The pudendal nerve originates from the sacral plexus (S2-S4). It has both sensory and motor fibres. The sensory pudendal nerve branches into 3 smaller nerves: the inferior rectal nerve, the perineal nerve (which supplies the perineum, vagina, male scrotum, labia, and urethra), and the dorsal nerve of the clitoris or penis. The motor branch of the nerve supplies the external anal sphincter, sphincter muscles of the bladder, and the muscles of the pelvic floor.
Irritation of the pudendal nerve, i.e. pudendal neuralgia, may result in sensory symptoms in any or all areas it supplies and spasms of the muscles supplied by it. A common site for pudendal nerve irritation may be at the Alcock’s Canal and/or at the obturator internus muscle. The sensory symptoms could manifest as itching, burning, tingling, cold sensations, and pain. The sensory symptoms may extend into the groin, abdomen, legs, and buttocks.
Pudendal neuralgia can occur in men or women. Signs and symptoms may include the following, but they may vary between individuals:
- Pelvic pain with sitting, but improvement with standing or sitting on a toilet seat.
- Discomfort with tight clothing.
- Bladder and/or bowel symptoms (hesitancy, frequency, retention, constipation)
- Dyspareunia and/or pain/spasm after orgasm
- Possible abnormal pudendal nerve motor latency test (This may NOT be present in pudendal neuralgia)
- Pudendal nerve block may assist in decreasing symptoms
Physical Therapy Treatment may consist of:
- rehabilitation of the pelvic floor, abdominal, gluteal, lumbosacral and hip rotator muscles
- pudendal nerve mobilization, connective tissue mobilization and myofascial trigger point release of the surrounding muscles and tissues.
- range of motion and strengthening of certain muscles to improve core and lower extremity balance and stability.