Pudendal Nerve Entrapment

[mlzippy7]

Can I ask a dumb question probably? How do they diagnose this because all the symptoms sound a lot like me?
Just wondering.
Thanks for any response at all!!

[leelee88]

It is not a dumb question.. There are a few here on the boards that have this. Maybe they will chime in and answer this for you..

[stef000]

I would like to know too....
they do sound a lot like IC, endo, PFD too
just wonderin how to get diagnosed between all of these....
since i know i have IC and mild endo but the symptoms definitely relate to those too...
:confused::bonk:

[ICNDonna]

Ideally a neurologist would be the one to see if you feel you might have a problem with a nerve.

Donna

[Kara29]

Doctors may differ in the diagnostic process Also there are several types of Doctors that can diagnose but may not treat PN and PNE. Some OBGYN Chronic Pelvic Pain Specialists can do the diagnostic process, some team up with a Neurological team, and I think some may even be in orthopedics. Here is a link to who diagnoses and may also treat PNE: http://www.spuninfo.org/index_files/Page843.htm The medical exams that may be done are:

1. The clinical exam

2. MRI or CT Scan

3. Pudendal Nerve Motor Latency Test (PNMLT)

4. Diagnostic block


Pudendal Nerve Motor Latency Test (PNMLT)

A PNMLT is an electrophysiological procedure, similar to an EMG (electromyogram), which measures the speed of nerve conduction. This exam is done by a neurologist. Not all neurologists have the necessary equipment to do this type of examination. During this exam, the pudendal nerve is stimulated electrically inside the rectum (or vagina) at the ischial spine with electrodes on the tip of a special glove. The speed of the nerve conduction is recorded by a small needle inserted in the perineum. If the nerve responds slower than normal, this gives an indication that the nerve may be entrapped or damaged.

The PNMLT examines only the motor function of the nerve. There is no way to test for the sensory fibers of the nerve which transmit pain. The reason for the test is based on the assertion that an abnormal motor function will most likely conceal a sensory affection as well. So, an abnormal PNMLT indicates that the pudendal nerve is affected but a normal reading does not rule out PNE. In this case an entrapment could exist even if the motor fiber of the nerve has not been affected yet. This is more common with people who have had PNE only for a short period of time. Nevertheless, the PNMLT is the most accurate neurological examination for the pudendal nerve.

The neurological examination can be completed by the measurement of the anal reflex latency, measurements of the bulbocavernosus reflex latencies (BCRLs), somatosensory evoked potentials of the pudendal nerve (SEPPNs) and the sensory conduction velocity of the dorsal nerve of the penis (SCVDNP). Those exams can give further information about the condition of the nerve or the origin of the pain.

5- Diagnostic block.

A diagnostic block, or a "blockage of the nerve", is an injection with a local analgetic such as lidocaine or one of its derivatives (also used by dentists). The block is usually done in the buttock to reach the pudendal nerve at the ischial spine where it is most often entrapped between the href="anatomical_images/PelvisLigamentsRearFemale.jpg">sacrospinous and sacrotuberous ligaments. One block for each side affected is necessary. If the pain diminishes immediately or even vanishes completely as long as the effect of the local analgetic persists, this is an indication that your pudendal nerve is being compromised in some fashion, and that possibly some damage to the nerve has occurred.

Injections can serve as diagnostic tool but can also serve as a therapeutic tool. In the latter case, the injection consists of steroid.

These injections must be given only under strict radiological control for safety reasons since the exact placement of the needle is critical in confirming the diagnoses, or even curing the patient. Injections at the ischial spine, can be done under fluoroscopy or CT scan while the final injection done into alcock’s canal must be done under CT guidance only.

In search for a diagnoses

The final diagnoses of pudendal neuralgia is based on a persona having at least two out of the three criteria:

1. typical PNE symptoms,
2. an abnormal electrophysiological test
3. a positive response to the nerve block.



It is important to note PN is largely a “rule out” condition. In other words, because its symptoms can be indicative of another problem, extensive testing is required to ensure that your symptoms are not related to another condition. Common conditions that should be evaluated include coccygodynia, piriformis syndrome, interstitial cystitis, chronic or non-bacterial prostatitis, prostatodynia, vulvodynia, vestibulitis, chronic pelvic pain syndrome, proctalgia, anorectal neuralgia, pelvic contracture syndrome/pelvic congestion, proctalgia fugax or levator ani syndrome.

In addition to eliminating other diagnoses, it is important to determine if the pudendal neuralgia is caused by a true entrapment or other compression / tension dysfunctions. In almost all cases, pelvic floor dysfunction accompanies pudendal neuralgia. Electrodiagnostic studies will help the practitioner determine if the symptoms are caused by a true nerve entrapment or by muscular problems and neural irritation. It is crucial to a successful treatment outcome to acknowledge both dysfunctions and treat accordingly. In the event of a true entrapment, surgical decompression followed by post-operative physical therapy will be necessary to restore patient health. In cases of pudendal neuralgia, pudendal nerve blocks and physical therapy can alleviate the symptoms and resolve the original problem.

A diagram was created and copyrighted by Dr. Jacques Beco in 1998 which clearly illustrates the pathway of the pudendal nerve. In this diagram, we have overlayed the most likely sites of a nerve entrapment. This original diagram is available on www.pudendal.com.

The Resources section of this website contains many links to sites containing detailed clinical information surrounding this condition, including how to contact treating physicians to discuss a specific clinical issue. The Patients’ Resources section of this site contains information about how to contact treating physicians for an appointment.


If you have any questions....I've been through the whole testing process with two teams of Doctors. I can tell you what to expect. The Doctors can also tell you what to expect in the diagnostic process and treatments.

The Doc that I go to with all of my Questions is Dr. Mark Conway. I have his contact info if needed. He's wonderful!

Kara


I just found a New PN/PNE site! Pretty Cool. This gives us some more information: http://www.pudendalhelp.com/treatment_options.html

[Briza]

Thank you for that post, Kara, it was very informative and I am going to save it! I know many of us wonder what is causing our symptoms, and PNE seems to be even more mysterious and harder to dx than even IC, VV, PFD,etc. Good post, thank you :)