alcock Canal Syndrome”.

The disease can progress due to the formation of a hernia or injury to the inguinal zone. - this is the result of the fact that muscle scars begin to form. As a rule, this occurs after an injury or surgical intervention.

Also, neuropathy can develop as a result of the following factors:

protracted labor activity;
the presence of fractures of the pelvic bones;
hypertonicity of the piriform gland;
herpes;
tension of the obturator internal muscle;
the presence of malignant neoplasms in the pelvic area;
spasm of the muscles that are located in the anus;
nerve damage from cycling or horseback riding.

Examination will help to determine exactly whether there is a pathology. To do this, you need to contact a neurologist, he will prescribe diagnostic measures in order to establish a diagnosis.

Main symptoms

Symptoms of neuropathy vary. The main symptom is a change in the function of the organs that are in the pelvis. A person may have a violation of sensitivity, or problems with vegetative. Moreover, a change in sensitivity may be accompanied by a pronounced pain syndrome, and as for vegetatives, there will be violations of the function of the glands and other structures that consist of smooth muscle fibers.

Violations of the trophism of the epidermis of the scrotum, perineum, the area near the anus are also a symptom that infringement could occur.

Consider the symptoms of pathology:

violation of the function of the genital organs;
feeling sensation of foreign bodies in the groin area;
discomfort in the groin area - burning sensation, severe itching;
pain that is aching in nature - in the pelvic area;
excessive sensitivity of the epidermis in the inguinal zone;
after urination, the patient experiences discomfort, accompanied by pain;
false urge to empty the bladder may be present.

Less often, with pathology, the following symptoms can be noted:

constipation;
soreness during intercourse;
feeling as if the muscles of the perineum were numb.

Experts have also found that the disease contributes to increased anxiety, and in some cases even causes depression. As a concomitant disease, pathology can also be accompanied by Alzheimer's disease.

Diagnosis and treatment

In order to correctly carry out diagnostic measures, the patient must tell the doctor about all the symptoms that are present. For example, in the presence of pathology, pain sensations decrease if the patient is in a supine position, and intensify if he sits. When applying cold, the patient may also feel temporary relief - this indicates the presence of neuropathy. Also, the doctor can examine the patient by palpation to find areas characteristic of a pinched nerve.

The following diagnostic measures are prescribed:

ultrasound - to determine if there are violations of blood flow through the genital artery;
dopplerography - performed for the same purpose as ultrasound;
novocaine blockade of the nerve tract - check if there is a disappearance of discomfort after the procedure.

Only after the diagnosis is established, the patient is prescribed therapy, the main purpose of which is the restoration of nerves, as well as the removal of unpleasant symptoms in the perineal and pelvic region.

Muscle relaxants - are needed in order to relax the muscles of the femoral-genital nerve.
Anticonvulsant drugs - they relieve pain, Gabapentin is a popular one.
Sedatives are also prescribed to reduce pain.
Solutions of hormones, as well as anesthetics - for blockade of the pudendal nerve - preparations of the Neuromultivit class. When applied, urination and defecation should normalize, and discomfort should pass.
Rectal or vaginal suppositories with an active ingredient such as Diazepam.
The use of vitamins C and group B - to normalize the general condition.
Physiotherapeutic methods - phonophoresis, electrophoresis. They are used against the background of a chronic course of pathology.
Therapeutic exercise - for each patient is selected individually, it is needed in order to massage the muscles of the perineum.

If all of the above methods are ineffective, then the patient is prescribed surgical decompression.

Preventive measures

In some cases, the disease tends to recur if the patient does not follow certain rules. Doctors say that if the sciatic nerve is pinched again, the symptoms become brighter, and it will be more difficult to cure the pathology. To avoid relapse, you must adhere to the following recommendations of a specialist:

if a person is professionally engaged in equestrian sports or cycling, it is necessary to take breaks and take precautions to protect the groin area from damage;
traction in case of a hip fracture should be carried out using a perineal fixator, in which the area of \u200b\u200bsupport is not more than 9 cm, there should also be a softening pad;
the introduction of a solution of magnesium sulfate intramuscularly (if large doses are planned) should be carried out with caution to avoid the occurrence of ischemic necrosis of the muscles of the buttocks.

If the patient notes unpleasant symptoms, pain - you should sign up for a consultation with your doctor as soon as possible.

Genital femoral nerve- This is a nerve formed from the plexus of the upper lumbar spinal nerves. Its path runs along the anterior surface of the psoas major muscle, perforating its thickness. Passing behind the ureter, the nerve rushes to the inguinal canal. The femoral-genital nerve branches in the thickness of the muscle and forms two branches: the femoral branch and the inguinal branch.

The femoral branch is located at the iliac external vessels, located posteriorly and outwardly from them. The branch stretches behind the iliac fascia, bypasses it in front and goes already in the vascular lacuna. Here, the femoral branch is located in front and outside of the femoral artery. Then it passes through the wide fascia of the thigh, which is located in the subcutaneous opening and forms a network of branches in the skin of this area. A separate part of the nervous network penetrates under the inguinal ligament and, passing through the wide femoral fascia, divides again. The division into other branches occurs here in the skin of the femoral triangle. The path of the femoral branch can be considered complete in the form of a reunion with the ilioinguinal nerve and with the anterior cutaneous branches of the femoral nerve.

The genital branch of the femoral-genital nerve is located in the region of the psoas major muscle, on its anterior surface. The genital branch passes next to the femoral branch along an identical path, that is, in relation to the external iliac vessels - outward from them. Further, her path lies in the inguinal canal - to the superficial ring. In men, the genital branch comes out in union with the spermatic cord; in women, along with the round ligament of the uterus.

In the male body, the genital branch of the femoral-genital nerve innervates the skin of the scrotum and, branching, directs its network to the muscle that raises the male testicle. Also, the branching nerve pathways go in the skin of the scrotum, the fleshy membrane of the scrotum, then to the middle upper parts of the thigh surface.

In the female body, the genital branch multiplies in the round ligament of the uterus, on the skin of the inguinal ring and in the region of the labia majora. Further, the genital branch fuses with the femoral branch.

Nerve diseases

A characteristic syndrome with damage to the femoral-genital nerve: intense pain, aching and aching in the region of the gluteal region and anogenital. The pain occurs on the inner and front surface of the thigh - on 1/3 of its part.

The intensity of the pain increases when the patient walks, sits, and also suffers when performing a bowel movement. During the diagnosis test, in which the patient tries to reach the knee of the opposite shoulder, severe pain occurs. As a rule, with damage to the femoral-genital nerve, there is a lack of a cremasteric reflex, or a decrease in it. The disease can cause a slight disorder in the work of the external sphincters of the pelvic organs. The prerequisites for the occurrence of neuropathy of the nerve is the impact on it in the area of inflection through the sciatic spine, or through the sacrospinous ligament. Another cause of neuropathy may be compression of the nerve by the piriformis muscle, when it is tense.

The causes of damage to the femoral-genital nerve can be not only compression factors, which are also responsible for the defeat of the ilio-hypogastric nerve and the ilio-inguinal nerve. Also, the formation of the disease can be facilitated by compression on the femoral branch, which is located under the inguinal ligament in the vascular space, or compression in the inguinal canal of the genital branch. You can acquire the disease due to hard physical work, after surgical operations in the groin area. Local adhesions and cicatricial processes can also provoke an ailment.

Signs and symptoms of damage to the femoral nerve:

paresthesia and pain in the groin
pain in the external genitalia
pain with tension of the abdominal press and flexion-extension of the hip
pain in the testicle, with a return of pain in the upper part of the inner femoral surface, when the patient is standing
pain occurs when probing the lower region of the pupart ligament in the direction of the outer side of the femoral artery
sensation of pain on palpation of the inguinal ring
a clear symptom of Wasserman
formation of hypoesthesia

Similar symptoms manifest themselves neuropathy of the ilioinguinal nerve and iliohypogastric nerve. In rare cases, neuropathy of the genitofemoral nerve contributes to the development of damage to the inguinal nerve. The reason is the close anatomical neighborhood of the nerves. The signs and culprits of damage to these nerves are identical, however, sensory dysfunctions are aggravated in the proximal and medial genital areas.

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Pinched pudendal nerve in men and women

"Pudendal", or pudendal nerve (n. Pudendus) is very often the cause of chronic pelvic pain occurring in adults. The most common cause of this is compressive neuropathy. Moreover, the “pinching” of the pudendal nerve in men is three times less common than in women.

A bit of anatomy

The pudendal nerve is small in length, but a very important nerve of the latter, if you go from the brain, the sacral plexus. It lies in the pelvic cavity, envelops the ischium along the way. Further, it is divided into three branches - rectal, perineal and dorsal nerve of the penis (clitoris). Its functions are varied:

they innervate the muscle that raises the anus;

innervates the anal sphincter;

sphincter

gives branches to the muscles of the perineum;

innervates the genital organs: the cavernous bodies of the penis in men, the clitoris in women;

gives sensitivity to the skin of the external genitalia and anus;

innervates the sphincter of the urethra.

As you can see, this nerve plays a big role not only in the intimate life of a person, but also in urination and defecation. The pudendal nerve contains a large number of autonomic fibers that provide the "unconscious work" of the sphincters. After all, a person never thinks, does not control and consciously compresses the muscles so as not to accidentally defecate or urinate in broad daylight. This is done by autonomic nerve fibers that enter the lumen of the pudendal nerve.

The pudendal nerve in the male body (in yellow)

This nerve can be pinched by the piriformis muscle, which is located in the pelvic cavity, or be sandwiched between two ligaments.

In addition, the nerve can be damaged, for example, due to a car accident, a fall from a great height, in which the pelvic bones are fractured. A fairly common cause of chronic pelvic pain is nerve damage during childbirth, as well as the involvement of the nerve trunk in the growth of a malignant neoplasm.

In addition, activities such as riding a horse or cycling can also lead to pudendal compression neuropathy over time.

Symptoms of neuropathy of the pudendal nerve

As with any neuropathic lesions, all symptoms are made up of pain, sensory disturbances, autonomic disorders and muscle weakness. Pinching of the pudendal nerve is manifested by the following symptoms:

pain in the perineum;

discomfort in the anus and genitals;

burning shade of pain;

decrease in skin sensitivity in these areas, "crawling";

an unpleasant feeling of foreign body sensation in the urethra and anus;

incontinence of feces and urine. It may be incomplete, and manifest as fecal smearing or drip incontinence;

sexual disorders: impotence, anorgasmia.

Pinched pudendal nerve in women causes the above symptoms also in the lower third of the vagina.

Pinched pudendal nerve in men, in addition to the above, can cause pain during intercourse.

The very nature of the pain becomes burning, touching the skin becomes excruciatingly unpleasant. There are sensations of electric shocks, a sensation of either a hot or cold foreign body, problems with urination and defecation, and other various and unpleasant symptoms.

About diagnosing neuropathy

With such unpleasant and painful sensations, a person is not inclined to endure for a long time, as, for example, with pain in an arm or leg. Therefore, most often he turns to a neurologist, or a proctologist, in the event that violations of the anal sphincter are expressed and there are problems with the retention of urine and feces.

Less often, a patient turns to a sexopathologist, but a competent specialist should, with the help of an elementary question, identify organic disorders and refer the patient to a specialist. Neuropathy of the pudendal nerve is diagnosed on the basis of the following complaints and studies;

complaints of the patient, which were described in detail above;

the nature of the pain, which indicates neuropathic changes (burning, crawling, all kinds of itching, unpleasantness when touched);

trial therapeutic and diagnostic novocaine blockade of this nerve significantly reduces the severity of symptoms, or completely relieves the patient of suffering for the duration of novocaine - from 12 hours to 3 days;

when performing ultrasound of the perineum and small pelvis with Dopplerography, almost always with compression-ischemic neuropathy of the pudendal nerve, a decrease in the volumetric blood flow velocity in the nearby pudendal artery is noted. This happens “for company”: the pudendal artery passes along with the nerve in the same canals, and its narrowing indirectly confirms the compression of the pudendal nerve;

an important diagnostic criterion is the increase in pain if the person is sitting and the decrease in pain if the person lies on their back. Also, pudendal neuropathy is characterized by a unilateral lesion. On the same side, disorders arise;

Patients often find that applying cold to the perineum relieves the burning pains. This symptom indicates the neuropathic nature of nerve damage.

In addition to these diagnostic criteria, palpation of the perineum can reveal characteristic pain points that reflect a spasm in the piriformis muscle.

It is important that the pathology of this nerve has a deep connection with the progression of the myofascial syndrome. This syndrome is more difficult to treat because the muscles are deeply located.

In addition, pudendal neuropathy exacerbates depression, anxiety, and makes people more susceptible to negative events.

Treatment of neuropathy

As in all other cases, the therapy of this disease should be comprehensive. The basic principles of treatment are as follows:

impact on the neuropathic nature of pain with gabapentin (Tebantin, Lyrica);

conducting regular nerve blocks with anesthetics and hormones;

physiotherapeutic effect: phonophoresis, Amplipulse - therapy, electrophoresis;

muscle relaxants of central action (Mydocalm). Allows you to relax the muscles, including reducing the tone of the piriformis muscle;

B vitamins, which are part of the blockade, as well as tablet forms.

Sometimes the treatment requires the support of a psychologist, corrective therapy is performed, antidepressants are prescribed. Sometimes the appointment of rectal or vaginal suppositories with diazepam is required, as well as the performance of special exercises. Their meaning lies in the gradual relaxation - compression of the muscles of the perineum.

You should find out what exercises to do with a pinched pudendal nerve

In the event that conservative treatment is ineffective, then decompressive surgical operations are performed, which are performed in centers for the treatment of chronic pelvic pain.

It should be remembered that the treatment of neuropathy of the pudendal nerve is a long process, and all the prescriptions of specialists must be followed for at least 6 months.

Neuropathy of the femoral nerve

Neuropathy of the femoral nerve- defeat n. femoralis of various etiologies, leading to a violation of the conduction of nerve impulses through it. Clinical manifestations depend on the topic of the lesion and can be pain and sensory disorders along the antero-medial surface of the thigh and lower leg, difficulty walking due to impaired extensor movements in the knee, etc. In the diagnosis of neuropathy n. femoralis rely on nerve ultrasound and EMG data. Therapeutic tactics include the elimination of nerve compression, metabolic, vascular, anti-inflammatory, analgesic and decongestant therapy, physiotherapy exercises and electromyostimulation.

Neuropathy of the femoral nerve

For the first time neuropathy of the femoral nerve was described under the name "anterior crural neuritis" in 1822. Today, it is one of the most common variants among mononeuropathy of the lower extremities. Despite the almost 200-year history of the study of femoral neuropathy and its sufficient prevalence, it remains in some ways a little-known disease. Lack of awareness of both general practitioners and some specialists in the field of neurology leads to the fact that neuropathy of the femoral nerve is often regarded as a vertebrogenic pathology (radicular syndrome, myelopathy, etc.) or as manifestations of polyneuropathy. This is facilitated by the wide variability of symptoms, from purely sensory disturbances to the predominance of motor dysfunction, depending on the topic of the lesion.

Anatomical features of the femoral nerve

The beginning of the femoral nerve (n. femoralis) takes from 3 lumbar spinal roots L2, L3 and L4, which, merging, form a single nerve trunk. The latter goes between the iliac and psoas major muscles, descends to the inguinal ligament, passing under which it enters the front surface of the thigh, where it is divided into skin (sensory) and muscle (motor) branches and the saphenous nerve. In the iliopsoas segment, the femoral nerve innervates the muscles between which it passes. Their function is flexion and supination of the hip, and with a fixed hip, flexion of the lumbar spine, which ensures that the torso is tilted forward.

Muscular branches that extend from the femoral nerve after it passes under the inguinal ligament innervate the muscles responsible for hip flexion and knee extension. Cutaneous branches provide sensory receptivity to the anterior and slightly inner thigh. The saphenous nerve is separated from n. femoralis in the region of the inguinal ligament, goes in front along the thigh, then takes a medial direction and enters the intermuscular canal of Gunther (adductor canal), at the exit from which it passes along the medial edge of the knee joint, where it gives off the infrapatellar branch that innervates the anterior surface of the patella. Further, the saphenous nerve passes along the medial edge of the lower leg and foot, reaching the base of the thumb. It provides sensitivity to the skin of the lower leg in front and on the medial surface, as well as the skin of the medial edge of the foot.

Causes of neuropathy of the femoral nerve

The pathology of the femoral nerve at the iliac-lumbar level is often caused by its compression as a result of muscle spasm or hemorrhages in the lumbar muscle that occur when it is overloaded or injured. Less commonly, neuropathy of the femoral nerve is caused by retroperitoneal hematomas or tumors (sarcomas, lymphomas). Hematomas can form with hemophilia, thrombocytopathy and thrombocytopenia; as a complication of anticoagulant therapy used for thromboembolism and thrombosis, especially in patients with abdominal aortic aneurysm. Cases of femoral neuropathy caused by nerve damage during appendectomy, operations on the ureters and kidneys, as well as bursitis and abscesses of the iliopsoas muscles are described.

The causes of compression of the femoral nerve in the region of the inguinal ligament can be: inguinal lymphogranulomatosis, femoral hernia, compression of the nerve by the inguinal ligament with a long forced position of the thigh (including during surgical interventions). Nerve damage is possible during operations on the hip joint, surgical treatment of inguinal hernia, etc.

The occurrence of femoral neuropathy at the level of Gunter's canal is observed with professional or sports overstrain of the adductor muscles of the thigh that form this canal. Less often, muscle tension is due to instability or abnormalities of the knee joint. Iatrogenic neuropathy may develop as a complication of knee surgery.

Isolated neuropathy of the subpatellar branch n. femoralis is often idiopathic but may be associated with thrombophlebitis, varicose veins, and repetitive minor knee injuries.

Symptoms of neuropathy of the femoral nerve

The clinical symptom complex of femoral neuropathy depends on the topic of the process. When a pathology occurs at the iliac-lumbar level, a full range of symptoms develops, including sensory, motor and autonomic-trophic disorders throughout the area innervated by the femoral nerve. In rare cases, with high division of the nerve, only sensory or only motor disturbances can be observed, sometimes a mosaic picture of motor and sensory disturbances.

Complete neuropathy of the femoral nerve is accompanied by only a partial disruption of the iliopsoas muscles, due to the existence of their alternative innervation. Therefore, flexion and supination of the thigh are practically not disturbed. More pronounced paresis of the quadriceps muscle, which is responsible for leg extension in the knee joint. Due to difficult extension, patients try not to bend the leg at the knee. Difficulty running and walking, especially when climbing stairs. The gait changes. The leg is fixed in the overextension position. There is no patellar reflex.

Sensory disorders include disorders of tactile and pain perception on the anterior-inner surface of the thigh and lower leg, the medial edge of the foot. Trophic and vegetative changes are observed in the same zone, irritative pains are possible. In the prone position, symptoms of tension are revealed - pain along the anterior surface of the thigh when trying to maximize the straight leg (Wassermann symptom) or bend the leg at the knee joint (Mickiewicz symptom).

Neuropathy of the femoral nerve with its defeat in the region of the inguinal ligament is in general similar to the clinic described above. With a high discharge of the saphenous nerve, predominantly motor disorders can be observed. Along with symptoms of tension, soreness with pressure in the middle of the inguinal ligament is revealed.

Compression of the femoral nerve trunk in Gunter's canal is characterized by pain and tactile hypesthesia of the skin of the medial edge of the knee joint, the anterior-inner surface of the lower leg and the inner edge of the foot. In the same area, paresthesias and pains are observed, which increase their intensity when the lower leg is extended. The latter forces the patient to walk and stand with the leg slightly bent at the knee. The knee jerk is not disturbed. Soreness is determined at the exit point of the saphenous nerve from the adductor canal, Tinel's symptom is the appearance of paresthesia along the nerve when it is tapped with a neurological hammer.

Neuropathy of the femoral nerve with an isolated lesion of the subpatellar branch is manifested by paresthesia and numbness of the skin over the patella, tenderness of the saphenous nerve point, and a positive Tinel's symptom.

Diagnosis of neuropathy of the femoral nerve

The diagnosis of femoral neuropathy requires the neurologist to carefully and carefully study the topic of the lesion. X-ray of the spine is not very informative, since neuropathy of the femoral nerve often occurs in patients who already have changes in the spinal column (spondyloarthrosis, osteochondrosis, etc.) and the pathology of the spine revealed by radiological does not exclude the presence of neuropathy. In such cases, the neural rather than segmental nature of the disorders identified during neurological examination testifies in favor of neuropathy. EMG contributes to the resolution of controversial diagnostic situations. With neuropathy, it reveals a slowdown in the conduction of impulses along the femoral nerve, a decrease in the amplitude of the M-response, signs of denervation in the muscles innervated by the femoral nerve, and the absence of such signs in the paravertebral muscles of the L2-L4 segments.

A relatively new, but promising method for studying peripheral nerve trunks is ultrasound, which can be used to assess the integrity of the nerve, identify its tumor changes, edema, cicatricial adhesive deformity, and degenerative processes. Ultrasound diagnosis of the femoral nerve (ultrasound of the nerve) with dynamic tests allows you to determine the degree of its mobility in the adductor canal.

The defeat of the femoral nerve needs to be differentiated from L2-L4 vertebrogenic radiculopathies, lumbosacral plexopathy (especially due to diabetes mellitus), knee injury or gonarthrosis. To exclude the pathology of the retroperitoneal space, it is necessary to conduct its ultrasound, CT or MRI.

Treatment of neuropathy of the femoral nerve

Treatment tactics are largely determined by the etiology of femoral neuropathy. With compression of the femoral nerve by a retroperitoneal hematoma, urgent surgery is performed. Surgical treatment is also required in cases of traumatic nerve injury with its almost complete interruption. Otherwise, conservative treatment is sufficient. It is based on decongestant therapy, relief of pain, improvement of blood supply and metabolism of the femoral nerve.

Decongestant and anti-inflammatory therapy with glucocorticoids is carried out in cases of compression of the femoral nerve in the intermuscular canals or under the inguinal ligament. In this case, solutions of glucocorticoids (hydrocortisone, diprospan) in combination with local anesthetics (lidocaine, novocaine) are injected directly into the compression area in the form of blockades. With the intense nature of pain, the use of NSAIDs and analgesics is combined with the appointment of antidepressants (amitriptyline) or anticonvulsants (topiramate, pregabalin, gabapentin). For the functional recovery of the femoral nerve, vasoactive (pentoxifylline, nicotinic acid) and metabolic (vitamins B6, B1 and their combinations) therapy is of great importance.

With paresis of the quadriceps and lumboiliac muscles, exercise therapy, electromyostimulation and drugs that improve neuromuscular transmission (ipidacrine, neostigmine) are necessary to prevent muscle atrophy and contractures.

Neuropathy of the pudendal nerve

The main symptom of neuropathy of the genital (PN) nerve is pain in one or more areas that are innervated by n. pudendus (genital or pudendal nerve) or its branches. These are the areas of the rectum, anus, urethra, perineum and genitals. One of the typical symptoms is increased pain when sitting (as a rule, the pain decreases when lying down) and progression during the day. Also, pain during defecation and sexual intercourse is typical for PN neuropathy. Mild sphincter disorders may be observed.

A few words about the anatomy of the PN. The genital nerve contains both afferent (sensory, sensory) and efferent (motor, motor) fibers, which causes sensory and motor disorders of the corresponding organs. Being the caudal part of the sacral plexus (S 2 (3) - S 4) PN (n. pudendus) exits through the foramen infrapiriforme (subpiriforme opening), from the pelvic cavity along with a. pudenda interna (internal genital artery). Then it goes around the back of the spina ischiadica (sciatic spine) or sacrospinous ligament and through the foramen ischiadicum minus (small ischial hole) enters the fossa ischiorectalis (ischiorectal fossa), where it lies on the surface of the fascia obturatoria (obturator fascia) and then passes through Alcock's canal (which is formed by the split fascia of the obturator internus muscle). Foramen ischiadicum majus (large ischial foramen) from n. pudendus departs branch - n. perforans ligamentum tuberososacrum, which perforates the corresponding ligament and goes down to the ischial tuberosity, lying under m. glutaeus maximus (gluteus maximus). Reaching the bottom edge m. glutaeus maximus, the perforating branch bends around the muscle and goes through the fascia to the skin of the gluteal region.

In fossa ischiorectalis, at the ischial tuberosity, the following branches depart from the pudendal nerve:

1. Lower rectal nerves, nn. haemorrhoidales inferiores (often depart from the pudendal nerve before it enters the foramen ischiadicum minus), short trunks, crumble into numerous branches, heading forward and medially to m. sphincter ani externus (external muscle of the anal sphincter) and to the skin around the anus (anus).

2. Nerve of the perineum, n. perinei, from the place of its origin it goes forward and medially and is divided into nn. scrotales (labiales) posteriores (nerves of the scrotum or labia) - to the skin of the perineum and scrotum (large lips in women), and rami muscularcs (muscular branches) - to m. transversus perinei superficialis, mm. bulbo-et ischiocavernosi. N. perinei anastomoses with n. haemorrhoidalis inferior and perineal branch n. cutaneus femoris posterior.

3. Dorsal nerve of the male penis (clitoris), n. dorsalis penis (clitoridis), goes from the ischial tuberosity forward and medially along with the corresponding artery, along the inner surface of the lower branches of the ischium and pubic bones, above the diaphragma urogenitale. Giving branches to m. transversus perinei profundus and m. sphincter urethrae membranaceae, n. dorsalis penis passes through the urogenital diaphragm and is located on the sides of the lig. suspensorium penis, goes to the back surface of the penis (clitoridis). Passing along with a. dorsalis penis (clitoridis) on the back of the penis, it gives off several branches to the skin of the penis and to the cavernous body and ends with several branches in the glans penis. In women, the terminal branches of n. dorsalis clitoridis extend into the thickness of labia majora et minora.

Thus, the PN provides innervation to the muscle that lifts the anus and the coccygeal muscle, the sphincter of the anus, the transverse muscle of the perineum, the bulbous-cavernous muscle, innervates the skin of the anterior part of the anus, the back of the scrotum or labia majora, the skin of the penis or clitoris, the urethra and urethral sphincter.

The causes of PN neuropathy are still debated, but the best known is compression of the pudendal nerve in the Alcock canal (which is formed by the split fascia of the obturator internus muscle). Also, compression of the PN can develop due to its compression between the sacrospinous and sacrotuberous ligaments. According to A. Shafik (1991), R. Robert (1991), compression of the pudendal nerve in men and women occurs in a ratio of 1:3. Other causes are: piriformis-syndrome, damage to the pudendal nerve during childbirth, trauma to the pelvis and malignant neoplasms. Therefore, for any chronic pelvic pain, an MRI of the pelvic organs is desirable. The role of the herpes virus is also actively discussed - indirect evidence is the effectiveness of acyclovir and valaciclovir in some cases of PN neuropathy.

There are so-called Nantes criteria for PN, which were developed by J.J. Labat, R. Robert, G. Amarenco (these criteria were discussed and ratified by a multidisciplinary working group in Nantes [France] on 23-24 September 2006 [Nantes criterion] and subsequently approved by the SIFUP PP). Five main criteria have been identified:

Typically, patients describe the pain of PN neuropathy as neuropathic, ie. burning, paresthesia. Most often, the pain is localized on one side. The feeling of a foreign body in the rectum is very characteristic.

It is hypothesized that pudendal nerve dysfunction may lead to overactive bladder symptoms of predominantly sensory origin, by increasing the number of C-fibers in the bladder, as well as by cross-sensitization in organs receiving the same innervation (from the pudendal nerve) due to sensory convergence. pathways in the pelvis.

Diagnosis of PN neuropathy is based on the above Nantes criteria, in addition, it is necessary to palpate trigger points m. piriformis and m. obturatorius for the diagnosis of myofascial syndromes. When conducting a neurological examination, the earliest and, most often, the only neurological symptom of a lesion of the pudendal nerve is a violation of sensitivity in the zone of its innervation. In the diagnosis of compression of the pudendal nerve in the Alcock canal, transvaginal ultrasound with an assessment of blood flow in a. pudenda and v. pudenda, because when the nerve is compressed, these vessels are also compressed and the blood flow velocity on the side of the lesion decreases.

Complaints of patients with PN neuropathy can be regarded as manifestations of diseases of the lower urinary tract, and without a detailed neurological examination, PN pathology may remain undiagnosed for a long time. A logical consequence is the rather rare detection of PN neuropathy.

Treatment of neuropathy of the pudendal nerve. Drug treatment usually includes pregabalin, starting at 75 mg twice daily, titrated up to 600 mg/day. To relax the muscles, vaginal suppositories with diazepam are used, injections of local anesthetics with glucocorticoids into the muscles concerned. In the case of a positive effect, botulinum toxin is injected under EMG control. For diagnosis and treatment, pudendal nerve blockade is used under X-ray or ultrasound control. Usually 5 ml of 0.5% bupivacaine is administered with 80 mg of triamcinolone - 3 injections. Surgical treatment is carried out only with proven compression of the pudendal nerve, resistant to drug therapy. Currently, transgluteal and transsciorectal approaches are used (indications for pudendal nerve decompression, its methodology requires further discussion and study).

Additional information about pudendal neuropathy, you can get on the "Prostatitis and Prostatitis Treatment Forum" (www.hron-prostatit.ru) - forum topic "Pudendal Neuralgia Symptoms" [or saved copy in PDF format].

Sexual neuropathy

Sexual neuropathy- a disease that is provoked by compression processes in the coccygeal plexus and pudendal nerve. Most often, such phenomena occur in patients with pronounced changes in the dystrophic direction in the muscles and ligaments of the pelvis, as well as the piriformis muscle.

Neuropathy of the pudendal nerve manifests itself most often in the form of aching pains in the buttocks, genitals and rectum. Also during this disease there is a strong violation of sexual function, difficult defecation and urination. There is an increase in pain in a sitting position, when lifting too much weight, straining. Also very often there are pains in the iliac region. During flexion of the hip joint, with strong pressure in the buttock area. In the event that the groin and genital area are very severely affected by neuropathy, the pelvic muscles are greatly weakened and as a result, frequent and involuntary urination and fecal incontinence occur. Neuropathy of the ilioinguinal nerve causes sensory disturbances in the genital area and anus.

Sexual neuropathy can be localized in various places that are close to the genitals. In any case, the main cause of the development of sexual neuropathy is the pinching of the pudendal nerve. There is neuropathy of the genitofemoral nerve. The genitofemoral nerve is formed by the anterior branch of the spinal nerve and is responsible for the innervation of the muscles of the scrotum and its upper part, the inner thigh and labia majora. A lesion in the region of this nerve can be provoked by hernias and injuries in the groin. Also in this case, sensory disorders are noted. In particular, there is a violation of the muscles in the groin area, severe pain is noted, especially when the body is in an upright position. In the same area, in addition to pain, severe sensitivity disorders can also be noted. There are disorders of motor activity, increased pain in the groin during palpation. Flexion of the hip joint also leads to increased pain.

Neuropathy of the ilioinguinal nerve is another type of genital neuropathy. This nerve is also formed by the anterior branches of the spinal nerve and is responsible for the innervation of the oblique muscles of the abdomen, the skin on the inner thigh and pubis, the proximal scrotum and the upper part of the labia. Often, damage to the pudendal nerve in this area is observed after injuries and operations, during the formation of muscle scars. With this course of the disease, motor and sensory disorders are observed. The presence of pain in the inguinal region and the inner surface of the thigh is noted. In one half of the pubis, the upper part of the scrotum, the labia, there is a partial or complete violation of sensitivity. On palpation in the region of the ilium, painful sensations are also observed.

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6 comments on “Sexual Neuropathy”

For the first time I hear about this pathology, although I have been working as a local therapist for many years. Indeed, more often patients with symptoms such as discomfort in the pelvic organs and rectum turn to a gynecologist, urologist, proctologist, but not to a neuropathologist. Thanks for the informative article

Yes, indeed, often patients fall into the wrong hands and no one needs examinations, but the reason is completely different.

Really interesting and informative article. It turns out that I myself have such symptoms with which I have been living for many years. Went to see a urologist, prescribed a bunch of medications and zero results. Now I will make an appointment with the right doctor.

Yes, it's quite a nasty disease. Sometimes, even an experienced doctor does not always understand that the cause of the disease is a nervous breakdown (not in the emotional sense, but in the sense of pathological and anatomical changes in the body).
It is good that there are articles that help patients to monitor themselves and understand the true cause of the disease.

This type of neuralgia is very difficult to identify, since the symptoms are very similar to other diseases.

Really interesting and informative article.

Symptoms: pain in the perineum, genitals, anus. Like all types of neuropathic pain, this pain is characterized by a burning, tingling, tingling sensation. The sensation of a foreign body in the rectum, vagina and/or urethra is quite common. In addition to these symptoms, there may be: urinary or fecal incontinence, sexual dysfunction. The pain is aggravated by sitting. In women, the symptoms of pudendal neuralgia include pain (burning, itching, tingling) in the clitoris, pubis, vulva, lower 1/3 of the vagina and labia. The skin in these areas may be hypersensitive to touch and pressure (hyperesthesia and allodynia).

Possible symptoms also include burning, numbness, increased sensitivity, sensation of an electric shock or a knife, aching pain, sensation of a lump or foreign body in the vagina or rectum, a feeling of twisting or constriction, abnormal temperature sensations, feeling of a "hot poker", constipation, pain, and difficult bowel movements, difficulty or burning when urinating, pain during intercourse, and sexual dysfunction - loss of sensation in the clitoris and/or anterior third of the vagina.

Diagnostic criteria for pudendal neuropathy:

Pain (burning, itching) in the region of the three branches of the pudendal nerve (clitoris, anus, vaginal vestibule)
Neuropathic nature of pain (burning, itching, tingling, goosebumps, hypersensitivity or loss of sensation)
Effect of pudendal nerve block (pain reduction for hours)
Reduced blood flow velocity in the pudendal artery, which is determined during ultrasound Doppler scanning. Since the pudendal artery passes along with the pudendal nerve in the Alcock canal, the processes that lead to compression of the pudendal nerve also lead to compression of the pudendal artery.

The pudendal nerve exits the spinal cord at the level of the 2nd, 3rd, and 4th sacral vertebrae (S2-S4), leaves the pelvic cavity through the greater sciatic foramen, and then returns to the pelvis through the piriformis foramen, under the piriformis muscle. The piriformis muscle can cause compression (compression) of the pudendal nerve in myofascial syndrome (piriformis syndrome).

In the pelvic cavity, the pudendal nerve passes through the Alcock canal, where it can also be compressed by the sacrospinal ligament.

That is why, the symptoms of neuropathy of the pudendal nerve appear in the anus, perineum and vulva.

Causes of neuropathy of the pudendal nerve:

Obstetric neuropathy - damage to the pudendal nerve during childbirth, sometimes the obturator nerve suffers along with it
Myofascial syndromes - hypertonicity of the piriformis muscle can cause compression of the pudendal nerve in the foramen infrapiriformis. In addition, compression of the pudendal nerve can be caused by spasm of the obturator internus or levator ani muscle.
Traumatic neuropathy - caused by chronic injury (cycling or horseback riding) or fracture of the pelvic bones.
Compression of the pudendal nerve in the Alcock canal

Diagnosis of neuropathy of the pudendal nerve:

The diagnosis is made on the basis of the so-called diagnostic criteria (Aix-en-Provence diagnostic criteria):

Localization of pain (one or more branches of the pudendal nerve - more often on one side)
The nature of the pain (burning, "goosebumps", tingling, sensation of "electric shock")
Increased pain in sitting position
Reducing pain in the supine position
Unilateral character of pain
The positive effect of cold
An anesthetic injection into the pudendal nerve reduces pain for 12 hours or more
An ultrasound examination of the Alcock canal with the determination of the blood flow velocity in the pudendal artery makes it possible to suspect compression of the pudendal nerve with a decrease in the blood flow velocity in the artery - since they pass together in this canal.

Treatment must be comprehensive:

Drugs affecting neuropathic and chronic pain (Lyrica, Tebantine)
Physiotherapy
Pudendal nerve blocks with anesthetics and glucocorticoids
Surgery - pudendal nerve decompression
neuromodulation

Remember that the duration of treatment is at least 6 months.

In the field of diagnosis and treatment of pudendal neuralgia, we work closely with Prof. Eric Botrand, one of the world's leading specialists in the treatment of chronic pelvic pain, who regularly consults in our clinic. The next visit of Prof. Botran will take place in December 2014.

In our clinic we use all modern methods of treatment.

We are the only clinic in Russia where pudendal nerve decompression surgeries are performed.

Patients from other cities believe that the treatment in our clinic is long and therefore it is difficult for them to come to us! Sometimes this is true, but in most cases, one day is enough for diagnosis. The next day, botulinum toxin injection, pudendal nerve cryoneurolysis, pudendal nerve decompression, TVT surgery are performed - in general, the most effective manipulations for the treatment of chronic pelvic pain syndrome and urinary disorders. Patients can continue treatment at home - under our close supervision via Skype, e-mail, etc. We provide all the necessary drugs and (if necessary) devices for home physiotherapy.

Infringement of the pudendal or femoral-genital nerve

There are many nerve pathways in the human body, each of which innervates a specific area. Among them, one can single out the pudendal nerve, which in medicine is called the genital. It is responsible for the innervation of the pelvic floor muscles, and when this bundle is pinched, people experience chronic pain in the pelvic area. This phenomenon usually occurs due to compression neuropathy. It is a compression (nerve pinching). In men, this problem occurs 2-3 times more often than in women due to anatomical features.

Features of the anatomy of the pudendal nerve

The pudendal nerve path begins much higher than the innervated zones, so doctors often call it the femoral pudendal nerve. It passes through the muscles of the lower back and over the ureter, and then stretches to the inguinal zone. At this point it is divided into 2 branches:

The femoral-genital nerve, passing into the inguinal branch, has 2 options for continuing, depending on the gender of the person:

Male. It exits through the canal along with the spermatic cord and follows into the scrotum;
Female. In the case of the weaker sex, the pudendal nerve exits the canal along with the round ligament of the uterus and smoothly passes into the skin of the labia majora.

The inguinal nerve in women and men innervates the following tissues:

Muscle tissue of the anus;
The outer skin of the anus and genitals;
anal sphincter;
Musculature of the perineum;
female clitoris;
Male cavernous bodies of the penis;
Bladder sphincter.

The pudendal nerve pathway is responsible not only for the sensations experienced during intercourse, but also directly for defecation and urination.

It performs the last two functions thanks to the vegetative fibers in its composition. It is the autonomous (vegetative) part of the nervous system that is responsible for many systems that are not controlled by the human mind, for example, constriction of the pupils, heart rhythm, etc.

Damage to this nerve is caused by pinching of the piriformis muscle, ligaments, etc. Sometimes the cause of such compression lies in the resulting injury, as a result of which the pelvic bones were crushed or ligaments were torn. Usually this type of neuralgia is accompanied by a feeling of tension and inflammation.

Causes of inflammation

Traction-compression neuropathy of the left or right nerve pathway occurs in Alcock's canal. Therefore, a pinched pudendal nerve that occurred in this area is called Alcock's syndrome. Among other varieties of neuropathy characteristic of this nerve pathway, one can distinguish the femoral-genital form. It manifests itself mainly due to trauma to the groin or the development of an inguinal hernia. Neuropathy of the ilioinguinal nerve also belongs to this group. It occurs due to the appearance of scars on the muscle tissue, which are the result of surgical intervention.

Infringement of the pudendal nerve occurs mainly due to the following factors:

Injury received during childbirth;
Spasm of the muscle tissue of the anus;
pelvic fracture;
The development of oncological diseases of a malignant nature;
High tone of the piriformis muscle;
Complications of herpes;
Spasm of the obturator internus muscle;
Squeezing of the shameful path due to riding a horse or bicycle.

Symptoms

Compressive neuropathy of the pudendal nerve has many symptoms, but their severity is rather weak. For this reason, diagnosing pathology is extremely difficult. Among the main manifestations of the disease are the following:

In the female, severe itching and burning in the genital area can be added to the main symptoms of neuropathy. In a sitting position, these symptoms are greatly enhanced.

In more rare cases, the following symptoms are observed:

Violation of the stool (constipation);
Numbness of the genitals;
Pain during intercourse and urination.

Diagnostics

The doctor identifies the presence of a problem, focusing on the symptoms that appear and the results of an ultrasound scan. With neuropathy, it will indicate impaired blood flow in the pudendal artery, which goes through the Alcock canal. From this we can conclude that with it there was a compression of the pudendal nerve pathway.

An effective diagnostic method is the blockade of the pudendal nerve pathway. If the discomfort disappears, then all the blame lies with neuropathy. Usually, in such a situation, a course of therapy is prescribed, which includes glucocorticoid injections, vaginal suppositories, and other methods of restoring strangulated nerve fibers.

Course of therapy

Treatment of neuropathy should consist of a set of measures aimed at eliminating inflammation, relieving pain and restoring nerve conduction. It usually includes the following therapies:

Elimination of pain with the help of anticonvulsants (Gebapentin);
The use of physiotherapy procedures (phonophoresis, electrophoresis, etc.);
Blocking the nerve pathway with a solution of hormones and anesthetics;
The use of muscle relaxants (Mydocalm);
The use of vitamin complexes (Neuromultivit).

Vitamins Neuromultivit and their analogues can be taken both as a component of the solution for the blockade, and in the form of tablets. If the discomfort is severe, then suppositories for rectal or vaginal use based on Diazepam and special sets of exercises are used. The essence of physical therapy for neuropathy of the pudendal nerve is to compress and relax the muscles of the perineum.

If there is no point in continuing to treat medically damaged nerve tissue due to the lack of results, then surgery will be required to decompress the compressed nerve. Such operations are extremely effective, but have a long recovery period.

With a long absence of treatment, the development of the consequences of pathology is possible. The disease can become chronic and some symptoms will be extremely difficult to eliminate. There were cases of impotence and a decrease in libido, as well as involuntary urination and defecation.

Neuropathy of the pudendal nerve is an unpleasant phenomenon, but some people live with it for years. This is usually associated with vague symptoms and a chronic type of course. You can avoid such discomfort, but for this you will have to undergo an examination and follow all the recommendations of the doctor.

Pinching and neuropathy of the pudendal nerve in women and men

Does the pudendal (genital) nerve and its damage differ from a similar pathology in other “regions” of the body?

Yes, the nature of the pathology is already different in that the pudendal nerve serves the pudendal region - the zone of the genitals, the structure of which is different for men and women. The words of one very focused boy from the movie "Kindergarten Cop" immediately come to mind, with which he stopped everyone who entered the kindergarten door: boys have a penis, girls have a vagina.

In men, the concept of external genital organs includes much more structures both in number, volume, and area occupied, therefore the pudendal nerve has a more complex and branched structure, while in women, due to the greater “compactness” of the external genitalia, its length is much less.

The pudendal nerve is a paired structure, formed on both sides of the body also by paired branches of the sacral spinal (spinal) nerves, which provides innervation to the organs present in both sexes: the perineum, sphincters of the bladder and rectum, as well as the levator ani muscle, but then they begin differences in structure: in women, it provides sensitivity and vegetation of the labia majora and labia minora and clitoris, in men, the same functions in relation to the cavernous bodies of the penis and scrotum.

In the photo, the same painful area in women is highlighted in yellow.

About the causes and symptoms of functional disorders

For the etiology of damage, the proximity to the ischium, which the nerve goes around, entering the pelvic cavity, as well as the relatively shallow depth of the terminal branches under the surface of the skin and mucous membranes of the pelvic organs, is important. Therefore, dysfunction can occur as a result of:

perineal injury;

Injury to the perineum can lead to more serious consequences.

Provoking factors can be:

riding a horse or cycling (rather frequent or professional);
protracted childbirth;
fracture of the pelvic bones (when falling from a height, in a car or plane crash).

To understand that something is wrong with the femoral-genital nerve, disorders of the functions of the organs located in the pelvis allow. These may be sensory disturbances or vegetative disorders.

Deviations in the vegetative system are expressed by violations of the functioning of the glands and other structures containing smooth muscle fibers, in particular, disorders of the mechanism of blood filling of the cavernous bodies of the penis or clitoris.

Trophic disorders of the skin of the perineum, scrotum and perianal zone can also be a sign of disorders.

In addition to physical factors of influence, general somatic diseases can also be the cause of the pathology:

tuberculosis;
collagenoses;
circulatory disorders due to endocrine disorders and vascular accidents or for another reason.

Infringement of rights, or about neuralgia

It has long been observed that the disenfranchised either yell loudly about this fact or grumble about it in an undertone until no one hears.

Provoking factors

The situation is exactly the same if the pudendal nerve is pinched in the enclosing canal. A channel with a narrowed diameter for some reason (due to bone growths, bone fractures, or for another reason) puts pressure on the nerve, which leads to predominantly pain sensations of varying intensity.

Nerve compression can be caused by its "swelling", accompanied by an increase in diameter, which causes it to mismatch the diameter of the enclosing canal.

But the structure of the affected pudendal nerve does not change with neuralgia. Movement disorders do not occur in the same way as loss of sensitivity.

Therefore, neuralgia is exclusively pain of a different nature and intensity.

And the infringement of the pudendal nerve can occur in the inguinal canal:

with varicose veins of the spermatic cord in men;
due to the pathology of the round ligament of the uterus in women;
due to inguinal hernia or the occurrence of cicatricial changes after hernia repair.

Pelvic neuralgia, which often accompanies infringement of the pudendal nerve, can also occur due to:

trauma during childbirth;
muscle spasm in the anus, hypertonicity of the piriformis muscle or obturator internus muscle;
development of oncopathology in the pelvic organs;
complications of herpes.

Features of symptoms

The symptomatology of this form of neuralgia is chronic pain in the pelvic region, which has the character:

aching;
burning sensation and itching, especially strong in women and especially in a sitting position;
excessively high sensitivity of the skin of the groin and perineum;
sensations of constant discomfort in the area of \u200b\u200bthe natural openings of the body;
false-obtrusive sensation of a foreign body in the genital area.

Against the background of chronic stress from long-term sensations, the following may appear:

urination disorders (involuntary act) or pain when urinating;
dysfunction of the genital organs (pain during intercourse);
stool disorders (constipation).

Diagnostic criteria and treatment

For diagnosis, symptoms are important - the sensations of the patient, as well as the absence of external manifestations of pathology.

To identify the disease helps the use of:

In the first case, a violation of blood flow through the genital artery is detected, in the second case, the disappearance of discomfort after manipulation.

In treatment, the main goals are: pain relief, elimination of inflammation and restoration of nerve conduction.

Therefore, it is advisable to use:

anticonvulsants (Gabapentin), providing pain relief;
muscle relaxants (Mydocalm) used to relax muscles;
blockade of the pudendal nerve with a combination of solutions of anesthetics and hormones;
vitamin complexes (Neuromultivit class);
physiotherapeutic techniques (electro-, phonophoresis and the like).

To reduce the symptoms of discomfort, vaginal or rectal suppositories with Diazepam and exercise therapy techniques are used (for massaging the muscles of the perineum).

With the ineffectiveness of therapeutic methods, surgical decompression is used, which relieves infringement and symptoms.

Surgical decompression is sometimes the only way out

If there is no limit to indignation, or about neuropathy

In addition to neuralgia, the genital nerve can also become the scene of an inflammatory process, then they talk about neuropathy (neuropathy), or pudendal neuritis (a term rarely used today).

Neuropathy differs from neuralgia by the presence of structural changes in the pudendal nerve, as well as motor disorders and the possibility of loss of sensitivity, which is a reason for the indignation and grief of the patient, because we are talking about neither more nor less about the genitals.

What could be the reason?

The cause of the pathology (also called pudendoneuropathy) is the implementation of two mechanisms:

compression-squeezing of the nerve trunk in the "scissors" sacrospinous ligament-piriformis muscle;
traction due to overextension of the nerve in the area of its transfer over the sciatic spine.

An illustration of the first is the consequences of prolonged or unsuccessful equestrian or cycling (compression with a hard saddle), and the second is the consequences of surgical intervention, so when the thigh is traction using a perineal fixator, the nerve is pressed against the pubic region.

Features of symptoms

The clinic may consist of lesions of the main nerve trunk or signs of involvement of various branches of the pudendal nerve.

When using a surgical fixator in the perineal area, isolated damage to the dorsal nerve of the penis occurs with anesthesia of the penis and a complete breakdown of previously normal erection.

Full recovery of sensitivity can occur within 6 to 18 months after surgery, while restoration of erection can be only partial.

When compressed with a hard saddle, the disorders are felt as transient numbness or the appearance of paresthesia in the genital area.

Both unilateral and bilateral sensitivity loss can be observed, not outlined by the penis zone, but continuing to manifest itself in the scrotum as well.

Neuropathy of the pudendal nerve can signal itself with pain in the bottom of the buttocks and in the anus area, a short-term urinary retention or a disorder of the imperatives to it, accompanied by a sharp pain when probing in the projection of the ischium.

In men, the inflamed pudendal nerve designates itself with characteristic symptoms - paresthesia or hypesthesia and pain in the perianal region, in the area of \u200b\u200bthe penis and scrotum.

Diagnosis and treatment methods

The main diagnostic criterion is that pulling the knee to the opposite shoulder causes pain in the buttock (due to sprain of the sacrospinous ligament).

A simple diagnostic method is to pull the knee to the shoulder

The clinic is confirmed by electromyography, stating an elongation of the anal reflex, which closes on the pudendal nerve trunk, as well as a test blockade with the introduction of a novocaine solution into the ischial spine.

The choice of treatment method depends on whether the process is running or is in an acute stage.

So, all the symptoms disappeared in a group of cyclists on their own, after they agreed to refrain from cycling for a month. In the chronic course of neuropathy, long-term restorative therapy is necessary.

In a chronic course, methods of drug exposure are applicable in combination with rational exercise therapy and physiotherapy.

Drug therapy includes the use of anti-inflammatory drugs (glucocorticoids Prednisolone, Triamcinolone, Hydrocortisone) in combination with anesthetics (Novocaine 0.5 or 1%) in the form of blockades. A case of the passage of pain, noted for 14 years, after a course of perineural administration of Triamcinolone is described.

Blockade is an effective method, the point of injection is indicated with a finger

Pure novocaine blockades are usually less effective.

In order to relieve pain, suppositories of a combined formulation with anesthetics, sedative and antispastic compounds, both rectal and vaginal, are applicable.

Vitamin therapy (the introduction of vitamin C and group B in adequate doses) is especially effective in combination with physiotherapy (various methods of heat treatment), exercise therapy also allows you to increase the possibilities of muscles spasmed with pain and helps to raise the overall tone of the body.

Surgical intervention is applicable in the absence of the effect of treatment with therapeutic methods.

You should be extremely careful in the case of neuropathy of oncogenic etiology.

Preventive measures

When riding a bicycle or a horse professionally, you should take precautions and follow a regimen with mandatory work breaks.

The implementation of traction in case of a hip fracture requires the use of a perineal fixator with an adequate support area (up to 9 cm) with a mandatory softening pad.

Intramuscular administration of a solution of magnesium sulfate in large doses requires caution to prevent the occurrence of ischemic necrosis of the gluteal muscles.

With the appearance, and even more so - an increase in pain in the pelvis, perineum and genitals, you should immediately seek help from a neurologist.

Incontinence due to damage to the pudendal nerve

The pudendal nerve is responsible for sensation in the vulva, lower rectum, and perineum. The perineum is the space between the genitals and the anus. Neuropathy occurs due to disease or damage to the nerves, and pudendal neuropathy can cause symptoms in these areas.

Pudendal nerve entrapment is often misdiagnosed as a disease of the prostate, such as prostatodynia or non-bacterial prostatitis. Unknown causes of vaginal pain, ovarian pain, rectal pain, penile pain, coccyx pain, and buttock pain may result from pudendal nerve neuropathy. About 2/3 of patients with pudendal nerve entrapment are women.

Pudendal nerve entrapment may occur suddenly or develop over time. Long sitting, cycling. repetitive movements and leg exercises can lead to pudendal nerve entrapment.

Some people have mostly rectal pain sometimes with bowel problems. In others, pain in the perineum or genitals predominates. Symptoms may include stabbing, cramping, or burning pain, tingling, numbness, or tenderness. Usually the symptoms are worse when sitting and better when standing or lying down. There may be a feeling that a person is sitting on a tubercle.

Pudendal nerve injury is identical to Carpal Tunnel syndrome, which is also a form of nerve entrapment. However, damage to the pudendal nerve is much more difficult to treat due to its localization.

Pudendal nerve entrapment is a condition that causes pain for no apparent reason in the area innervated by the pudendal nerve. There is no dominant pain pattern. The pain can be localized in one area, several, in all. It can be one-sided, two-sided or in the middle. Often there are also problems in the urinary, rectal and reproductive systems.

Pudendal neuropathy is often caused by inflammatory damage or chronic mechanical compression of the pudendal nerve.

Pudendal nerve injury can occur suddenly as a result of trauma, such as pelvic surgery, falls, bicycle accidents, or childbirth, and sometimes severe constipation. It can also come from sustained injury over a long period of time, such as cycling, or aggressive lifting of heavy weights that tense the pelvic muscles. It can also be caused by diseases such as diabetes or multiple sclerosis. Trauma may cause direct stretching or compression of the nerve, or fibrosis may impinge on the nerve.

Treatment for neuropathy of the pudendal nerve should be comprehensive.

The course of therapy is prescribed individually by the attending physician and includes:

taking special medications that affect neuropathic and chronic pain;
physiotherapy procedures (neuromodulation, acupuncture);
blockade of the pudendal nerve - droppers using anesthetics and glucocorticoids;
massage;
physiotherapy exercises

Massage, drips and blockades are the most effective ways to get rid of pain. They significantly improve the results of treatment. Physiotherapy procedures will allow to restore the disturbed function of the nerve. Also, for this purpose, the specialist can prescribe appropriate exercises to strengthen the muscles of the pelvic floor. The duration of treatment is at least 6 months.

How to treat pudendal nerve?

The pudendal nerve, which is called the genital, is the cause of chronic pain in the pelvic region. The disease appears due to a pinched nerve. Despite the fact that this problem is common in men and women, neuropathy is diagnosed extremely rarely. If the pudendal nerve is pinched, only a specialist will prescribe treatment.

Causes of the disease

The main factor in the occurrence of this disease is the pinching of the pudendal nerve, which occurs in the Alcock canal. Pudendal neuropathy occurs in the following cases:

All of these causes cause pain in the pelvic area.

Symptoms of pathology

Pudendal neuropathy is characterized by many features. Patients complain about the following:

Pain of a aching nature that occurs in the anus or genitals.

When a disease occurs, women feel itching and pain in the region of the labia, clitoris and vagina.

Diagnosis and treatment of pathology

When patients turn to a specialist with signs of infringement of the pudendal nerve, the diagnosis is established according to the characteristic features. Patients undergo ultrasound Doppler scanning. As a result, the slowing of the blood flow velocity in the genital artery is determined.

"Gabapentin". The drug helps to reduce pain.

If you experience discomfort caused by a pinched pudendal nerve, you must urgently seek help from a specialist.

What to do when the pudendal nerve is pinched or inflamed? Symptoms and treatment of the disease

The pudendal nerve, which is also called the genital nerve, is quite often the cause of chronic pelvic pain that occurs in adults. The reason for this in most cases is a pinched nerve, which is called compressive neuropathy. The pudendal nerve is pinched more often in women. In men, this happens three times less often.

Anatomical features

The pudendal nerve is short in length. But this is a very important nerve of the last sacral plexus (if you move from the brain). It is located in the pelvic cavity and bypasses the ischium along the way. It then divides into three branches:

Rectal.
Perineal.
Dorsal nerve of the clitoris or penis.

What functions does it perform?

Innervates the muscle that raises the anus and sphincter.
Innervates the sphincter of the canal for urination.
Innervates the female clitoris and the cavernous bodies in men.
Makes the skin of the anus and external genital organs sensitive.

From the above list, it can be seen that the pudendal nerve plays a very important role both in the intimate life of a person, and in defecation and urination. The composition of this nerve includes a large number of autonomic fibers that ensure the correct functioning of the sphincters without the use of conscious tension. After all, people never think, do not try to control and do not contract their muscles consciously, so as not to urinate or defecate completely by accident at the wrong time. These functions are assigned to the vegetative fibers that enter the pudendal nerve.

Pinching: causes

Trouble can occur due to the piriformis muscle located in the pelvic cavity or due to clamping between a pair of ligaments.

In addition, the pudendal nerve can be damaged after unforeseen situations, which include a car accident, a fall from a height. In such situations, fracture of the pelvic bones can occur. Very often, the cause of chronic pain is nerve damage during childbirth or its involvement in the growth of a malignant tumor.

It is worth mentioning that some human activities over time can also lead to pinching of the pudendal nerve. This includes cycling or horseback riding.

The pudendal nerve: symptoms of neuropathy

As with any other pinching, the symptoms are pain, sensory disturbances, muscle weakness and disorders of the autonomic system.

When the pudendal nerve is pinched, the symptoms in women and men are similar:

There are painful sensations in the perineum.
The pain has a burning tinge.
There are unpleasant sensations in the genitals and anus.
Urinary and fecal incontinence, which may be incomplete, that is, manifest itself in the form of drip incontinence or fecal smearing.
Skin sensitivity decreases in these areas, a feeling of "goosebumps" appears.
An unpleasant presence of something foreign can be observed in the anus and urethra.
Sexual disorders such as lack of orgasm and impotence may be observed.

When the pudendal nerve is pinched, symptoms in women, whose treatment should not be delayed, are observed in the lower part of the vagina. This causes great discomfort.

Severe pain may be felt during intercourse and walking - such, if the pudendal nerve is pinched, symptoms in men. Treatment is required immediately, as the pain becomes burning, and touching the skin acquires excruciatingly unpleasant consequences. Feelings can be described as the presence of a cold or hot foreign object or electric shocks. In general, a pinched pudendal nerve entails a large number of unpleasant symptoms.

Jamming diagnostics

With the above painful and unpleasant sensations, a person is simply not able to endure for a long time, because this is not such pain as in a leg or arm. Most often, those suffering from neuropathy turn to either a neurologist or a proctologist if there are disorders associated with the anal sphincter, or problems with fecal and urinary incontinence.

In rare cases, patients may go to a sex therapist. But a good specialist, with the help of the simplest questions, should be able to identify organic disorders, and then refer the patient to the appropriate doctor. Pinched pudendal nerve is diagnosed with the following studies and complaints:

All those complaints that were listed earlier.
Patients may note that when something cold is applied to the perineum, temporary relief occurs and the burning pain begins to pass. This symptom suggests that nerve damage is neuropathic in nature.
When using a trial therapeutic and diagnostic blockade of the nerve with the help of novocaine, the severity of the symptoms decreases or completely eliminates all the suffering for the duration of the painkiller, which lasts from 12 hours to 3 days.
The nature of the pain indicates that a pinching has occurred (unpleasant sensations when touched and all kinds of itching, burning and a feeling of "goosebumps").
When conducting ultrasound and Dopplerography of the small pelvis and perineum, in almost all cases, when the pudendal nerve is pinched, a slowdown in the rate of blood flow in the nearby pudendal artery is observed. Since it passes through the same channel as the nerve, the narrowing of the artery indicates that it has also undergone compression.
A very important criterion in the diagnosis is the increase in pain in a person in a sitting position and a decrease when the patient lies on his back. For pinching of the pudendal nerve is also characterized by a lesion on one side only. It is on her that frustration is felt.

In addition to such diagnostic criteria, when probing the perineum, one can find characteristic areas that are pain points that reflect spasm in the muscles.

It is important that the pathology of the pudendal nerve is closely associated with the development of myofascial syndrome, which can be treated much worse due to the deep location of the muscles.

In addition, a pinched pudendal nerve greatly increases depression and anxiety, and people become more susceptible to negative events.

Treatment of pudendal neuropathy

As in other situations, the treatment of this disease should be comprehensive.

What are the basic principles of neuropathy treatment?

The impact on the characteristic of pinching the nature of pain with the help of gabapentin, which is part of the drugs.
Regular nerve blocks with hormones and anesthetics.
The use of centrally acting muscle relaxants, which allow the muscles to relax, as a result of which the tone of the piriformis muscle decreases.
The use of physiotherapeutic effects, which include electrophoresis, phonophoresis.
Taking vitamins of group B, which are part of the blockade, as well as in the form of tablets.

Other procedures

Often, the treatment of a pinched pudendal nerve requires the support of a good psychologist who performs corrective therapy and prescribes antidepressants. You may need to prescribe vaginal or rectal suppositories, which include diazepam. The patient may be assigned to perform special physical exercises, the meaning of which is to slowly compress and relax the muscles in the perineum.

In those situations where conservative methods of treatment do not have a positive effect, surgical operations of the decompressive type are performed. They are performed in specialized centers for the treatment of chronic pelvic pain.

Long term treatment

It must be remembered that the treatment of pudendal neuropathy is a very long process, during which all the recommendations of the attending physician should be followed. The recovery period takes at least six months.

Treatment of the disease should be carried out only in a hospital, as this will allow doctors to take control of the recovery process, as well as successfully select a set of those means that will be used for proper treatment. Indeed, a person may be allergic to some funds, which will only worsen the situation.

Results

Thus, it was considered what the pudendal nerve is, the symptoms and treatment for its pinching, diagnosis. In order to avoid this disease, it is recommended to be careful not to get injured, as well as to lead an active lifestyle, exercise and have an active sex life. Well, if the trouble still happened, then you must strictly follow the recommendations of doctors.

Neuropathy of the pudendal nerve

In fossa ischiorectalis, at the ischial tuberosity, the following branches depart from the pudendal nerve:

1. pain in the area innervated by the pudendal nerve;

2. predominant pain in the "sitting" position;

3. the pain does not cause sleep disturbance (i.e. does not cause the patient to wake up at night);

4. pain does not cause serious sensory disturbances;

5. blockade of the pudendal nerve relieves pain.

Pinched pudendal nerve in men and women

A bit of anatomy

they innervate the muscle that raises the anus;

innervates the anal sphincter;

sphincter

gives branches to the muscles of the perineum;

innervates the genital organs: the cavernous bodies of the penis in men, the clitoris in women;

gives sensitivity to the skin of the external genitalia and anus;

innervates the sphincter of the urethra.

The pudendal nerve in the male body (in yellow)

This nerve can be pinched by the piriformis muscle, which is located in the pelvic cavity, or be sandwiched between two ligaments.

In addition, activities such as riding a horse or cycling can also lead to pudendal compression neuropathy over time.

Symptoms of neuropathy of the pudendal nerve

pain in the perineum;

discomfort in the anus and genitals;

burning shade of pain;

decrease in skin sensitivity in these areas, "crawling";

an unpleasant feeling of foreign body sensation in the urethra and anus;

incontinence of feces and urine. It may be incomplete, and manifest as fecal smearing or drip incontinence;

sexual disorders: impotence, anorgasmia.

Pinched pudendal nerve in women causes the above symptoms also in the lower third of the vagina.

Pinched pudendal nerve in men, in addition to the above, can cause pain during intercourse.

About diagnosing neuropathy

complaints of the patient, which were described in detail above;

the nature of the pain, which indicates neuropathic changes (burning, crawling, all kinds of itching, unpleasantness when touched);

trial therapeutic and diagnostic novocaine blockade of this nerve significantly reduces the severity of symptoms, or completely relieves the patient of suffering for the duration of novocaine - from 12 hours to 3 days;

when performing ultrasound of the perineum and small pelvis with Dopplerography, almost always with compression-ischemic neuropathy of the pudendal nerve, a decrease in the volumetric blood flow velocity in the nearby pudendal artery is noted. This happens “for company”: the pudendal artery passes along with the nerve in the same canals, and its narrowing indirectly confirms the compression of the pudendal nerve;

an important diagnostic criterion is the increase in pain if the person is sitting and the decrease in pain if the person lies on their back. Also, pudendal neuropathy is characterized by a unilateral lesion. On the same side, disorders arise;

Patients often find that applying cold to the perineum relieves the burning pains. This symptom indicates the neuropathic nature of nerve damage.

In addition to these diagnostic criteria, palpation of the perineum can reveal characteristic pain points that reflect a spasm in the piriformis muscle.

In addition, pudendal neuropathy exacerbates depression, anxiety, and makes people more susceptible to negative events.

Treatment of neuropathy

As in all other cases, the therapy of this disease should be comprehensive. The basic principles of treatment are as follows:

impact on the neuropathic nature of pain with gabapentin (Tebantin, Lyrica);

conducting regular nerve blocks with anesthetics and hormones;

physiotherapeutic effect: phonophoresis, Amplipulse - therapy, electrophoresis;

muscle relaxants of central action (Mydocalm). Allows you to relax the muscles, including reducing the tone of the piriformis muscle;

B vitamins, which are part of the blockade, as well as tablet forms.

You should find out what exercises to do with a pinched pudendal nerve

In the event that conservative treatment is ineffective, then decompressive surgical operations are performed, which are performed in centers for the treatment of chronic pelvic pain.

It should be remembered that the treatment of neuropathy of the pudendal nerve is a long process, and all the prescriptions of specialists must be followed for at least 6 months.

I understand that the site is "psychological", but psychology and psychosomatics are not interested.

What exactly is this pathology?

There can be many options

Psychologist, Business Trainer Coach RPT Therapist

Neuropathy of the pudendal nerve, who faced?

Who made the diagnosis?

And yes, it will be easier.

How long has this been going on?

Go to a neurologist.

I dealt with neuropathy of different nerves.

And yes, it will be easier.

What objective methods verified dz?

How long has this been going on?

Is the onset gradual or rapid?

What happened the day before (a week, a month, 1/2 year)?: physical and / or psychological trauma?

Psychologist, Group leader

It took a long time for a diagnosis to be made.

Psychologist, Group leader

The day before there was NOTHING, it came from nowhere. started about 3 months ago, gradually on the rise. It took a long time for a diagnosis to be made.

In the same place, viral diseases, and drug treatment and other things can disrupt chemical processes - injure nerve endings. Didn't hurt anything? Not treated?

Oh! Sorry. It's really very hard. I remember neuropathy of the sciatic nerve after childbirth for the rest of my life. Horror. Due to breastfeeding (and heroic stubbornness) she was not treated with anything. Now I’m thinking in vain, but my doctors were somehow passive in this regard - they didn’t offer anything but painkillers and peace. Within three months, everything was completely gone. But sometimes, at a certain position of the body (if I sit in a certain position for a long time, for example), I feel pain.

But I had traumatic neuropathy. Have you established a physiological cause?

Neuropathy - damage to the pudendal nerve

Neuropathy of the pudendal nerve is a disease that is a consequence of the development of compression processes affecting the coccygeal plexus and the nerve itself. As a rule, such a violation occurs against the background of degenerative changes in the ligaments and muscles of the pelvis. Pathology develops in both men and women of different ages. Despite the prevalence of this problem, diagnosing neuropathy is extremely rare. This is due to the fact that only a small percentage of patients pay attention to the symptoms of the disease and seek medical help.

Sexual neuropathy can affect different nerve fibers surrounding the genital organs (femoral-genital, ilioinguinal nerve).

Reasons for the development of the disease

The main etiological factor provoking sexual neuropathy is the pinching of the pudendal nerve, which occurs in the Alcock canal. In connection with the affected area, the disease is also called Alcock's canal syndrome.

This type of pathology, like femoral-genital neuropathy, progresses due to injury to the inguinal zone or the formation of a hernia. The defeat of the ilioinguinal nerve is the result of the formation of muscle scars that appear after surgery or injury.

Neuropathy of the pudendal nerve also develops for the following reasons:

labor activity (obstetric neuropathy);
hypertonicity of the piriformis muscle;
spasm of the muscles of the anus;
tension of the internal obturator muscle;
fracture of the pelvic bones;
malignant tumors in the pelvic cavity;
herpes virus;
nerve damage caused by horseback riding or cycling.

Main symptoms

Neuropathy of the pudendal nerve is manifested by multiple, but mild symptoms. It is in connection with the blurring of symptoms that this disease is difficult to diagnose. Patients complain about the following phenomena:

aching pain in the perineum, anus and genitals;
burning and tingling in the groin;
discomfort in the anus;
sensation of the presence of a foreign body in the rectum, urethra, or vagina (in women);
violations of the functions of the genital organs;
urinary incontinence;
hypersensitivity of the skin in the pubic area.

In women, the development of pathology is accompanied by itching and burning in the clitoris, labia, and vagina. Unpleasant sensations become more intense in the sitting position.

Often, patients are concerned about the feeling of numbness of the genital organs, problems with defecation (constipation), discomfort during urination, pain during sexual contact.

Diagnosis and treatment

When patients complain of symptoms of neuropathy of the pudendal nerve, the specialist makes a diagnosis on the basis of an anamnesis, which contains signs characteristic of the disease (pain, burning sensation, impaired sensitivity). Also, patients are prescribed the passage of an ultrasound Doppler scan, during which a slowdown in the velocity of blood flow in the genital artery can be detected, indicating a probable pinching of this vessel. And since this artery passes along with the pudendal nerve through the Alcock canal, it can be concluded that compression processes are the cause of the violation. The method of diagnosing the disease is the blockade of the pudendal nerve. If after its implementation the pain syndrome weakens, then this indicates the development of neuropathy.

Treatment of pathology is based on the use of such medications:

Pregabalin;
vaginal suppositories with diazepam;
injections of glucocorticoids with local anesthetics.

If the pinched nerve is quite complex and not amenable to pharmacological therapy, then patients may be prescribed surgical treatment.

Pudendal nerve neuropathy, also known as "Pudendal neuralgia", "Pudendal canal syndrome", "Alcock canal syndrome", "Pudendal nerve compression syndrome", "Tunnel pudendopathy" is a fairly common but rarely diagnosed disease.

Symptoms: pain in the perineum, genitals, anus. Like all types of neuropathic pain, this pain is characterized by a burning, tingling, tingling sensation.

urinary or fecal incontinence, sexual dysfunction. The pain is aggravated by sitting. In women, the symptoms of pudendal neuralgia include pain (burning, itching, tingling) in the clitoris, pubis, vulva, lower 1/3 of the vagina and labia.

Possible symptoms also include burning, numbness, increased sensitivity, sensation of an electric shock or a knife, aching pain, feeling of a lump or foreign body in the vagina or rectum, a feeling of twisting or constriction, abnormal temperature sensations, feeling of a "hot poker", constipation, pain, and difficult bowel movements, difficulty or burning when urinating, pain during intercourse, and sexual dysfunction - loss of sensation in the clitoris and/or anterior third of the vagina.

Diagnostic criteria for pudendal neuropathy:

Pain (burning, itching) in the region of the three branches of the pudendal nerve (clitoris, anus, vaginal vestibule)
Neuropathic nature of pain (burning, itching, tingling, goosebumps, hypersensitivity or loss of sensation)
Effect of pudendal nerve block (pain reduction for hours)
Reduced blood flow velocity in the pudendal artery, which is determined during ultrasound Doppler scanning. Since the pudendal artery passes along with the pudendal nerve in the Alcock canal, the processes that lead to compression of the pudendal nerve also lead to compression of the pudendal artery.

In the pelvic cavity, the pudendal nerve passes through the Alcock canal, where it can also be compressed by the sacrospinal ligament.

That is why, the symptoms of neuropathy of the pudendal nerve appear in the anus, perineum and vulva.

Causes of neuropathy of the pudendal nerve:

Obstetric neuropathy - damage to the pudendal nerve during childbirth, sometimes the obturator nerve suffers along with it
Myofascial syndromes - hypertonicity of the piriformis muscle can cause compression of the pudendal nerve in the foramen infrapiriformis. In addition, compression of the pudendal nerve can be caused by spasm of the obturator internus or levator ani muscle.
Traumatic neuropathy - caused by chronic injury (cycling or horseback riding) or fracture of the pelvic bones.
Compression of the pudendal nerve in the Alcock canal

The diagnosis is made on the basis of the so-called diagnostic criteria (Aix-en-Provence diagnostic criteria):

Localization of pain (one or more branches of the pudendal nerve - more often on one side)
The nature of the pain (burning, "goosebumps", tingling, sensation of "electric shock")
Increased pain in sitting position
Reducing pain in the supine position
Unilateral character of pain
The positive effect of cold
An anesthetic injection into the pudendal nerve reduces pain for 12 hours or more
An ultrasound examination of the Alcock canal with the determination of the blood flow velocity in the pudendal artery makes it possible to suspect compression of the pudendal nerve with a decrease in the blood flow velocity in the artery - since they pass together in this canal.

Treatment must be comprehensive:

Drugs affecting neuropathic and chronic pain (Lyrica, Tebantine)
Physiotherapy
Pudendal nerve blocks with anesthetics and glucocorticoids
Surgery - pudendal nerve decompression
neuromodulation

Remember that the duration of treatment is at least 6 months.

In our clinic we use all modern methods of treatment.

We are the only clinic in Russia where pudendal nerve decompression surgeries are performed.

Patients from other cities believe that the treatment in our clinic is long and therefore it is difficult for them to come to us! Sometimes this is true, but in most cases, one day is enough for diagnosis.

The next day, botulinum toxin injection, pudendal nerve cryoneurolysis, pudendal nerve decompression, TVT surgery are performed - in general, the most effective manipulations for the treatment of chronic pelvic pain syndrome and urinary disorders.

Patients can continue treatment at home - under our close supervision via Skype, e-mail, etc. We provide all the necessary drugs and (if necessary) devices for home physiotherapy.

There are many nerve pathways in the human body, each of which innervates a specific area. Among them, one can single out the pudendal nerve, which in medicine is called the genital.

It is responsible for the innervation of the pelvic floor muscles, and when this bundle is pinched, people experience chronic pain in the pelvic area. This phenomenon usually occurs due to compression neuropathy.

It is a compression (nerve pinching). In men, this problem occurs 2-3 times more often than in women due to anatomical features.

It has long been observed that the disenfranchised either yell loudly about this fact or grumble about it in an undertone until no one hears.

Nerve compression can be caused by its "swelling", accompanied by an increase in diameter, which causes it to mismatch the diameter of the enclosing canal.

But the structure of the affected pudendal nerve does not change with neuralgia. Movement disorders do not occur in the same way as loss of sensitivity.

Therefore, neuralgia is exclusively pain of a different nature and intensity.

And the infringement of the pudendal nerve can occur in the inguinal canal:

with varicose veins of the spermatic cord in men;
due to the pathology of the round ligament of the uterus in women;
due to inguinal hernia or the occurrence of cicatricial changes after hernia repair.

Pelvic neuralgia, which often accompanies infringement of the pudendal nerve, can also occur due to:

trauma during childbirth;
muscle spasm in the anus, hypertonicity of the piriformis muscle or obturator internus muscle;
development of oncopathology in the pelvic organs;
complications of herpes.

The symptomatology of this form of neuralgia is chronic pain in the pelvic region, which has the character:

aching;
burning sensation and itching, especially strong in women and especially in a sitting position;
excessively high sensitivity of the skin of the groin and perineum;
sensations of constant discomfort in the area of \u200b\u200bthe natural openings of the body;
false-obtrusive sensation of a foreign body in the genital area.

Against the background of chronic stress from long-term sensations, the following may appear:

urination disorders (involuntary act) or pain when urinating;
dysfunction of the genital organs (pain during intercourse);
stool disorders (constipation).

For diagnosis, symptoms are important - the sensations of the patient, as well as the absence of external manifestations of pathology.

In the first case, a violation of blood flow through the genital artery is detected, in the second case, the disappearance of discomfort after manipulation.

In treatment, the main goals are: pain relief, elimination of inflammation and restoration of nerve conduction.

Therefore, it is advisable to use:

anticonvulsants (Gabapentin), providing pain relief;
muscle relaxants (Mydocalm) used to relax muscles;
blockade of the pudendal nerve with a combination of solutions of anesthetics and hormones;
vitamin complexes (Neuromultivit class);
physiotherapeutic techniques (electro-, phonophoresis and the like).

To reduce the symptoms of discomfort, vaginal or rectal suppositories with Diazepam and exercise therapy techniques are used (for massaging the muscles of the perineum).

With the ineffectiveness of therapeutic methods, surgical decompression is used, which relieves infringement and symptoms.

Surgical decompression is sometimes the only way out

The pudendal nerve is responsible for sensation in the vulva, lower rectum, and perineum. The perineum is the space between the genitals and the anus.

Pudendal nerve entrapment may occur suddenly or develop over time. Long sitting, cycling. repetitive movements and leg exercises can lead to pudendal nerve entrapment.

impact on the neuropathic nature of pain with gabapentin (Tebantin, Lyrica);

conducting regular nerve blocks with anesthetics and hormones;

physiotherapeutic effect: phonophoresis, Amplipulse - therapy, electrophoresis;

muscle relaxants of central action (Mydocalm). Allows you to relax the muscles, including reducing the tone of the piriformis muscle;

B vitamins, which are part of the blockade, as well as tablet forms.

Pregabalin;
vaginal suppositories with diazepam;
injections of glucocorticoids with local anesthetics.

There are painful sensations in the perineum.
The pain has a burning tinge.
There are unpleasant sensations in the genitals and anus.
Urinary and fecal incontinence, which may be incomplete, that is, manifest itself in the form of drip incontinence or fecal smearing.
Skin sensitivity decreases in these areas, a feeling of "goosebumps" appears.
An unpleasant presence of something foreign can be observed in the anus and urethra.
Sexual disorders such as lack of orgasm and impotence may be observed.

The impact on the characteristic of pinching the nature of pain with the help of gabapentin, which is part of the drugs.
Regular nerve blocks with hormones and anesthetics.
The use of centrally acting muscle relaxants, which allow the muscles to relax, as a result of which the tone of the piriformis muscle decreases.
The use of physiotherapeutic effects, which include electrophoresis, phonophoresis.
Taking vitamins of group B, which are part of the blockade, as well as in the form of tablets.

mechanical damage to the hip joint and adjacent tissues (including during operations);
hypothermia of the tissues of the small pelvis;
tumor processes;
muscle spasm;
hypertonicity of the piriformis muscle;
complications of herperovirus infection;
long and frequent horse rides.

exposure to laser or dynamic currents;
hot baths;
wrapping;
paraffin applications;
electro- and phonophoresis.

A bit of anatomy

Rectal.
Perineal.
Dorsal nerve of the clitoris or penis.

The femoral-genital nerve, passing into the inguinal branch, has 2 options for continuing, depending on the gender of the person:

Male. It exits through the canal along with the spermatic cord and follows into the scrotum;
Female. In the case of the weaker sex, the pudendal nerve exits the canal along with the round ligament of the uterus and smoothly passes into the skin of the labia majora.

The inguinal nerve in women and men innervates the following tissues:

Muscle tissue of the anus;
The outer skin of the anus and genitals;
anal sphincter;
Musculature of the perineum;
female clitoris;
Male cavernous bodies of the penis;
Bladder sphincter.

The pudendal nerve pathway is responsible not only for the sensations experienced during intercourse, but also directly for defecation and urination.

The pudendal nerve is small in length, but a very important nerve of the latter, if you go from the brain, the sacral plexus. It lies in the pelvic cavity, envelops the ischium along the way.

they innervate the muscle that raises the anus;

innervates the anal sphincter;

sphincter

gives branches to the muscles of the perineum;

innervates the genital organs: the cavernous bodies of the penis in men, the clitoris in women;

gives sensitivity to the skin of the external genitalia and anus;

innervates the sphincter of the urethra.

After all, a person never thinks, does not control and consciously compresses the muscles so as not to accidentally defecate or urinate in broad daylight. This is done by autonomic nerve fibers that enter the lumen of the pudendal nerve.

This nerve can be pinched by the piriformis muscle, which is located in the pelvic cavity, or be sandwiched between two ligaments.

In addition, the nerve can be damaged, for example, due to a car accident, a fall from a great height, in which the pelvic bones are fractured.

A fairly common cause of chronic pelvic pain is nerve damage during childbirth, as well as the involvement of the nerve trunk in the growth of a malignant neoplasm.

In addition, activities such as riding a horse or cycling can also lead to pudendal compression neuropathy over time.

The lumbar plexus is a fairly powerful bundle of nerves that lie in front of the lumbar vertebrae, deep in the psoas major muscle.

Variety of nerves of the lumbar plexus

decreased skin sensitivity in the groin, paresthesia, "crawling", numbness; pain in the groin, of various localization and strength. iliac-hypogastric nerve.

It provides motor innervation of the abdominal muscles, gives sensitivity to the skin of the buttocks from above, innervates the inguinal canal; ilioinguinal nerve. Innervates the labia majora, or scrotum, as well as the skin of the pubis.

femoral;
Inguinal (sexual).

sphincter

Genital nerve in the female body

sphincter

The pudendal nerve in the male body (in yellow)

In the anatomy of the pudendal nerve in men and women, there are noticeable differences due to the structural features of the small pelvis. In the former, more structures are included in the concept of the genital organs than in the latter, and it is more branched. In addition, in women, these nerve fibers are located more compactly.

However, in both men and women, the pudendal nerve is a paired structure that branches off from the spinal plexus. In people of both sexes, this nerve is divided into two large branches (femoral and inguinal), which are responsible for innervation:

sphincters of the bladder;
perineal tissues;
muscles that lift the anus;
sphincters of the rectum.

The inguinal branch in men and women performs various functions:

In men, it is responsible for sensitivity and autonomic processes in the cavernous bodies of the penis and scrotum.
In women, it performs the same functions in relation to the large and small labia, the clitoris.

This structure, as well as the presence of vegetative fibers, ensures the automatic work of various muscle groups responsible for urination and defecation, without the participation of consciousness.

Due to the fact that with neuropathy of the pudendal nerve pain occurs in the pelvic area, ultrasound is indicated for diagnosis, which allows differentiating the pathology from other disorders of the genital organs.

Through ultrasound, it is possible to determine the nature of blood circulation in the affected area. The absence of disturbances in this area indicates the presence of neuropathy. The doctor draws similar conclusions if, after applying cold to the perineum, the patient experiences temporary relief.

To rule out prostatitis, cancer or prostate adenoma, the doctor performs direct palpation of the prostate gland in men through the rectum. In the case of severe deformation of local tissues and bones, such violations can be detected by X-ray or external examination.

Also, in order to confirm suspicions of neurosis of the genital organs, in rare cases, a novocaine blockade is placed. The drug is injected directly into the nerve plexus.

sphincter

What functions does it perform?

perineal injury;

Provoking factors can be:

riding a horse or cycling (rather frequent or professional);
protracted childbirth;
fracture of the pelvic bones (when falling from a height, in a car or plane crash).

To understand that something is wrong with the femoral-genital nerve, disorders of the functions of the organs located in the pelvis allow. These may be sensory disturbances or vegetative disorders.

Trophic disorders of the skin of the perineum, scrotum and perianal zone can also be a sign of disorders.

In addition to physical factors of influence, general somatic diseases can also be the cause of the pathology:

tuberculosis;
collagenoses;
circulatory disorders due to endocrine disorders and vascular accidents or for another reason.

Innervates the muscle that raises the anus and sphincter.
Innervates the sphincter of the canal for urination.
Innervates the female clitoris and the cavernous bodies in men.
Makes the skin of the anus and external genital organs sensitive.

After all, people never think, do not try to control and do not contract their muscles consciously, so as not to urinate or defecate completely by accident at the wrong time.

perineal injury;
Injury to the perineum can lead to more serious consequences.
hypothermia of the perineal region;
pressing to the ischial bone by the piriformis muscle due to the presence of a volumetric process in the small pelvis, either due to clamping between the ligaments of the pelvis, or due to another reason;
damage to the formations that make up the sacral plexus or the sacrum itself.

Recently, especially in French and Spanish-speaking medical circles, the approach to the pathogenesis, diagnosis and treatment of diseases of the pelvic organs has changed significantly.

First of all, it has become complex or, as they say in Europe, "multimodal", since the pelvic organs are closely interconnected, often have a common efferent and efferent innervation, blood circulation, and musculoskeletal apparatus.

An example is the occurrence of painful bladder syndrome (not interstitial cystitis - these are different things, it will be explained below why), in patients with adenomyosis or IBS.

This is due to the phenomenon of the so-called. cross sensitization. Most of the pelvic organs receive sensory and motor innervation through the n.pudendus. In addition, in some cases, these organs are represented in the same or neighboring centers of the brain. This issue will also be discussed in more detail below.

Secondly, the point of view about reducing the role of inflammatory diseases in the pathogenesis of chronic pelvic pain syndrome is increasingly prevailing. Currently, the main role, according to French colleagues, is played by myofascial (spastic) syndromes of the pelvic floor muscles and neuropathy of the pudendal nerve, which is unofficially called the king of perineum - “the king of the perineum”.

Thirdly, the terminology has changed: the term “chronic pelvic pain syndrome and dysfunction” is increasingly used instead of the term “chronic pelvic pain syndrome”.

We hope that the I International Congress on Pelvic Pain and Dysfunction, which will be held in Amsterdam, will adopt a common terminology.

Within the framework of this article, it is not possible to consider all pain syndromes and dysfunctions of the pelvic organs, therefore, we suggest paying attention to the syndromes of the female pelvic organs related to the practice of a urologist, that is, urogynecological syndromes.

painful bladder syndrome;
neuropathy of the pudendal nerve;
myofascial syndromes.

Violations of the accumulative and evacuation function of the bladder:

overactive bladder with detrusor overactivity;
overactive bladder with increased bladder sensitivity;
stress incontinence in women and men.

As for the painful bladder syndrome, according to G. Amarenco, this is a condition caused just by cross-sensitization of the bladder due to damage to neighboring organs, for example, the large intestine (IBS) or the uterus in adenomyosis.

In this case, the number of C-fiber receptors also increases, central sensitization occurs - but this is a consequence of a pathological process in another organ.

Pathological changes in the lamina propria can cause damage to the umbrella cells, similar to IC - but in this case it will be secondary.

Clinical case

A 38-year-old patient who has not given birth. She applied for a long-term (3 years) dysuria, pollakiuria, nocturia, pain syndrome with localization in the urethra, irradiation to the right lower limb.

Repeated courses of antibiotic therapy for U. urealitycum were carried out. Urine cultures are sterile, general urine tests are unchanged. Cystoscopy revealed visual signs of leukoplakia in the region of Lieto's triangle.

Pathological examination: no evidence of leukoplakia was found.

The patient underwent TUR of the altered area in the region of Lieutaut's triangle. After the operation, the condition improved somewhat, but after a month it returned to the situation that preceded the intervention.

The patient was examined together with Professor E. Botran (L’Avancee Perinneal-Pain Clinic, Aixen-Provence).

The examination revealed adenomyosis, increased tone of the right internal obturator muscle, pain at the trigger point m. obturatorius int.

In the expert opinion of Prof. Botran, in this case there is a painful bladder syndrome caused by cross-sensitization due to adenomyosis and aggravated by a myofascial reaction of the right internal obturator muscle.

In addition, due to neurogenic inflammation in the lamina propria of the urothelium caused by cross-sensitization, the patient has damage to the urothelium.

The pathogenesis of this condition may be as follows. Adenomyosis, like any other condition that causes chronic pain, leads to a decrease in the pain threshold.

Its essence is as follows: two groups of rats were taken, one was induced with chronic pain syndrome by introducing a chemical reagent under the skin of the back, the other group remained intact.

A month later, a test was carried out, squeezing the paw of the rats of both groups with a special device. The vocalization threshold was determined, i.e. when the rats started to squeak.

So, before the start of the study, the threshold in rats of both groups was the same. But a month later, in the group of rats with chronic pain, vocalization occurred at a much weaker pressure on the paw, compared with intact rats.

This seems quite logical. Pain is a signal of tissue damage. If the pain has become chronic, then the brain has not taken action sufficient to eliminate the cause of the pain.

The next step is peripheral sensitization. In the affected organ, the production of nerve growth factor (NGF, NGF) increases. This leads to an increase in the number of receptors affiliated with demyelinated C-fibers.

The main role of C-fibers is the transmission of chronic pain impulses. Accordingly, an increase in their number leads to an increase in pain in the affected organ.

However, as we have already discussed, the pelvic organs have cross-innervation, and in this case, the number of receptors for C-fibers increases not only in the endo- and myometrium, but also in the urothelium.

In addition, this patient was diagnosed with myofascial reaction m. obturatorius int. dext. Muscle contraction is a normal response to pain. However, long-term pain leads to spastic contractions, which, in turn, cause pain due to the accumulation of lactate in the muscle and compression of nerve fibers.

Returning to the examined patient, she was referred to a gynecologist for the treatment of adenomyosis. In addition, for the purpose of treating painful bladder syndrome, it was recommended:

katadolon 200 mg - to relieve pain and central sensitization;
pregabalin - 75 mg 2 times a day with a gradual dose titration - to eliminate peripheral sensitization;
injection of 100 units of botulinum toxin into the right obturator muscle under electromyographic (EMG) control;
intravesical electrophoresis 200 units of botulinum toxin;
intravesical administration of sodium hyaluronate (URO-HYAL) in order to restore the urothelium.

Attention should be paid to the effectiveness, albeit short-term, of the TUR of the Lieto triangle. As is known, the main afferent innervation of the bladder is localized in the region of Lieutaut's triangle - apparently, TUR temporarily disabled the endings of the afferent fibers.

Causes of inflammation

Traction-compression neuropathy of the left or right nerve pathway occurs in Alcock's canal. Therefore, a pinched pudendal nerve that occurred in this area is called Alcock's syndrome.

Among other varieties of neuropathy characteristic of this nerve pathway, one can distinguish the femoral-genital form. It manifests itself mainly due to trauma to the groin or the development of an inguinal hernia.

Neuropathy of the ilioinguinal nerve also belongs to this group. It occurs due to the appearance of scars on the muscle tissue, which are the result of surgical intervention.

Infringement of the pudendal nerve occurs mainly due to the following factors:

Injury received during childbirth;
Spasm of the muscle tissue of the anus;
pelvic fracture;
The development of oncological diseases of a malignant nature;
High tone of the piriformis muscle;
Complications of herpes;
Spasm of the obturator internus muscle;
Squeezing of the shameful path due to riding a horse or bicycle.

Symptoms

In the female, severe itching and burning in the genital area can be added to the main symptoms of neuropathy. In a sitting position, these symptoms are greatly enhanced.

In more rare cases, the following symptoms are observed:

Violation of the stool (constipation);
Numbness of the genitals;
Pain during intercourse and urination.

Diagnostics

Pinching: causes

Trouble can occur due to the piriformis muscle located in the pelvic cavity or due to clamping between a pair of ligaments.

In addition, the pudendal nerve can be damaged after unforeseen situations, which include a car accident, a fall from a height. In such situations, fracture of the pelvic bones can occur.

It is worth mentioning that some human activities over time can also lead to pinching of the pudendal nerve. This includes cycling or horseback riding.

All those complaints that were listed earlier.
Patients may note that when something cold is applied to the perineum, temporary relief occurs and the burning pain begins to pass. This symptom suggests that nerve damage is neuropathic in nature.
When using a trial therapeutic and diagnostic blockade of the nerve with the help of novocaine, the severity of the symptoms decreases or completely eliminates all the suffering for the duration of the painkiller, which lasts from 12 hours to 3 days.
The nature of the pain indicates that a pinching has occurred (unpleasant sensations when touched and all kinds of itching, burning and a feeling of "goosebumps").
When conducting ultrasound and Dopplerography of the small pelvis and perineum, in almost all cases, when the pudendal nerve is pinched, a slowdown in the rate of blood flow in the nearby pudendal artery is observed. Since it passes through the same channel as the nerve, the narrowing of the artery indicates that it has also undergone compression.
A very important criterion in the diagnosis is the increase in pain in a person in a sitting position and a decrease when the patient lies on his back. For pinching of the pudendal nerve is also characterized by a lesion on one side only. It is on her that frustration is felt.

In addition to such diagnostic criteria, when probing the perineum, one can find characteristic areas that are pain points that reflect spasm in the muscles.

It is important that the pathology of the pudendal nerve is closely associated with the development of myofascial syndrome, which can be treated much worse due to the deep location of the muscles.

In addition, a pinched pudendal nerve greatly increases depression and anxiety, and people become more susceptible to negative events.

Does the pudendal (genital) nerve and its damage differ from a similar pathology in other “regions” of the body?

the perineum, the sphincters of the bladder and rectum, as well as the levator ani muscle, but then the differences in structure begin: in women, it provides sensitivity and vegetation of the labia majora and labia minora and clitoris, in men, the same functions in relation to the cavernous bodies of the genital penis and scrotum.

In the photo, the same painful area in women is highlighted in yellow.

Infringement of the nerves and associated pain exist not only in the limbs, in the neck, chest, but also in the groin. After all, this area is innervated by many anterior branches of the lumbar plexus.

Due to its anatomical structure, compression-ischemic neuropathies of this anatomical region are somewhat less common than in the limbs, which move intensively.

The main reasons are the following:

Osteochondrosis of the lumbar spine is a degenerative process that causes destruction of cartilage and bone tissue, with disc protrusion and hernias that compress the nerve roots at the point where they exit the spinal canal.
Inflammation of the piriformis muscle, which happens with a heavy load - long walking or running, jumping, in people who are unaccustomed to sports, as well as when they are in an uncomfortable position for a long time and with hypothermia - a spasm of the piriformis muscle clamps the sciatic nerve.
The nerve is also infringed by tumor formations.

The formation of pinching of the sciatic nerve in the hip joint is influenced by a number of provoking factors:

Overweight and sedentary lifestyle;
Joint diseases and bone pathologies;
Injuries and inflammation of the hip joint and organs in this area;
severe colds;
Hereditary predisposition, which largely determines the anatomical features of the location of the neurovascular bundles and ligamentous apparatus, as well as congenital defects of the articular apparatus, for example, hip dysplasia.

Separately, it is worth noting such a cause of infringement of the sciatic nerve in the hip joint as pregnancy. The increase in the load on the woman's body, due to the increasing uterus, which puts pressure on many organs and nerve bundles, careless movement can provoke pinching.

Also, pregnancy increases the load on the spine, which can also cause pinching of the nerve. It can also occur with postpartum divergence of the pelvic bones.

Clinical picture

Among the symptoms of pinching of the sciatic nerve in the hip joint, the main one is a sharp, acute pain in the lumbar region with irradiation to the thigh and buttock.

In addition to pain, patients also indicate the following list of symptoms:

Limitation of the range of motion of the hip joint.
Paresthesia - a feeling of tingling and burning at the site of injury.
Numbness at the site of injury.
In some cases, fever, chills, sweating, and weakness join.

The return of pain in the leg or back is called sciatica and is quite common in patients with pinched sciatic nerve, especially when trying to change posture - stand up or lie down, or during physical exertion.

Typical patient complaints of pain and rebound, paresthesias, and associated symptoms usually make it easier to diagnose a pinched nerve in the hip region.

In addition, the doctor collects an anamnesis and prescribes visual and laboratory diagnostic methods to confirm the diagnosis and select further treatment:

CT, MRI of the spine and soft tissues;
X-ray of the pelvic bones and spine;
Ultrasound of the hip joint;
Electromyography;
General and biochemical blood tests, general urinalysis.

Pinching treatment

Treatment in some cases is conservative and includes a set of methods:

Anesthesia, with the appointment of a course of analgesic drugs, including analgin, novocaine, ketorol and others. These drugs are administered intramuscularly at the beginning of treatment, then the patient is transferred to oral administration.
Non-steroidal anti-inflammatory drugs - drugs that relieve inflammation, pain and swelling. These include diclofenac, indomethacin, nimesulide, ketoprofen, movalis and others. They are prescribed as injections during the first days of therapy, after which they are taken orally in the form of tablets. These same drugs can be applied topically, in the form of ointments and creams applied to the hip area.
Physiotherapeutic procedures, these include hardware methods of treatment, such as: electro- and phonophoresis, magnetotherapy, UHF, laser, diadynamic currents, also hot baths, body wraps, paraffin applications, splinting and massage. Massage in the category of physiotherapy procedures is quite popular among prescriptions, as it is highly effective in relieving a pinched nerve, and the combination of massage actions with locally acting products containing bee products and snake venom accelerates recovery. At the same time, massage and all types of manual therapy require the supervision of a doctor in order to avoid complications, and are carried out when acute phenomena subside.
Physiotherapy. They start it with a set of exercises lying down while the patient is in bed - flexion-extension of the legs in the hip and knee joint, abduction-adduction of the leg in the joint, rotation of the leg. As the patient recovers, he can already perform standing exercises, strengthening the muscular frame of the back. These include squats, bends. All exercises must be carried out under the supervision of an instructor, at least at first.

Joint treatment More >>

Hormonal preparations. If there is no effect from other medications and physiotherapy, the doctor may prescribe a course of drugs containing hormones.
Oriental medicine methods. In the treatment of neurological diseases, alternative approaches to treatment show high efficiency and can be prescribed along with other methods. These include acupuncture, stone therapy, hirudotherapy and manual therapy techniques. The principle of their work lies in the impact on the active zones of the body, which stimulates blood circulation in the affected area, eliminates congestion, relieves pain and inflammation.
Folk remedies. At home, pinching in the hip joint is treated with baths with decoctions of medicinal plants - thyme leaves, calamus roots, oak bark. You can also take inside decoctions of oregano, horse chestnut and chamomile. It is also recommended that among home remedies there is a mixture of ground walnuts, sunflower seeds, dried apricots and prunes - these products have a beneficial effect on the articular system. However, the treatment of pinching at home should be complementary to the main course of medical prescriptions, and not independent.
Daily routine and diet. Patients with acute pain must observe strict bed rest during the first days of the disease, after 2-3 days it is allowed to get out of bed, move within the room, after a week - go outside. The bed is recommended to be flat and hard to avoid displacement of the vertebrae. The sleeping position should be on the side or on the back, with a small pillow placed under the lower leg. The pillow under the head should be low.

Diagnosis and treatment

Special gymnastic exercises are effective. To prevent exacerbations in the treatment of the pudendal nerve at home, it is recommended to bend and unbend the legs in the hip and knee joints daily in the supine position, to perform rotational movements with the lower limbs.

Over time, you can expand the list of exercises performed to include squats. The action of therapeutic exercises is aimed at strengthening the muscular corset.

As an addition, a tincture of spruce cones, dandelions or pine needles (one glass per 0.5 liter of vodka) is often added to the general scheme of pudendal nerve therapy.

A warm compress with beeswax melted in a water bath helps to achieve a temporary effect. This procedure is carried out before going to bed.

To relieve pain, an ointment is also used, obtained as follows: dried lilac buds are ground into powder, and then mixed with pork fat in a ratio of 1:4. The resulting product is applied to the problem area twice a day.

Less often, a patient turns to a sexopathologist, but a competent specialist should, with the help of an elementary question, identify organic disorders and refer the patient to a specialist.

complaints of the patient, which were described in detail above;

the nature of the pain, which indicates neuropathic changes (burning, crawling, all kinds of itching, unpleasantness when touched);

trial therapeutic and diagnostic novocaine blockade of this nerve significantly reduces the severity of symptoms, or completely relieves the patient of suffering for the duration of novocaine - from 12 hours to 3 days;

when performing ultrasound of the perineum and small pelvis with Dopplerography, almost always with compression-ischemic neuropathy of the pudendal nerve, a decrease in the volumetric blood flow velocity in the nearby pudendal artery is noted. This happens “for company”: the pudendal artery passes along with the nerve in the same canals, and its narrowing indirectly confirms the compression of the pudendal nerve;

an important diagnostic criterion is the increase in pain if the person is sitting and the decrease in pain if the person lies on their back. Also, pudendal neuropathy is characterized by a unilateral lesion. On the same side, disorders arise;

Patients often find that applying cold to the perineum relieves the burning pains. This symptom indicates the neuropathic nature of nerve damage.

In addition to these diagnostic criteria, palpation of the perineum can reveal characteristic pain points that reflect a spasm in the piriformis muscle.

In addition, pudendal neuropathy exacerbates depression, anxiety, and makes people more susceptible to negative events.

It should be remembered that the treatment of neuropathy of the pudendal nerve is a long process, and all the prescriptions of specialists must be followed for at least 6 months.

sphincter, perineum, genitals. Pinching or inflammation of the femoral-genital nerve causes chronic pain in the pelvic area, which can be confused with cystitis, prostatitis and other diseases.

All about stress and depression

The reason for this in most cases is a pinched nerve, which is called compressive neuropathy. The pudendal nerve is pinched more often in women.

However, you should not get carried away with this type of treatment, as systemic effects of corticosteroids (formation of ulcers in the stomach, fluid and salt retention, immune suppression) may occur.

Good help means such as lotions with a solution of Dimexide (in a dilution of 1: 1), can be used in lotions and local anesthetics (Lidocaine, Novocaine). In the first days of the disease, Ksefokam, Movalis have a good effect.

For the relief of burning pain, which is neuropathic in nature, anticonvulsants (Carbamazepine), gabapentin derivatives (Tebantin, Lyrica) can be used.

Great importance is attached to metabolic therapy: B vitamins, antioxidant drugs (alpha-lipoic acid), Prozerin, Neurobion are used.

After the elimination of acute manifestations, physiotherapy is possible: electrophoresis with hormones, vitamin B1, with lidase, phonophoresis, manual therapy.

For the fifth year I have been suffering from very severe pain in the groin area on the left. The pain is constant, aching, occurs immediately after sleep. Often I can not fall asleep, work is also very problematic.

ENMG was also done - like no deviations

In the end, neurologists from the Research Institute of Neurology established the diagnosis: "compression-ischemic neuropathy of the iliac-inguinal nerve."

They suggested to be treated first with courses of hydrocartisone ultraphonophoresis. The procedures didn't work.

Now they are treating with blockades of diprospan novocaine. It has not helped yet, after the first blockade.

There is very little information about this disease, even on English-language sites (especially for me with my engineering education).

Please tell me in which direction you can go at all (acupuncture, manualism, etc.). The pain is very strong and painkillers are not particularly stray.

Patients with vagus nerve disorders may have a variety of symptoms, including low blood pressure, irregular heart rhythms, difficulty swallowing, and digestive problems.

Treatment is often limited to reducing or eliminating symptoms with exercise and short-term or long-term medication, but surgery may also be required.

Pacemakers can significantly increase the life expectancy of patients with congenital heart disease.

Exercises for vagus disorders usually involve the pharynx, the area of the throat between the mouth and larynx. The patient can also be taught how to massage the soft palate or the upper part of the mouth.

Patients with vagus nerve disorders may experience low blood pressure.

Patients with vasovagal syncope usually experience syncope due to a psychological disorder, which may be caused by watching a disturbing scene or emotional shock.

This is one of the vagus disorders that can be relieved with medication. Doctors may prescribe blood pressure medications or antidepressants such as sertraline or paroxetine.

Patients with vagus nerve disorder may require the assistance of a pacemaker.

Vagal nerve disorders also include gastroparesis, a disorder in which the stomach does not have enough muscle contractions to properly pass food through the intestines.

If this is difficult, a feeding tube may need to be inserted to get the nutrients into the intestines without going into the stomach. If the patient experiences nausea or vomiting, medicines such as ondansetron

May be helpful. Because of the significant risks associated with drugs like metoclopramide, which is used to stimulate the stomach muscles, doctors usually reserve this option for the most severe cases.

Pharynx exercises may be prescribed to help reduce the risk of problems associated with a vagus nerve disorder.

Surgical solutions for these disorders depend on the nature of the symptoms the patient is experiencing. Some patients with gastroparesis may be candidates for gastric bypass surgery.

Although many patients with vagus nerve disease require little or no treatment, disorders can pose a significant risk.

For example, some people may have a vagus nerve disorder in which the brain never receives a signal to notify it that the person is hungry and needs food. Without the hunger signal, the patient could literally starve.

Course of therapy

Treatment of neuropathy should consist of a set of measures aimed at eliminating inflammation, relieving pain and restoring nerve conduction. It usually includes the following therapies:

Elimination of pain with the help of anticonvulsants (Gebapentin);
The use of physiotherapy procedures (phonophoresis, electrophoresis, etc.);
Blocking the nerve pathway with a solution of hormones and anesthetics;
The use of muscle relaxants (Mydocalm);
The use of vitamin complexes (Neuromultivit).

If there is no point in continuing to treat medically damaged nerve tissue due to the lack of results, then surgery will be required to decompress the compressed nerve. Such operations are extremely effective, but have a long recovery period.

With a long absence of treatment, the development of the consequences of pathology is possible. The disease can become chronic and some symptoms will be extremely difficult to eliminate.

Neuropathy of the pudendal nerve is an unpleasant phenomenon, but some people live with it for years. This is usually associated with vague symptoms and a chronic type of course.

The information on the site is provided for informational purposes only, does not claim to be reference and medical accuracy, and is not a guide to action.

Due to the fact that different causes and symptoms lead to inflammation of the pudendal nerve in women, treatment is largely determined by the characteristics of the provoking factor.

In this case, patients are prescribed complex therapy. Muscle relaxants and anticonvulsants are used to treat pudendal neuropathy. These drugs improve the general condition of the patient.

With damage to the pudendal nerve in the treatment of men and women, rectal suppositories with an active substance such as diazepam are used. Suppositories also provide an analgesic effect.

With severe pain caused by pinching of the pudendal nerve, painkillers are used, which are selected based on the degree of intensity of symptoms.

In addition to anticonvulsant drugs, sedatives are often prescribed for these purposes, which calm the central nervous system. In extreme cases, when decompressing the pudendal nerve, droppers are prescribed (which ones will help, the attending physician determines, taking into account the nature of the lesion).

Basically, a mixture of anesthetics and hormones is used for these purposes. This group includes drugs of the neuromultivit class. Thanks to this blockade of the pudendal nerve, urination is restored and defecation is normalized.

If necessary, treatment tactics are adjusted. In case of compression of nerve fibers caused by a fracture of the pelvic bones or the growth of tumors, surgical intervention is performed.

To do this, impulse currents are applied to the affected area. Such an effect relieves pain, normalizing the patient's condition for more than a year.

Other procedures

Often, the treatment of a pinched pudendal nerve requires the support of a good psychologist who performs corrective therapy and prescribes antidepressants.

You may need to prescribe vaginal or rectal suppositories, which include diazepam. The patient may be assigned to perform special physical exercises, the meaning of which is to slowly compress and relax the muscles in the perineum.

If there is no limit to indignation, or about neuropathy

In addition to neuralgia, the genital nerve can also become the scene of an inflammatory process, then they talk about neuropathy (neuropathy), or pudendal neuritis (a term rarely used today).

The cause of the pathology (also called pudendoneuropathy) is the implementation of two mechanisms:

compression-squeezing of the nerve trunk in the "scissors" sacrospinous ligament-piriformis muscle;
traction due to overextension of the nerve in the area of its transfer over the sciatic spine.

An illustration of the first is the consequences of prolonged or unsuccessful equestrian or cycling (compression with a hard saddle), and the second is the consequences of surgical intervention, so when the thigh is traction using a perineal fixator, the nerve is pressed against the pubic region.

Preventive measures

When riding a bicycle or a horse professionally, you should take precautions and follow a regimen with mandatory work breaks.

The implementation of traction in case of a hip fracture requires the use of a perineal fixator with an adequate support area (up to 9 cm) with a mandatory softening pad.

Intramuscular administration of a solution of magnesium sulfate in large doses requires caution to prevent the occurrence of ischemic necrosis of the gluteal muscles.

With the appearance, and even more so - an increase in pain in the pelvis, perineum and genitals, you should immediately seek help from a neurologist.

This section was created to take care of those who need a qualified specialist, without disturbing the usual rhythm of their own lives.

Men and women should immediately consult a doctor if persistent discomfort (pain) occurs in the perineum.

For the prevention of exacerbations of pudendal neuritis, exercises to strengthen the muscular corset of the small pelvis are mandatory. Therapeutic exercises are recommended to be performed daily.

Treatment of lesions

Neuropathy of the pudendal nerve is a disease that is a consequence of the development of compression processes affecting the coccygeal plexus and the nerve itself.

As a rule, such a violation occurs against the background of degenerative changes in the ligaments and muscles of the pelvis. Pathology develops in both men and women of different ages.

Despite the prevalence of this problem, diagnosing neuropathy is extremely rare. This is due to the fact that only a small percentage of patients pay attention to the symptoms of the disease and seek medical help.

Sexual neuropathy can affect different nerve fibers surrounding the genital organs (femoral-genital, ilioinguinal nerve).

Reasons for the development of the disease

The main etiological factor provoking sexual neuropathy is the pinching of the pudendal nerve, which occurs in the Alcock canal. In connection with the affected area, the disease is also called Alcock's canal syndrome.

Neuropathy of the pudendal nerve also develops for the following reasons:

labor activity (obstetric neuropathy);
hypertonicity of the piriformis muscle;
spasm of the muscles of the anus;
tension of the internal obturator muscle;
fracture of the pelvic bones;
malignant tumors in the pelvic cavity;
herpes virus;
nerve damage caused by horseback riding or cycling.

A characteristic syndrome with damage to the femoral-genital nerve: intense pain, aching and aching in the region of the gluteal region and anogenital.

The intensity of the pain increases when the patient walks, sits, and also suffers when performing a bowel movement. During the diagnosis test, in which the patient tries to reach the knee of the opposite shoulder, severe pain occurs.

As a rule, with damage to the femoral-genital nerve, there is a lack of a cremasteric reflex, or a decrease in it. The disease can cause a slight disorder in the work of the external sphincters of the pelvic organs.

The prerequisites for the occurrence of neuropathy of the nerve is the impact on it in the area of inflection through the sciatic spine, or through the sacrospinous ligament.

The causes of damage to the femoral-genital nerve can be not only compression factors, which are also responsible for the defeat of the ilio-hypogastric nerve and the ilio-inguinal nerve.

Also, the formation of the disease can be facilitated by compression on the femoral branch, which is located under the inguinal ligament in the vascular space, or compression in the inguinal canal of the genital branch.

You can acquire the disease due to hard physical work, after surgical operations in the groin area. Local adhesions and cicatricial processes can also provoke an ailment.

Signs and symptoms of damage to the femoral nerve:

paresthesia and pain in the groin
pain in the external genitalia
pain with tension of the abdominal press and flexion-extension of the hip
pain in the testicle, with a return of pain in the upper part of the inner femoral surface, when the patient is standing
pain occurs when probing the lower region of the pupart ligament in the direction of the outer side of the femoral artery
sensation of pain on palpation of the inguinal ring
a clear symptom of Wasserman
formation of hypoesthesia

The reason is the close anatomical neighborhood of the nerves. The signs and culprits of damage to these nerves are identical, however, sensory dysfunctions are aggravated in the proximal and medial genital areas.

Main symptoms

aching pain in the perineum, anus and genitals;
burning and tingling in the groin;
discomfort in the anus;
sensation of the presence of a foreign body in the rectum, urethra, or vagina (in women);
violations of the functions of the genital organs;
urinary incontinence;
hypersensitivity of the skin in the pubic area.

In women, the development of pathology is accompanied by itching and burning in the clitoris, labia, and vagina. Unpleasant sensations become more intense in the sitting position.

Often, patients are concerned about the feeling of numbness of the genital organs, problems with defecation (constipation), discomfort during urination, pain during sexual contact.

Symptoms of sexual neuropathy

Neuropathy (not to be confused with neuritis) is an unpleasant disease associated with pinching of a nerve by its surrounding tissues. Especially often occurs in areas of the peripheral nervous system where the nerve passes through narrow bone tubules.

So, the pudendal nerve, passing from the small pelvis, branches towards the perineum, rectum and muscles of the external genital organs, being responsible for the occurrence of an erection, provides the sensitivity of the genital organs and the work of the sphincters.

Pinching occurs in the bone-connecting canal under the pubic bone. Distinguish, with a similar clinical picture, ilio-inguinal, ilio-hypogastric and femoral-genital neuropathy.

The causes of sexual neuropathy are usually commonplace. These include inflammatory diseases not cured in time, various types of tumors, surgical intervention (for example, to suture an inguinal hernia), the consequences of childbirth and trauma.

Symptoms of genital neuropathy are usually associated with pain in the pelvic area. It could be:

violation of sensitivity (paresthesia) in the vulva, over the inguinal region and the base of the genitals, which is more common in women;
pain in the perineum. Moreover, they can be both local in nature and be pulling along the perineum. In a sitting position or with loads and straining, the pain multiplies. At night, in the supine position, it subsides without causing sleep disturbances;
loss of sensation in the lower gluteal region;
deep pain in the rectum;
violation of sexual function;
problems with urination and defecation, while it is observed, depending on the pinched branch of the nerve, as the opening of the anal canal and bladder neck and vice versa;
excruciating pulling pains in the scrotum or vagina.

Treatment is prescribed by a neuropathologist, after palpation and ultrasound examination. To relax the muscles, vaginal suppositories are used, local injections of analgesics are carried out in the area of pain, blockade of the pudendal nerve.

A bit of anatomy

they innervate the muscle that raises the anus;

innervates the anal sphincter;

gives branches to the muscles of the perineum;

innervates the genital organs: the cavernous bodies of the penis in men, the clitoris in women;

gives sensitivity to the skin of the external genitalia and anus;

innervates the sphincter of the urethra.

The pudendal nerve in the male body (in yellow)

This nerve can be pinched by the piriformis muscle, which is located in the pelvic cavity, or be sandwiched between two ligaments.

In addition, activities such as riding a horse or cycling can also lead to pudendal compression neuropathy over time.

Symptoms of neuropathy of the pudendal nerve

pain in the perineum;

discomfort in the anus and genitals;

burning shade of pain;

decrease in skin sensitivity in these areas, "crawling";

an unpleasant feeling of foreign body sensation in the urethra and anus;

incontinence of feces and urine. It may be incomplete, and manifest as fecal smearing or drip incontinence;

sexual disorders: impotence, anorgasmia.

Pinched pudendal nerve in women causes the above symptoms also in the lower third of the vagina.

Pinched pudendal nerve in men, in addition to the above, can cause pain during intercourse.

About diagnosing neuropathy

With such unpleasant and painful sensations, a person is not inclined to endure for a long time, as, for example, with pain in an arm or leg. Therefore, most often he turns to, or a proctologist, in the event that violations of the anal sphincter are expressed and there are problems with the retention of urine and feces.

complaints of the patient, which were described in detail above;

the nature of the pain, which indicates neuropathic changes (burning, crawling, all kinds of itching, unpleasantness when touched);

trial therapeutic and diagnostic novocaine blockade of this nerve significantly reduces the severity of symptoms, or completely relieves the patient of suffering for the duration of novocaine - from 12 hours to 3 days;

when performing ultrasound of the perineum and small pelvis with Dopplerography, almost always with compression-ischemic neuropathy of the pudendal nerve, a decrease in the volumetric blood flow velocity in the nearby pudendal artery is noted. This happens “for company”: the pudendal artery passes along with the nerve in the same canals, and its narrowing indirectly confirms the compression of the pudendal nerve;

an important diagnostic criterion is the increase in pain if the person is sitting and the decrease in pain if the person lies on their back. Also, pudendal neuropathy is characterized by a unilateral lesion. On the same side, disorders arise;

Patients often find that applying cold to the perineum relieves the burning pains. This symptom indicates the neuropathic nature of nerve damage.

In addition to these diagnostic criteria, palpation of the perineum can reveal characteristic pain points that reflect a spasm in the piriformis muscle.

In addition, pudendal neuropathy exacerbates depression, anxiety, and makes people more susceptible to negative events.

Treatment of neuropathy

As in all other cases, the therapy of this disease should be comprehensive. The basic principles of treatment are as follows:

impact on the neuropathic nature of pain with gabapentin (Tebantin, Lyrica);

conducting regular nerve blocks with anesthetics and hormones;

physiotherapeutic effect: phonophoresis, Amplipulse - therapy, electrophoresis;

muscle relaxants of central action (Mydocalm). Allows you to relax the muscles, including reducing the tone of the piriformis muscle;

B vitamins, which are part of the blockade, as well as tablet forms.

You should find out what exercises to do with a pinched pudendal nerve

In the event that conservative treatment is ineffective, then decompressive surgical operations are performed, which are performed in centers for the treatment of chronic pelvic pain.

It should be remembered that the treatment of neuropathy of the pudendal nerve is a long process, and all the prescriptions of specialists must be followed for at least 6 months.

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6 comments on “Sexual Neuropathy”

Infringement of the pudendal or femoral-genital nerve

Features of the anatomy of the pudendal nerve

Causes of inflammation

Symptoms

Diagnostics

Course of therapy

Pinching and neuropathy of the pudendal nerve in women and men

About the causes and symptoms of functional disorders

Infringement of rights, or about neuralgia

Provoking factors

Features of symptoms

Diagnostic criteria and treatment

If there is no limit to indignation, or about neuropathy

What could be the reason?

Features of symptoms

Diagnosis and treatment methods

Preventive measures

Incontinence due to damage to the pudendal nerve

How to treat pudendal nerve?

Causes of the disease

Symptoms of pathology

Diagnosis and treatment of pathology

What to do when the pudendal nerve is pinched or inflamed? Symptoms and treatment of the disease

Anatomical features

What functions does it perform?

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