Health Organization for Pudendal Education

Hi,

Does anyone know how to differentiate between hypogastric and pudendal nerve entrapment?

George

It would be based partly on your symptoms, your history, and what a doctor finds during an examination. But you still might need to try a nerve block to the pudendal nerve or a nerve block to the hypogastric plexus to try to isolate which nerve it is.

Violet

Hi Violet,

What is the difference in symptoms if you know?

George

Are you looking at a superior hypogastric plexus entrapment, inferior hypogastric plexus entrapment or iliohypogastric involvement?

This website has a good description of the what the superior hypogastric plexus innervates.
https://arizonapain.com/pain-center/pai ... ic-plexus/
It is difficult to differentiate between that and the pudendal nerve because it innervates a lot of the same structures as what the pudendal nerve innervates but as you can see, the area of possible innervation is a little more widespread than the pudendal nerve which primarily affects the pudendal nerve.

This article discusses the inferior hypogastric plexus although it is more geared toward women.
http://www.obgyn.net/gynecological-onco ... c-surgeons
Here is an article specific to males: https://onlinelibrary.wiley.com/doi/pdf ... 2/ca.10187

Here is an article on the iliohypogastric nerve. I'm sure you can find others.
https://link.springer.com/chapter/10.10 ... 27482-9_40

As you can see, it's not an exact science because the pelvic nerves are many, there can be variations in anatomy from one person to the next, they are small and can be difficult to locate. All of this makes a proper diagnosis difficult.

In the diagnosis, I think the clinical exam by a physician as well as a pelvic floor PT trained in treating pelvic pain is important and this exam should include pressing on the pudendal nerve along the course of the nerve at the ischial spine and Alcock's canal which are landmarks that an experienced examiner should be able to locate. Tenderness in those areas can be an indication of pudendal neuralgia with possible nerve entrapment according to the Nantes criteria article. Even that can be tricky since often the pain is referred or is so widespread it's hard to isolate it precisely. So, the more diagnostic tools you have the better. Also your history is important in the diagnosis.

Violet