Nervus Pudendus Neuralgia

Pudendal nerve neuralgia refers to damage to the pudendal nerve and the associated pain. The damage usually occurs at the greatest constriction during the course of the pudendal nerve, the so-called Alcock’s canal. For this reason, pudendal nerve neuralgia is often referred to as ‘Alcock’ syndrome.

In women, pudendal nerve neuralgia occurs twice as frequently as in men. Typical symptoms of Pudendal Neuralgia are the sudden pain in the perineal region – the area between the anus and the genitals. The pain can be of varying intensity.

Usually, they increase while sitting, as pressure is then applied to the corresponding area. When standing or while sitting on the toilet, pressure is relieved and the pain relieved. In the case of very severe injuries to the pudendal nerve, this can even lead to muscle paralysis and sensory disturbances.

This can even lead to urinary and fecal incontinence, since the injury to the nerve means that the anal sphincter muscles and the pelvic floor muscles can no longer be supplied. In addition to supplying the sphincters and the pelvic floor muscles, the pudendal nerve is also responsible for supplying the penis and clitoris. If the nerve is damaged, sexual function and fertility may be restricted.

Damage to the pudendal nerve can be caused mechanically, for example by pressure on the perineal region when riding a bicycle or special positioning during surgery. However, damage can also be caused by pelvic injuries, the consequences of childbirth or thromboses in the pelvic region. Pudendal neuralgia is usually diagnosed by a urologist or gynecologist, who then refers the patient to a treated neurologist.

What happens if the Pudendal Nerve is pinched?

If the pudendal nerve is pinched, this can cause severe pain. The pain can then usually be localized in the region between the anus and the genitals. They can occur very suddenly and very strongly.

Patients with a pinched pudendal nerve sometimes even describe the sensation as a razor blade. If the pudendal nerve is pinched, it is irritated by the tissue or muscle pressing on it. This irritation sends pain signals to the brain, which can eventually lead to a sudden and sometimes very strong sensation of pain.

The largest constriction through which the pudendal nerve passes is the canalis pudendus, also called the ‘Alcock’ canal. The highest risk of nerve entrapment is therefore present there. The cause of entrapment can be very simple, everyday movements, such as riding a bicycle.