Pudendal Nerve Entrapment or Pudendal Neuralgia
The basic idea here is that compression of the pudendal nerve in the Alcock’s canal (by impact trauma, an operation in the immediate area, or congenital malformations) can lead to a syndrome of pelvic pain.
Important warning: This is an extremely rare disorder. It was described by a 2010 paper as “an uncommon cause of pain in the pelvic floor”. Please read our in-depth warning about surgery offered for this condition. The surgery to alleviate it should not be entered into lightly. Many people who have “decompression of the pudendal nerve” surgery are still in great pain years later. Some are in worse pain than before the operation, and a significant percentage develop Sacroiliac Joint Dysfunction (SIJD) and pelvic instability due to the severing of the sacrotuberous and sacrospinous ligaments (leaving them unable to play sport, lift weights etc). Only a small handful of doctors in the world will do this operation. It is not mainstream medicine. The operation can cost tens of thousands of US dollars, and most insurances will not cover it. When the operation fails, as it usually does according to reports on our forum, patients are urged to submit to further operations. According to proponents of the theory, PNE can be identified if pain is relieved by anesthetic infiltration of the pudendal nerve. This is an essential criterion, they say, but it lacks specificity since pain related to any perineal disease may be relieved by pudendal nerve block. Our recommendation is that unless you have pain that comes on only when and immediately upon sitting, combined with episodes of penile numbness, and/or urinary or fecal incontinence, do not consider this option before thoroughly investigating the far more common causes of pelvic pain.
It is not unknown for men to be diagnosed with Pudendal Nerve Entrapment or Pudendal Neuralgia, and then end up getting treated (and cured!) with trigger point massage (only called something else such as “Active Release Technique”). Here’s an example.
In the unlikely case that a patient has PNE, he/she will also have some of these symptoms: positional pain worsened by sitting, genital numbness, fecal and/or urinary incontinence. Sitting pain relieved by standing or sitting on a toilet seat is the most reliable diagnostic parameter.
A review study in 2009 found that while some people do have the symptoms of pudendal neuralgia (which would include many people with IC and CPPS), “there is no evidence to support equating the presence of [these symptoms] with a diagnosis of pudendal nerve entrapment”.
Lastly, a 2015 paper from the University of Texas, a study of 13 normal female cadavers, found that the pudendal nerve is routinely “entrapped”, to the point where the authors suggest that there is no such thing as pudendal nerve entrapment, and that attachments (“entrapments”) are normal. This is an extract from the commentary section at the end:
Note that surgeons who perform PNE surgery claim that the pudendal nerve should “glide freely”. The above study clearly shows that this is not the case in most people, thus undermining the basis of the theory of pudendal nerve entrapment.An interesting finding of this study was the fixation of the pudendal nerve (PN) on the dorsal surface of the sacrospinous ligament (SSL). These connective tissue attachments were found not only on the dorsal surface of the SSL-ischial spine junction but within the pudendal canal. Whereas previous authors have noted that the PN is surrounded by a connective tissue sheath in the pudendal canal,(4,9) we found no specific descriptions or assessments of the mobility or connective tissue interactions of the PN on the dorsal surface of the SSL. This finding has potential implications in the surgical treatment of pudendal neuralgia, and it may be misleading to attribute pudendal neuralgia to nerve entrapment. Thus, procedures seeking to decompress the PN may not address the true etiology. In fact, these procedures may potentially result in significant complications, given the complexity of surrounding nerve and vascular anatomy.
Another warning: there are various forums in the internet that promote this surgery, even to anonymous members whose symptoms are identical to CPPS and/or IC. If you disagree with the people who run the forums, you are quickly banned, without discussion or warning. We have information that leads us to believe that the forums may be funded by the surgeons promoting this unusual surgery. Our advice is to avoid these forums.