Figure. Dr. Aaron G. Filler
Q What is pudendal nerve entrapment and how is it treated?
DR. AARON G. FILLER RESPONDS:
A A nerve entrapment occurs when a nerve becomes pinched, squeezed, or stuck to another tissue in the body, resulting in pain, numbness, and weakness. The most common and widely known entrapment is carpal tunnel syndrome, which occurs when the median nerve gets squeezed at the wrist.
The pudendal nerve carries movement and sensation signals to the skin between the legs, as well as to the urogenital (urinary and genital) structures, rectum, and bladder. An entrapped pudendal nerve can cause pain, numbness, or abnormal function in any part of those structures. Patients with symptoms affecting the lower abdomen and the urological, genital, or rectal structures should be evaluated first by a gynecologist, urologist, or general surgeon. If it becomes clear that the tissues in these areas are normal, the possibility of a neurological syndrome is investigated.
Pudendal nerve entrapment can be diagnosed by an electrical test (pudendal nerve latency test) or by a special imaging technique called magnetic resonance neurography (MR neurography). MR neurography is a specialized MRI that shows the nerves. If an entrapment is discovered, specialists guided by MRI can inject anesthetic, steroids, or anti-scarring materials into muscles along the course of the pudendal nerve. The injections help prove the diagnosis and may also relieve the condition. Recently, medical journals have reported on a variety of less invasive (minimal access) surgeries that can release the nerve entrapment and allow the nerves to heal so the symptoms will resolve.
Aaron G. Filler, M.D., Ph.D
A neurosurgeon who specializes in the treatment of nerve disorders at the Institute for Nerve Medicine in Santa Monica, CA. He is also a former director of peripheral nerve surgery at UCLA.