Pudendal Nerve Entrapment

Based on Anatomy

 

 

The pudendal nerve arises the sacram sacral spinal nerve roots S2, S3 and S4. 

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After re-entering the pelvis, it accompanies the internal pudendal artery and vein, coursing anterosuperiorly (in front and above) through the pudendal canal (also known  as Alcock’s canal) where the pudendal nerve divides into three branches in this order: 

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1. Inferior Rectal nerve (back) – innervates the perianal skin and lower third of the anal canal.

2. Perineal nerve (middle) – innervates the skin of the perineum, labia minora, majora or posterior scrotum.

3. Dorsal nerve (front) of the clitoris or penis – innervates the skin of the penis or clitoris. 

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Pudendal Nerve Entrapment (PNE) syndromes are subdivided into four types based on the location of the compression:

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• Type I - Entrapment below the piriformis muscle as the pudendal nerve exits the greater sciatic notch.

• Type II - Entrapment between Sacrotuberous Ligament (STL), the larger of the two and stabilizer of the pelvis, and Sacrospinous Ligament (SSL) is the most common site of pudendal nerve entrapment.

• Type III - Entrapment inside the Alcock aka Pudendal Canal (where PN first splits, into the rectal branch) - most common

• Type IV - Entrapment of terminal branches (at the far end) or distal part of each of the three branches)

 

A Magnetic Resonance Neurography (MRN) can identify some entrapments in Proximal section or Rectal Branch but not the two Distal branches (Perineal and Dorsal).

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Conventional MRIs can sometimes show nerve abnormalities, but MR Neurography (MRN) imaging is more sensitive, since it's specially tailored to image nerves. MR neurography uses advanced techniques to depict small nerves that may not be visualized on standard MRI exams.

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No examination at the moment allows doctors to see whether the pudendal nerve is compressed or not. A doctor can only be certain of PNE once they have entered the area through surgery and can see one of the entrapments listed above.

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Pudendal Neuralgia Alliance

contact@pudendalneuralgiaalliance.org

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