Pudendal Nerve

Original Editor - name here

Top Contributors - Manisha Shrestha, Lucinda hampton, Kim Jackson, Wendy Snyders and Cindy John-Chu

Description

The pudendal nerve is a mixed nerve having sensory, motor, and autonomic functions.

Course

• The nerve travels anterior to the piriformis muscle then passes between the sacrotuberous and sacrospinous ligaments, which are analogous to a "clamp" or "lobster claw," "pinching" or impinging on the nerve.
• Upon leaving this site, the nerve travels through the pudendal canal (Alcock canal) and divides into the perineal nerve, the dorsal nerve of the penis or clitoris, and the inferior rectal nerve.

Root

S2,S3,S4

Clinical relevance

• Pudendal Neuralgia
• Pudental Nerve Entrapment Syndrome
• Pudental Nerve Injury

Assessment

History

Common causes for pudendal nerve injury include:

• Prolonged sitting (e.g., seamstress, computer operators, judges, concert pianists, locomotive engineers)
• Repetitive hip flexion (sports activities, exercising, jogging, cycling)
• Direct trauma includes falls, motor vehicle accidents, vaginal delivery and pelvic surgeries, especially when using mesh (eg: surgeries for urinary incontinences, total abdominal hysterectomy)
• Radiation therapy especially in males treated for prostate cancer and patients treated for rectal and gynecological cancers  

Pain Assessment

• Patient with pelvic pain (especially perineal and genital) with or without concurrent sexual, bladder, or bowel symptoms
• Gradual onset of pain except for acute trauma
• Pain is less in morning and progress with progression of the day
• Type of pain is usually burning pain , but may also experience tingling, aching, stabbing, and shock-like pain
• Pain aggravates while sitting and relieves when standing, lying down, or seated on a toilet.
• Pain distribution may be limited or extensive and may include the vulva, vagina, clitoris, perineum, and rectum in females; glans penis, scrotum, perineum, and rectum in males
• Other symptoms associated with PN include urinary frequency, urgency, symptoms mimicking interstitial cystitis, painful ejaculation, dyspareunia, painful nocturnal orgasms, and persistent sexual arousal.
• Foreign body sensation

Physical Examination

• Sensory
• Motor
• Autonomic

References

Original Editor - Manisha Shrestha Top Contributors - Manisha Shrestha, Lucinda hampton, Kim Jackson, Wendy Snyders and Cindy John-Chu