Pudendal Neuralgia

Learn more about pudendal nerve entrapment and its variations

Symptoms of pudendal nerve entrapment include pain or numbness involving the area between the legs, including the genitals and occasionally some of the inside of the thigh, typically only one side is affected, and the pain may be aggravated by sitting.
The diagnosis is based on matching the affected area to the areas supplied by the pudendal nerve, and MR Neurography imaging can identify entrapments. MR-injections can confirm the diagnosis and may also offer relief.
What causes the problem? There are four common sites of nerve entrapment that can cause a pudendal nerve syndrome. The nerve may be entrapped as it :
  • Passes under the piriformis muscle;
  • Crosses the sacrospinous ligament and dives under the sacrotuberous ligament;
  • Travels across the obturator foramen within the Alcox canal; and
  • Upon exit from Alcox canal and branching in the perinea! area (between the legs)
Another cause is entrapment or irritation of the Impar ganglion on the internal surface of the coccyx
How can it be treated? At NIMA, Dr. Aaron Filler uses open MR guidance to inject anesthetic, steroid, or anti-scarring materials at the various possible entrapment points. In some cases, injections such as these help relieve symptoms, but most often the injections serve to confirm the diagnosis and pinpoint the cause.
Dr. Filler has also developed minimal access surgical treatments that are directed at releasing the nerve entrapments. In some pa-tients, this involves cutting or trimming the piriformis muscle. In other patients, the sacrotuberous or sacrospinous ligaments must be cut or trimmed. Others require dilation of the Alcox canal.
Overall, the surgical treatments for pudendal nerve entrapment syndrome at NIMA are both novel and effective.Dr. Fillers outcomes have success rates of 85-90% which exceed the uncertain outcomes of older types of puden-dal nerve surgery. Many patients can expect significant relief of symptoms from effective treatment - often within days of the surgery.
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