Pudendal Nerve Entrapment/Neuropathy/Damage

@qball2019 do you have chronic regional pain syndrome (CRPS)? Also, have you tried other nutritional supplements that calm the nerves. I take 1 tbsp hemp seed oil, various flavonoids including soy isoflavinoids, quercetin, rutin, resveratrol (always with food). These may help somewhat. You can purchase these on amazon or at vitamin shops.

My pain is sitting pain now and it is much better but at one point I had large regions of tension in glutes, legs and back and various sciatica symptoms along with back pain. Probably mostly from lower lumbar ddd. Often the nerve pinch is above the pain points. Has your doctor ordered a back / hip mri? For me, stretching, exercise (detailed in several other posts here by me), nortriptyline, inversion table, and the supplements really helped get rid of most of my nerve pain. I do think the supplements help somewhat. Good luck.

@richman54660 Thank you for the supplement recommendations. I do have some that I take including PEACure, B vitamins, Acetyl L-Carnitine, Alpha Lipoic Acid, Green Tea, Magnesium, etc.Those are on top of my medications which include Tramadol, Lyrica, Cymbalta, etc. I've had MRI's of my whole body over the last 15 years. I do have a bunch of degenerative changes, sciatica, muscles spasms in my lower back every time I try to stand up straight, Lots of nerve pain from the lower back down. The doctor just mentioned that he thinks I have peripheral neuropathy in the butt cheek and going down my legs to my feet. Physical therapy dishcharged me because it was making the nerve pain worse. I can't exercise at all. I have a hard time standing, sitting, walking, etc. I'm basically bedridden right now.

I will check into the psoas muscle. The sacrotuberous muscle also cross over the pudendal nerve and can be the source of pain. The problem is getting a doctor to help in locating where the entrapment problem is. Just every doctor we've been to just wants to prescribe meds.

The low grade pain is random. Most mornings when she gets up the pain level is lower but some days it is much lower. So this is a morning thing WHEN it occurs. During the day she is usually up and around but of course when sitting in the car or sitting anywhere the pain worsens. So we will check into the psoas muscle. We are also looking into an inversion table to straighten out her spine since given that she favors sitting on her right buttocks to keep any pressure off of the left buttocks. The thought is that due to this position something has gone abnormal and now is pressing on the pudendal nerve.

She tried lyrica but had a bad reaction to it so she never really was on it for a long period of time. She takes gabapentin and tramadol.

Request her records and read through to see if there are any "incidental findings". There may be something else causing the issue. I can't sit on my right butt cheek at all and I have multiple Tarlov cysts in my sacral area pinching those nerves. Sounds awfully familiar. Please keep us posted if you find something that helps the pain.

@bkruppa Be sure to check with your doctor. What does the MRI or xrays of back show? The doctor may like or not like the inversion table aspect (opinions vary). Be aware, it is clearly counterindicated with high blood pressure. Your blood pressure in your brain goes up somewhat - so you don't necessarily want to overdo inversion, either. Also, it is more important to do it frequently than for a long time (i.e. I still work but do it am and evenings; you could do 2-4 times a day for a few minutes each if you're home a lot). I got some of that info off the Teeter website. One pain Dr. told me don't try doing it when muscles are "cold" as you can trigger spasms (those of us with DDD know all about those spasms) - so I do a couple minutes of inversion at the end of my stretches / TRX suspension exercises - not first thing when I get up in the morning and you're stiff).

You need to go slowly unless your vertebrae can handle it (I could go fully inverted from the start - but my bulges aren't too bad and I also hung from my hands at the gym to elongate my spine every other day before buying the table (but hanging upside down is more mass on the lower back and vertebra crack and make popping sounds from higher up when I invert -it does work). I bought the Ironman inversion table on Amazon (comfortable ankle clamps - but I wear boots when clamped into the machine), Teeters are well known but a little pricier. As I mentioned, and everyone is guessing when it comes to pain in these regions of the body, but one of the therapists I've been working with told me two things I think are true statements. One thing he said: "If pain changes with time, it's most likely not (at least fully) structural." That being said, the soft tissues clamping on nerves are probably a common source of pain - not a ligament (bones and ligaments = structural; the pain wouldn't be as likely to vary much from hour to hour and day by day). It sounds like your wife's pain changes with time (as done mine. I'm 100% sure my pain is muscles clamping on nerves, but a nerve pinch does exist up above complements of my lumbar discs, I suppose). Second, he told me minor bulges can be remedied or bettered using an inversion table. All the things I've done, including the inversion table and other stretches / exercises (I mentioned psoas / quadratus lumborum / extermely deep inspirations / separately in other posts) all can help. In the reviews for inversion tables, many people with DDD and sciatica raved about how some of the pains got better / went away. Many do swear by these tables if the nerves are getting pinched. You get a lot of ideas and knowledge from reading the comments about the inversion tables from user reviews. The Ironman on Amazon was about $200.00, I think, and it is heavy to move - not real portable. I've tried a Teeter at my brother in law's house. I like my ironman better. I still use it everyday.

Hi there, I do not have this problem, but I’m a PT and we have actually more people than you would think with this or very similar problem.
I did not read through prior feeds so this may have already been suggested, but see if you can find a pelvic floor specialist (PT) or one that knows how to do nerve glides for this region as it may not be just the pudendal nerve as there are many nerves off the lumbosacral plexus and if the fascia is tight surrounding it (yes-psoas definitely could be clamping down causing symptoms) then those muscles and tissues need to be released.
If she has been sitting funny bc of it she likely has some thoracic and lumbar alignment issues now and may have a ‘functional’ scoliosis developing (functional meaning she wasn’t born with it, but bc of postural dysfunction her muscles have pulled her spine into various curvatures that is correctable with both manual therapy and specific neuromuscular re-education). These postural faults could also be causing or feeding into the problem even if it gives temporary relief sitting like that.
The pelvis and sacroiliac joint need to be assessed and corrected if out of alignment.
So basics that any good manual PT (one that specializes in manual therapy) can do is correct lumbar facet dysfunction followed by pelvic dysfunction, followed by releasing the tissue throughout that whole region as the fascial system overlaps and even her abdominal fascia up to her ribs I bet is tight as well as in her low back, pelvis and down to both knees.
Lastly, I’d work on checking nerves you can glide (sciatic, femoral and obturator) and do some nerve glides, teach how to perform at home and if a pelvic floor PT-prob knows some fancy ones that are more specific to that area.
After all that correction manually, then comes core stabilization of the transverse abdominis, pelvic floor and multifidi-basics first (Sahrmann) and then work on correcting posture (schroth-seated and sidelying).
Sorry for all that, but just wanted to help. Feel free to copy and paste and print all that out if you go to PT they’ll know what to do (if you find a good one). If they just use modalities (Ultrasound, estim, ice/heat, ionto) and exercise alone, you aren’t going to likely fix the problem. IMO. She should feel immediate relief in the first 3-4 visits-if not, may need to shop around. Look for (OCS, COMT, FAAOMPT, etc) for initials after their PT, DPT. Good luck

Thanks for the last two posts. Let me take you back to how this all started and why I am looking into the areas that I am. My wife developed a bad case of shingles that affected the pudendal nerve. Her left buttocks and pelvic are had very intense pain that lasted for about four months. During this time she was pretty much bed ridden and favored laying/sitting on her right side. Once the shingles started to subside it appeared that in a few months the pain would be gone but unfortunately after about 3 months of the pain going down it stopped and I believe that something else kicked in. Myofacial issues due to being bed ridden for so long? Nerve entrapment given that all the areas supported by the pudendal nerve were still in pain? Sacrotuberous issues due to muscle inflammation? Spinal issues (at the root of the pudendal nerve) due to her favoring one side for so long? So there are many areas that I suspect could be the root of the problem.

Inflammatory meds like Advil help a lot so this would say the source maybe is inflammation or a strained muscle as Advil helps these conditions. My thoughts regarding an inversion table is that if the spine is cocked due to the favoring position then this would help get it back to normal. I've read much about blood pressure being a concern but question this as one's blood pressure goes up quite high when doing normal exercises and just about every doctor on earth recommends exercises and many set goals of working in your heart target ranges which is quite stressful (I don't believe in this approach). We both are senior citizens so we are at the age where muscle just don't move, stretch, reform, etc. like they did many years ago.:):) So she doesn't see instant results using any technique but she does get relief when being massaged in the painful areas. She has been to a PT who specialized in pelvic pain and while the treatments helped (mainly massaging) it wasn't lasting.

So three things seem prominent: First is that inflammation seems to be part of the problem. Second is that sitting causes the pain to get significantly worse. Third massaging helps but so far hasn't been a solution. Fourth, one neuro doctor has suggested that the source may be at the roots of the nerve which is at the spinal column. He indicated that an inversion table may help since favoring her one side may have caused one side of a disk to be compressed and therefore causing pain. Finally is the question of why some mornings her pain level is way down at a two or three level???? Other mornings it is not. That's what I'm working with. I'm thinking to take her to a normal PT clinic to work on straightening out her entire muscle system in that area. The PT specialist only worked on massaging the pelvic area.

As for your concern regarding full inversion my wife would never go to that extreme. Thirty degrees or around that angle would be the most and yes this would be after warming up the muscles. In fact she warms up her muscles before doing any stretching techniques.

Thank you for all that. And as for the pelvic PT, that’s kinda crappy if they only massaged. A true pelvic floor specialist does far more specialized care. They have a certificatation for the pelvic floor (I do not, I specialize primarily in orthopedics, manual therapy and hope to learn Vestibular this year). They should have assessed mobility of spine, pelvis, hips, SIJ, etc. Hope seeing a new PT helps!!
As for the inflammation-until the problem is corrected it sounds like low level chronic inflammation that needs to go away!

@bkruppa You may want to look at myofascial release to free tight fascial tissue. I do this therapy myself for thoracic outlet syndrome which is a nerve/vessel entrapment under the collar bone area and it has helped me a lot. This is similar to massage , but the therapist holds the stretch and waits for the tissue to start to slide. According to the website, it helps Pundental nerve entrapment among many other conditions. MFR can also treat surgical scar tissue in the fascia. There are providers listed for Canada (your earlier post suggested this) at this link
https://www.mfrtherapists.com/app/list.asp?state=&country=CA

I created a discussion to collect information on MFR that you can check out at
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/