Damage to the pudendal nerve can occur over time due to entrapment of the nerve—similar to median nerve entrapment at the wrist which is called carpal tunnel syndrome. Damage to the nerve can also occur suddenly as a result of surgery or trauma to the pelvic region, prolonged bicycling—the nerve is compressed between the ischium and a hard object (the seat of the bicycle)—falls, childbirth, or from fracture traction from the fracture table during reduction and fixation of a fractured femur.
The pudendal nerve arises from S2, S3, and S4 and it carries sensations to the external genitals, the lower rectum, and the perineum. The pudendal nerve re-enters the pelvis under the sacrotuberous ligament and gives three branches. The first branch, the inferior rectal nerve, provides rectal tone and perianal sensation. The second branch, the Perineal Nerve, gives scrotal sensation. The third branch, the dorsal nerve of the penis (male) or the clitoris (female), gives branches to the corpus cavernosum.
Symptoms of pudendal nerve palsy include peroneal pelvic pain aggravated by sitting and relieved with standing. Pain is absent when lying down or sitting on the toilet. The pain can come and go and can be a sharp, burning, shooting pain. The pain will usually progressively resolve on its own. Other symptoms are as follows: loss of sensation or numbness, affecting the glans penis and scrotum in men and the perineum and labia in women, difficulty with bladder and bowel functions, and sexual dysfunction.
Treatment options are typically conservative, as the condition is usually transient and will improve over time. Treatment includes:
· Physical therapy
· Stretches and exercises
· Anti-inflammatory medications
· Injections/nerve blocks
· Surgery (as a last resort)
Prevention options for bicyclists consist of changing the sitting position while riding the bicycle and changing the seat from a narrow seat to a wider seat.