Symptoms of Pudendal Nerve Entrapment
 

The symptoms of pudendal nerve entrapment syndrome arise from changes in nerve function and structural changes in the nerve that arise from the mechanical effects of compression. These changes give rise to so-called "neuropathic" pain. Therefore, the main symptom of pudendal nerve entrapment (PNE) is pain in one or more of the areas innervated by the pudendal nerve or one of its branches. These areas include the rectum, anus, urethra, perineum, and genital area.

Neuropathic pain has many manifestations, most commonly spontaneous or evoked burning pain (also called "dysaesthesia") with or without a component of severe lancinating (sudden, 'electric shock-like') pain. Other manifestations of "neuropathic pain" include a deep aching pain/sensation, increased appreciation of a sensation to any physical stimulus ("hyperaesthesia"), exaggerated sensation of pain for a given stimulus ("hyperalgesia"), pain sensation occurring with stimulation which doesn't normally cause pain ("allodynia") or an unpleasant, exaggerated prolonged pain response ("hyperpathia").

In women this includes the clitoris, mons pubis, vulva, lower 1/3 of the vagina, and labia. In men this includes the penis and scrotum. But often pain is referred to nearby areas in the pelvis (for example, in male competitive cyclists -it is often called "cyclist syndrom-, who can rarely develop recurrent numbness of the penis and scrotum after prolonged cycling, or an altered sensation of ejaculation, with disturbance of urination and reduced awareness of defecation).

The symptoms can start suddenly or develop slowly over time.

Typically pain gets worse as the day progresses and is worse with sitting. The characteristic feature of pudendal nerve entrapment syndrome is aggravation of symptoms with assuming a sitting position, often after a short duration of sitting. Symptoms are typically relieved by standing and are usually absent when lying down or sitting on a toilet seat.

The pain can be on one or both sides and in any of the areas innervated by the pudendal nerve, depending on which nerve fibers and which nerve branches are affected. The skin in these areas may be hypersensitive to touch or pressure (hyperesthesia or allodynia).

Possible symptoms include burning, numbness, increased sensitivity, electric shock or stabbing pain, knife-like or aching pain, feeling of a lump or foreign body in the vagina or rectum, twisting or pinching, abnormal temperature sensations, constipation, pain and straining with bowel movements, straining or burning when urinating, painful intercourse, and sexual dysfunction- including uncomfortable arousal or the opposite problem, decreased sensation.

It is not uncommon for PNE to be accompanied by musculoskeletal pain in other parts of the pelvis such as the sacroiliac joint, piriformis muscle, or coccyx. It is usually very difficult to distinguish between PNE and pelvic floor dysfunction because they are frequently seen together. Some people refer to this condition as pelvic myoneuropathy which suggests both a neural and muscular component involving tense muscles in the pelvic flor.

Some tests can be used to help diagnose PNE, as described in the diagnosis section. However a large part of diagnosis relies on systematic study of the symptoms. This page is aimed at helping patients to determine the strong possibility of PNE from study of symptoms alone. History is also a factor in the diagnosis so it is important to consider possible causes as well as symptoms It can be frightening for the newcomer to read all of these symptoms and can lead to self rationalization that his/her condition cannot be such because it is not so bad at the moment. Remember that most people do not have all the classic symptoms and for most of them the problem started with a small amount of discomfort. Nerves can react in a variety of ways before complaining. So pain may not be the first symptom. Without treatment, over time there may be a progressive worsening of symptoms starting with a small amount of perineal discomfort that develops into a chronic and constant state of pain that does not decrease even when standing or lying down.

Other possible symptoms:

  • The chief symptom is pain in the area innervated by the pudendal nerves such that sitting becomes intolerable.
  • The pain may be lessened when sitting on a toilet seat or a doughnut pillow as this lessens the pressure on the pudendal nerve. Most people simply have to avoid sitting because it is impossible to find a cushion that relieves pain in all areas.
  • The pain is often not immediate but delayed and continuous and stays long after one has discontinued the activity that caused the pain (stop sitting, cycling, sex...).
  • Often the pain is lower in the morning upon awakening and increases throughout the day.
  • There may be extreme pain or tenderness along the course of the nerve when the nerve is pressed on via the vagina or rectum.
  • Pain in perineum.
  • Pain after orgasm.
  • Loss of sensation with difficulty achieving orgasm.
  • Strange feeling of uncomfortable arousal without sexual desire.
  • Intolerance to tight pants or elastic bands around the legs.
  • Friction and feeling of inflammation along the course of the nerve when walking for too long or running.
  • Constant pain even with standing or lying down.
  • Problem with urinary retention after urination. Need to push to empty bladder. Harder to detect the feeling of urine when passing through the urethra.
  • Urethral burning with or after urination
  • Feeling like the bladder is never empty or feeling the need to urinate even when the bladder is empty.
  • Urinary frequency.
  • Pain after bowel movement. Sometimes sufferers also report pain prior to and during the bowel movement.
  • Painful muscles spasms of the pelvic floor after bowel movement.
  • Constipation.
  • Sexual problems. Men complain of a diminution of sensations. Pain after ejaculation is common. For women pain during and after intercourse is often reported.
  • Scrotum/Testicular pain is possible. The testicle itself is innervated by another nerve however the difference in pain from scrotum/testicle can be hard to detect.
  • Buttock sciatica and everything that goes with it: numbness, coldness, sizzling sensation in legs, feet, or buttock. This is more often due to a reaction of the surrounding muscles to the pain in the pelvic region. It could also be from "cross talk" of the nerves.
  • Low back pain resulting from radiation of the pain.
  • The symptoms can be unilateral or bilateral. If the entrapment is only on one side, the pain can also be reflected to the other side.
  • Some people develop conditions such as complex regional pain syndrome and even post-traumatic stress disorder after prolonged or severe pain.