Health Organization for Pudendal Education

Hello friends,

My pain/numbness is from anus to clitoris. Anyone have a guess as to which branch of the nerve I may have entrapped? I'm still learning the anatomy of all this stuff. No ischial tuberosity pain.

thanks,
cari

Cari, the area you are describing is the saddle area typically innervated by the PN. My PN pain was not so much right on the ischial tuberosities either but more to the inside of them however, as the pain progressed it was everywhere -- just felt like I had been hit with a baseball bat throughout the pelvic region but part of that may have been due to muscles going into spasm.

I would guess (and that's really all it is) that you do have PN and possibly at a point after alcocks canal and therefore may be one of the branches of the pudendal nerve.I am basing this on Dr Hibner's statement that pain at the ischeal tuberosity is from Alcock's canal which I think would actually be a good survey to do with those who have had entrapment there, actually confirmed with surgery.
With the nature of nerve pain travelling distally down a nerve from any irritated/entrapped site could pain at ischeal tuberosity occur if the problem began further up ie ss and st ligaments I wonder, again a good survey? we might be getting somewhere if that could be found to be the case (or not) although there may always be exceptions.
The point Violet made about muscle involvement complicating the issue must also be taken into consideration BUT muscles may not be able to have any effect on the nerve at this point as it is protected to a good extent in alcocks? ? Obviously some people have different pathologies and the branches of the nerve divide before Alcocks ad are perhaps more exposed.
Is your numbness constant Cari? Do I get a prize if I'm right ?

Thanks for input dear friends...

My numbness is less often than the pain actually. Mostly pain. Sitting is getting intolerable.

Wish the prize could be a big hug because from you all I have gathered so much strength.

I would guess one the anterior alcocks canal or perineal branch but that's just a guesss based on your symptoms. Have you been checked for SI joint dysfunction? Also I know you were asking about meds have you tried amitriptyline?

helenlegs 11 wrote: The point Violet made about muscle involvement complicating the issue must also be taken into consideration BUT muscles may not be able to have any effect on the nerve at this point as it is protected to a good extent in alcocks? ?

Helen, I could be wrong but it's my understanding that alcock's canal is simply a small space that runs between the obturator internus muscle and the levator ani muscles through which the pudendal nerve travels. That's why I believe if those muscles are in spasm they can impinge on the nerve and cause irritation. Sometimes the nerve is entrapped in the fascia of the muscles or as Dr. Bautrant explained it, sometimes the obturator internus muscle is enlarged and that puts pressure on the nerve in alcock's.

Violet M wrote:[ Sometimes the nerve is entrapped in the fascia of the muscles or as Dr. Bautrant explained it, sometimes the obturator internus muscle is enlarged and that puts pressure on the nerve in alcock's.

So if the obturator internus muscle is enlarged, what do they do about that in surgery?

Dr. Bautrant and Dr. Filler sometimes cut part of it away. Not sure about the other docs. I've heard of it being shrunk/atrophied with Botox.

Violet M wrote:

helenlegs 11 wrote: The point Violet made about muscle involvement complicating the issue must also be taken into consideration BUT muscles may not be able to have any effect on the nerve at this point as it is protected to a good extent in alcocks? ?

Helen, I could be wrong but it's my understanding that alcock's canal is simply a small space that runs between the obturator internus muscle and the levator ani muscles through which the pudendal nerve travels. That's why I believe if those muscles are in spasm they can impinge on the nerve and cause irritation. Sometimes the nerve is entrapped in the fascia of the muscles or as Dr. Bautrant explained it, sometimes the obturator internus muscle is enlarged and that puts pressure on the nerve in alcock's.

Thanks Violet,
Had seen surgery pics of it and assumed it was a separate entity Wikipedia comments that it is 'formed by the obturator internus fascia.'

Some surgeons are removing some nerve supply to the OI muscle so it will atrophy and make more space in alcock's canal.