Pudendal nerve entrapment occurs when that nerve is compressed, such as from a tumor. Symptoms include painful bowel movements and groin pain. Some treatments and exercises may help you manage the pain.
Pudendal nerve entrapment happens when the pudendal nerve, which carries signals from your genital and anal area to your spinal cord, becomes compressed and causes chronic pelvic pain.
Read on to learn about the possible causes of pudendal nerve entrapment, how to recognize its symptoms, and the treatments available for this type of nerve pain.
Possible causes of pudendal nerve compression, also called entrapment, include:
- Putting too much pressure on your pelvis: Activities like riding a bike or not pooping regularly can overwork pelvic muscles and cause inflammation that compresses the pudendal nerve.
- Sitting for a long time: Activities that involve extended periods of sitting, such as working in an office job, are common causes of nerve compression in the lower spine and pelvic area.
- Muscle strains or tightness: Strained muscles or ligaments near the pudendal nerve can put pressure on the nerve and cause pain.
- Damage from surgery: Your pelvic area contains a dense network of nerves. Surgeries like prostatectomy can cause damage or irritation to them.
- Broken or fractured bones: Broken bones in your pelvis can irritate the pudendal nerve.
- Giving birth: Strain and pressure from childbirth can cause compression on or damage to the pudendal nerve.
- Growths, tumors, or cancerous tissue: Growths or tumors in your pelvic area, especially those associated with prostate cancer, can put pressure on the pudendal nerve.
Shooting, stabbing, or burning pain is the most noticeable symptom of pudendal nerve entrapment.
Branches of the nerve that travel to several major parts of your pelvic area can cause pain in your:
- vagina, labia, or clitoris (clitoral branch)
- penis or scrotum (penile branch)
- perineum (perineal branch)
- anus or rectum (rectal branch)
Other symptoms can include:
- pain or sensitivity that feels worse when you put on underwear or tight clothes on your pelvic area
- a feeling of swelling or fullness near your anus, like something is stuck
- a feeling like you need to urinate, even if nothing comes out
- pain or discomfort when you poop
- pain when you have sex (dyspareunia)
- difficulty having an orgasm when you have sex or masturbate
- difficulty getting or keeping an erection (erectile dysfunction)
- loss of feeling in your feet and legs
When to contact a doctor
Contact a doctor if you note any of the following symptoms:
- having a persistent feeling of tingling or numbness in your pelvic or genital area
- feeling like something’s stuck in your anus no matter how often you poop
- feeling like you need to urinate a lot even if very little comes out
- experiencing pain, burning, or stinging when you pee
- experiencing pain or numbness when you have sex
A doctor will likely ask you about your lifestyle and medical history. They’ll also do a physical examination to look for any other causes of pudendal nerve pain.
A doctor may recommend tests, depending on the pattern of pain and other symptoms you’re having. Potential tests include:
- Physical exam: Your doctor will check the strength, reflexes, and sensation in your legs and lower back. This will help them identify signs of a pinched nerve, muscle injury, or nerve damage.
- Digital exam: As part of your physical exam, your doctor might insert a finger into your vagina or rectum to feel for causes of pressure.
- CT or MRI scan: A CT scan or MRI scan can help doctors look at the pelvic area for a tumor that may be the underlying cause of the nerve entrapment.
- Electromyography (EMG): An EMG can show how the nerve responds to electrical signals.
- Nerve blockers: Doctors may inject nerve blockers into the pudendal nerve to see whether numbing the nerve helps reduce your pain.
Treatment for pudendal nerve entrapment depends on how serious the pain is and what’s compressing or damaging the nerve.
You may need to avoid or limit activities that cause pudendal nerve compression to help prevent, reduce, or eliminate the related pain. A doctor might suggest that you:
- Ride bicycles or motorcycles less frequently.
- Rest between long periods of walking, running, or sitting.
- Stand up and move around frequently when you have to sit for long periods.
- Use a standing desk or take a 5- to 10-minute break every hour to stand up.
- Use a seat cushion on the places you sit.
- Reduce how much you strain when you poop by eating more fiber or drinking enough water.
Local anesthetic or corticosteroid injections can help temporarily relieve pain. Anesthetic injections do this by blocking nerve signals. Corticosteroid injections reduce swelling and inflammation.
A healthcare professional will determine which of these methods could help your pudendal nerve compression, based on the cause of your pain. They will usually administer the injections every few months. But these medications are not recommended for long-term use.
Other prescribed medications to help manage pain may include:
- anticonvulsants like carbamazepine
- nerve stabilizers like gabapentin
- tricyclic antidepressants like amoxapine
In some cases, a doctor may recommend decompression surgery. This procedure can remove the cause of compression, such as a tumor or damaged tissue, to relieve the pressure on the pudendal nerve.
While you should avoid some exercises, such as hip flexion exercises and jogging, other exercises can be beneficial. Exercising or stretching your pelvic muscles regularly may help prevent strain or inflammation by strengthening your muscles and improving flexibility.
Your doctor may recommend physical therapy for
- Lie flat on your back and bend your knees, with your feet flat on the ground.
- Breathe out, then breathe in slowly while rapidly flexing and releasing your pelvic floor muscles. Flex your muscles for about 1 second each time.
- Repeat for about 10 flexes. Do this 2–3 times per day.
- Lie flat on your back and bend your knees.
- Inhale through your nose and exhale through your mouth.
- Lift your pelvis and flex your core muscles.
- Slide the heel of your right foot away from your body.
- Slowly inhale while sliding your foot back to your body.
- Repeat 10 times with each leg at least once per day.
- Lie flat on your back or sit on the ground.
- Spend a few moments relaxing and reducing tension throughout your body.
- Place one hand on your chest and the other on your stomach.
- Breathe in slowly through your nose for a few seconds, so that your stomach expands but not your chest.
- Breathe out slowly through your nose.
- Repeat a few more times, with your hands staying on your chest and stomach.
Pudendal nerve entrapment is often treatable, and if treated, it doesn’t cause long-term complications or changes to quality of life. But it can be difficult to treat and it may cause persistent pain and distress.
About 80% of people who receive nerve blockers feel some relief, but this may only last for about 30 days, according to a
And about 60%–80% of people who have severe pudendal nerve entrapment and get surgery also experience significant, long lasting relief, the review notes.
Pudendal nerve entrapment happens when your pudendal nerve is compressed and causes pain. Treatments and exercises are available that may help with the pain.
Reducing this pain can help you continue your daily activities with minimal disruption and improve your quality of life.