Pudendal Nerve Entrapment/Neuropathy/Damage

Posted by mandiPNE @mandee, Oct 5, 2018

Hello from a new member. Am wondering if anyone suffers from the monster Pudendal Nerve Entrapment/Neuropathy/Damage? I do. And I'm very alone in it. It is a very uncommon condition, and because of its personal nature, one that many people may not be comfortable opening up about. There seems to be a more vocal/visible presence of patients in the US, AUS and France. I hope, I need, I want - for it be made more aware of here in Canada. If there is any one who suffers from it, or who thinks they might, please feel free to open up about it. Please join me in advocating for ourselves in this horrible condition.

Interested in more discussions like this? Go to the Chronic Pain Support Group.

@bkruppa

My wife has had pudendal nerve pain for 8 years. Initially the pain was due to a bout of shingles. However, during the recovery period I believe that something new kicked in which I believe is PNE (Pudendal Nerve Entrapment) as the symptoms are identical and to me it makes sense. The pain areas in the pelvic region are exactly where the pudendal nerve goes. PNE normally is resolved by relief of any muscle or scar tissue that may be entrapping the pudendal nerve. There are many facilities around the country that treat this condition and the treatment is massaging, dialators, etc. of the muscles that could be entrapping the pudendal nerve. My wife gets some relief from this kind of treatment but it is temporary and it only helps some. We have been to many facilities including the Mayo Clinic but the doctors don't seem to recognize PNE as mostly they want to use pain meds as a course of action. We want a solution. We have tried nerve blocks in the caudal area as well as lower in the buttocks with zero pain relief.

There is a muscle group that entraps the pudendal nerve and that is the sacrotubernous ligament which can easily entrap the nerve. There are specific massaging techniques that can relieve this pressure.

Given that my wife's pain varies doctors have agreed that the nerve is not damaged. This is good news as apparently there is no treatment for a damaged nerve.

We have looked into neurostimulators. My main concern is affect on other nerves in the probe area as well as other more serious issues. I contacted two companies about their devices and neither company has any data on helping pudendal nerve issues so we would be on our own as far as what to expect. However, I had heard about paralysis as a possible side affect. Again I contacted both companies regarding the frequency of this issue but neither would respond to my requests. That was unfortunate. Then we find that a neighbor down the street from us was paralyzed due to this procedure. Now I don't want to scare people out of going through this procedure as this is a case of one out of ...............I don't know. A 100. A 1000, A 10,000. I just don't know. A doctor at Mayo told us that 20% of these need to be readjusted (surgery) within 5 years and over time they become less and less effective. Given all of the above we chose not to go through with the procedure.

Another neuro doctor is suggesting that the pain is due to inflammation of root of the pudendal nerve which resides at the spinal cord where it connects to the spinal column. Here they want to inject steroids to reduce the inflammation. Results may be nothing, good for two weeks, two months,????? They can't predict. IF this is the source then my choice would be to determine why it is inflamed at this area and resolve this issue rather than throwing meds at it.

We are also looking into inversion tables as a source of relief. The theory being that maybe her spine is shrinking due to aging and therefore entrapping the pudendal nerve. Also since she favors sitting on one side to relieve the sensitive side maybe the spine got reformed and therefore entrapping the nerve. So we will give it a try to see what happens. We have also tried acupuncture, all the suggested vitamins for neuropathy, etc., but with no success. I read a lot of articles where sugar can cause nerve pain issues to heighten so we will be doing a sugar free diet for a couple of weeks to see what happens. MRIs show nothing but a dual frequency laser treatment has helped some but for only a day or two. My wife is on gabapentin and CBD oil. CBD oil takes some of the edge off of the pain so she uses it frequently.

Scar tissue may be another cause of entrapment. Women who have an an episiotomy during child birth can develop scar tissue in this area which is close to where the pudendal nerve travels. Haven't found any doctors who buy into this theory but a lot of my wife's pain emanates from this area so I am suspect. A PT friend of mine says that when a rotator cuff is torn in the shoulder scar tissue can form around a nerve and cause pain. In these cases surgery has helped release the entrapment. However, the nerves in this area are not complex nerves like the pudendal nerve which I guess is one reason most doctors don't want to do anything invasive since they may end up causing damage to the nerve which would result in even more pain.

Sorry for the long post. However, I wanted to present everything that we have done. I would like to hear from the rest of you about what you tried and what were the results.

Jump to this post

I don’t know if you are still reading this post but when I read your post, a lot of it was me. I have suffered from PNE for 18 years. I can tell you I did get a stimulator implant and it was a complete failure. I have been told technology has gotten better. My thought about it is the stimulator works by basically sending a different sensation to the brain that is designed to override the pain. The issue for me was because of where the pain is. The stimulator is controlled by the patient and as your body moves the level of stimulation changes due to your body position and then you are scrambling to readjust the controller. For me, and my pain is in the genital area and down the back of one leg and the stimulator was a complete failure. I ended up having another surgery to remove it a few years later. I also had bilateral PNE surgery. It was a major surgery and done by a doctor who had spent many years focusing only on PNE issues. I had to travel quite a long distance to this doctor several times and the surgery was a complete failure which of course leads to the emotional disappointment and depression of going through all of that for nothing. I’ve done all of the things you mentioned. Acupuncture, invasive physical therapy and spent years taking narcotic pain meds which help but do not eliminate the pain. In the end, what finally ended up helping me was an implanted drug infusion system. In order to qualify, I had to break my chemical dependency on opioids and be off of them for six weeks. This allows your brain cells to go back to normal functioning and basically clears your brain cells of the opioids. The implanted infusion system does contain morphine and marcaine. It holds only 20 mg. It does not put opioids back into your entire body. It is implanted in your abdomen and tubing is tunneled and sewn to your spinal cord. A tiny amount of the meds are pumped into your spinal cord which basically blocks the pain before it gets to your brain. You are only using 20 mg about every 3 months. The whole system is completely implanted and your dosage is controlled by your doctor. There is no controller to keep up with, no battery to charge. They last about six years because the battery is built into the pump. I am getting ready to change out my second one for my third next month. It is not a magic bullet but if I didn’t have it I truly think the severity and location of my pain and the lack of knowledge by doctors to provide help would have driven me to suicide. I still have pain but not all of the time and not nearly as severe. The dose of meds is just enough to sit in the spinal cord to block the pain and doesn’t cause the side effects of opioids. I also supplement that with Gabapentin. Stress will really ramp up the pain so it is important to keep the stress in your life as low as possible. Sitting for long periods in hard chairs is a big trigger. Sadly, intimacy is still painful but possible with an understanding partner. I truly do not know how I would have made it without this system. It is manufactured by Medtronic and you need to find a good pain clinic and an experienced doctor. I go to the pain management clinic affiliated with the University of Kentucky and have for a long time. For friends, partners, relatives, understanding is crucial to the patients mental health and helping to keep the stress down.

REPLY

Yes but sitting in hard chairs for extended periods is a problem.

REPLY
@vklittle61

Wow I don’t l ow about removing thst muscle

Jump to this post

@cake @vklittle61 Most doctors won't operate on this area. It's too vascular and too many nerves. They would generally do more harm than good, I believe. Try exercise and change up your nutrition to the suggestions I posted above in this thread where I reviewed Dr. Fors' book (I was very detailed in that post). Also, be aware there are many YouTube videos about strengthening / stretching the pelvic floor (which includes the levator ani muscles and the obturator internus muscles as the pelvic floor main component). Also, things like Pilates Reformer and the TRX core exercises strenghten and get the core and pelvic floor moving (Kegels are just one exercise to strengthen the pelvic floor). Do what you can - these other exercises could help dramatically, too. If those are too strenuous, try some of Thomas Hanna's "Somatics" exercises. These are based on simple movements and stretches with an emphasis on also sensing tension but also sensing when you've regained relaxation. Again, there are all manner of videos on that on YouTube (he also has a book called "somatics" where they show the stretches / exercises). Good Luck.

REPLY
@billyboy1

I have had Pudendal Neuralgia for over 4 years and it has gotten much worse over time, but very slowly until a couple 2 months ago. I have tried just about everything that I've heard on this forum except for the surgery. The implanted pump sounds promising to me. Was your pump implanted at the UK Interventional Pain Management Clinic?

Jump to this post

R you speaking of Spinal cord stimulator or a pain pump, pls??

REPLY

After 8 weeks of all these monster symptoms, I had a Nerve Bock of the Pudendal Nerve, under CT scan guidance. Cortisone & lots of numbing meds were injected.
I got NO improvement, SO....it is ruled that I do NOT have PNN.
In researching & with my Dr & chiropractors help, tomorrow I go to an highly recommended Pelvic Floor Therapy! I spoke with one of them. It's MORE THAN LIKELY something triggering these pelvic floor symptoms.
Some of their therapy is uncomfortable, but she says I should start getting some relief with these treatments. I am VERY hopeful!!

REPLY

I hope you get some relief. What country or state are you located? I've had pudendal neuralgia symptoms for 20 months now.

REPLY
@cake

I hope you get some relief. What country or state are you located? I've had pudendal neuralgia symptoms for 20 months now.

Jump to this post

Bless your heart! I am in Charleston, SC. Where are you? Please send me a private message if you want to exchange contact information and you want to discuss anything further. We are both ' poor souls', but will figure this out !!😍

REPLY
@1mepnurse

Bless your heart! I am in Charleston, SC. Where are you? Please send me a private message if you want to exchange contact information and you want to discuss anything further. We are both ' poor souls', but will figure this out !!😍

Jump to this post

I'd love to converse. This is such a lonely condition. I'm in Wisconsin. I'll email you later or tomorrow.
Helen

REPLY
@1mepnurse

Bless your heart! I am in Charleston, SC. Where are you? Please send me a private message if you want to exchange contact information and you want to discuss anything further. We are both ' poor souls', but will figure this out !!😍

Jump to this post

Hello @1mepnurse, You will notice that we have removed your email address from your post to protect your privacy and prevent spammers from getting your email address. We encourage members who want to exchange personal contact information like email addresses and phone number to use the private message function of Connect.

How to Send a Private Message - https://connect.mayoclinic.org/get-started-on-connect/#send-private-message

REPLY
@johnbishop

Hello @1mepnurse, You will notice that we have removed your email address from your post to protect your privacy and prevent spammers from getting your email address. We encourage members who want to exchange personal contact information like email addresses and phone number to use the private message function of Connect.

How to Send a Private Message - https://connect.mayoclinic.org/get-started-on-connect/#send-private-message

Jump to this post

Thank u sir !!

REPLY
Please sign in or register to post a reply.