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PUDENDAL NERVE RELEASE
Pudendal nerve entrapment is a rare, but disabling problem. It causes severe, intense, throbbing pain in the pelvic floor (anywhere from the inferior buttocks, to the anus, to the genitalia). It is typically triggered by sitting and relieved by standing, although most patients are able to sit on a toilet seat without pain. Bending, stooping or lifting will often cause the pain as well. For most patients the pain is so severe that they cannot tolerate sitting more than a few minutes at a time, and subsequently they are unable to drive, sit at work or enjoy a movie or restaurant. Pudendal nerve entrapment is diagnosed by listening carefully to the patient’s history, doing a set of special nerve function tests and observing the results of diagnostic nerve blocks with local anesthetic.
Pudendal nerve release is an option that is usually considered after more conservative therapies such as lifestyle changes, pelvic floor physical therapy, and nerve blocks have not proved to be successful. According to research, the release does not always mean a cure to the pain.
The Pudendal Nerve is located between 2 ligaments in the pelvic floor. The top ligament is called the sacrotuberous ligament (ST) and the bottom ligament is called thesacrospinous ligament (SS). The cause of Pudendal Nerve Entrapment is sometimes unknown and other times some patients can pinpoint the exact activity that occurred when the pain struck for the first time. It can be caused by prolonged sitting, a trauma, heavy lifting or surgery. One hypothesis is that the patient is predisposed to PNE and something happens to trigger it.
The entrapment of the nerve can be caused by tight muscles, ligaments or an unaligned pelvis causing undue pressure on the nerve. These conditions cause the nerve to rub on one of the ligaments that encase it. This irritation is what causes the pain and what needs to be repaired. There are several different approaches to the release, but the method performed at HOSH is the transgluteal approach. It is probably the most widely used method because it allows the greatest visualization of the nerve during surgery.
An incision is made in the buttock on either or both sides. It extends through the gluteal muscles. A section of the ST ligament is removed and the SS ligament is divided releasing any compression at the ischial spine. The pudendal canal is explored and an incision is made to release the nerve from any binding fascia.
ADVANTAGES AND DISADVANTAGES
The procedure takes approximately one hour, and the patient stays in the hospital overnight. The best physical therapy for recovery is walking. There are advantages and disadvantages to this approach of release. The advantages of this method are that it allows the best visualization of the pudendal nerve, and if the nerve were entangled in the ST ligament, it allows for the physician to release the nerve from entanglement. The disadvantage is that this method produces a relatively large incision.
A successful procedure is if at least a 50% reduction in pain and symptoms is achieved. The key to success is early diagnosis. After the release, the nerve needs to repair itself internally from the deterioration caused by chronic entrapment. That being said, the fewer repairs the nerve has to make, the better the chance for success. That is a lengthy process; it can take up to a year or longer for the pain to finally resolve.
CONDITIONS TREATED BY PUDENDAL NERVE RELEASE
SYMPTOMS TREATED BY PUDENDAL NERVE RELEASE
Anus pain
Burning sensation in buttocks
Pain in buttocks when sitting
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Severe pain in buttocks
Throbbing pain in buttocks |
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