PN is pain, discomfort or numbness in the distribution of the pudendal nerve. The pudendal nerve is a peripheral nerve that is the main nerve of the pelvis/ pelvic floor. The pudendal nerve emerges from the S2, S3, and S4 roots’ ventral rami of the sacral plexus. It carries sensory, motor, and autonomic fibers, however an injury to the pudendal nerve causes sensory deficits more than motor. These areas include the rectum, anus, urethra, perineum, and genital area. In women this includes the clitoris, mons pubis, vulva, lower 1/3 of the vagina, and labia. In men this includes the penis and scrotum. But often pain is referred to nearby areas in the pelvis. The symptoms can start suddenly or develop slowly over time. Typically pain gets worse as the day progresses and is worse with sitting. The pain can be on one or both sides depending on which nerve fibers and which nerve branches are affected. The skin in these areas may be hypersensitive to touch or pressure (hyperesthesia or allodynia). This is a chronic/ lifelong issue that can severely affect a persons quality of life and there are no simple treatment options.
What is pudendal nerve entrapment syndrome?
Pudendal nerve entrapment or PNE… is pain caused by a mechanical compression/ entanglement of the pudendal nerve between ligaments or scar tissue. Usually the sacrotuberous ligament and or the sacrospinous ligament. The only way to really definitively tell if you have a nerve entrapment is via surgery although some other specified imaging techniques which are able to image/ doppler where there is a hold up/ issue with nerve within scar tissue. This phenomenon is still debated and under studied. Pudendal decompression surgery is how this issue is diagnosed/seen. There are a few doctors who perform the surgery in the USA, but in Europe there are more options in terms of surgical techniques and experience. Please visit www.pudendalhope.com for more information.
The pudendal nerve entrapment syndromes subdivide into four types based on the level of compression.
Type I - Entrapment below the piriformis muscle as the pudendal nerve exits greater sciatic notch.
Type II - Entrapment between sacrospinous and sacrotuberous ligaments - this is the most common cause of nerve entrapment.
Type III - Entrapment in the Alcock canal.
Type IV - Entrapment of terminal branches.
What is Maythurners Syndrome?
May-Thurner syndrome (MTS) — also called iliocaval compression syndrome, Cockett syndrome or iliac vein compression syndrome — occurs secondary to compression of the left iliac vein by the overriding right iliac artery. Most MTS patients present with left leg swelling, and are higher risk for DVT (deep vein thrombosis) /blood clots. However many people with left sided pelvic pain and absence of leg swelling may have symptoms of pain and discomfort if their vein compression is greater than 50%.
What are EHLERS-DANLOS SYNDROMES?
The Ehlers-Danlos syndromes are a group of connective tissue disorders that are genetic and are varied both in how they affect the body. They are generally characterized by joint hypermobility (joints that stretch further than normal), skin hyperextensibility (skin that can be stretched further than normal), and tissue fragility. Hypermobility does not always equal flexibility.
The Ehlers-Danlos syndromes (EDS) are currently classified into thirteen subtypes. Each EDS subtype has a set of clinical criteria that help guide diagnosis; a patient’s physical signs and symptoms will be matched up to the major and minor criteria to identify the subtype that is the most complete fit. There is substantial symptom overlap between the EDS subtypes and the other connective tissue disorders including hypermobility spectrum disorders, as well as a lot of variability, so a definitive diagnosis for all the EDS subtypes when the gene mutation is known—all but hypermobile EDS (hEDS)—also calls for confirmation by testing to identify the responsible variant for the gene affected in each subtype.