Pudendal nerve palsy - causes, symptoms & management

1. Pudendal Nerve Palsy

3. • Pudendal neuralgia is a condition that causes pain,
discomfort, or numbness in pelvis or genitals.

4. Content
• Anatomy
• Root value
• Course
• Motor supply
• Sensory supply
• Applied anatomy
• Clinical features
• Management

5. • Nerve roots – S2-S4

6. Motor supply
• Motor – innervates various pelvic muscles, the external
urethral sphincter and the external anal sphincter.

7. Sensory
• Sensory – innervates the external genitalia of both
sexes and the skin around the anus, anal canal and
perineum

8. • Autonomic – carries sympathetic nerve fibres to the
skin of the S2-S4 dermatomal region.

9. Applied Anatomy
• Pudendal nerve entrapment at different levels (ischial spine,
sacrospinous, and sacrotuberous ligament, Alcock's canal) is a
cause of disabling, chronic, and intractable pelvic pain.
• It is often associated with multiple, perplexing functional
symptoms.

10. • It can be unilateral or bilateral.
• Causes
• include compression, stretch, direct trauma, and radiation.
• pain occurs during a compression or stretch maneuver.
• worsens due to repetitive micro-trauma resulting in persistent pain
and dysfunctional complaints.
• compressed during prolong sitting and cycling.

11. Clinical features
• Pelvic pain with sitting
• Sexual dysfunction
• Difficulties with urination and/or defecation.

12. • Neuropathic pain
• – a burning, tingling, or numbing pain
• pain becomes more constant and severely
aggravated by sitting.
• Less pain when sitting on a toilet seat

13. Diagnostic criteria
• Pain limited to the territory of innervation of the
pudendal nerve
• pain predominant during sitting
• pain does not awaken the patient from sleep
• No objective sensory defects

14. Entrapment cite
• Type I, in the sciatic notch
• Type II, the ischial spine and Sacrosciatic ligament
• Type IIIa, the obturator internus muscle
• Type IIIb, the obturator internus and piriformis muscles
• Type IV, the distal branches of the pudendal nerve

15. Management
• Medical management
• Physiotherapy management

16. Medical Management
• Muscle Relaxants
• Analgesics

17. Treatment
• combination of physical therapy, lifestyle changes,
and medicines.
• Pain relieving modalities/ techniques.
• Stretching the muscles of lower back/ Pelvic Floor
Relaxation exercises
• Mobilize the sacro-iliac joints, decreasing tension on
the sacrotuberous and sacrospinous ligaments.

18. Exercises
• Standing backward leg lifts
• Side-lying hip abduction and extension
• Hip extension in the quadruped position
• Cobra pose
• Arch Backs

19. • Patient education for pain and mechanism
• correction of body mechanics, position or activity
modification
• Patient Self-Management: Patient should use a cushion(
Doughnut or C-Shaped) that supports the ischial
tuberosities to elevate the pelvic floor off the seat.