It’s one of those things you probably never think about until, well, something feels off. Maybe it’s a nagging pain when you sit, or some unexpected trouble down there. Sometimes, the culprit behind these very personal issues is a little-known but very important nerve called the pudendal nerve. It’s a key player in your pelvic region, and when it’s not happy, it can certainly let you know.
So, What Exactly is the Pudendal Nerve?
Think of the pudendal nerve as a crucial communication line for the lower part of your body. It’s a major nerve, one on each side of your pelvis, and it’s responsible for carrying messages about sensation and movement to and from your genital area. It’s part of what we call the peripheral nervous system – that’s the network of nerves that branches out from your brain and spinal cord (your central nervous system) to reach all the other parts of your body.
This nerve starts way down in your lower back, from a bundle of nerves called the sacral plexus, and then it travels through the muscles of your pelvic floor – those are the muscles that support your bladder and bowel – eventually reaching your external private parts.
What Does This Nerve Do All Day?
Quite a lot, actually! The pudendal nerve has a couple of big jobs:
- Movement Control (Motor Function):
- Sensation (Sensory Function):
It’s a busy nerve, working behind the scenes to manage some very vital functions.
Understanding the Pudendal Nerve’s Journey and Branches
It’s a bit like a tree, this nerve. It starts from nerve roots in the sacrum (the S2 to S4 levels, if you’re curious), which is that triangular bone at the base of your spine.
From there, the pudendal nerve takes a specific path:
- It winds its way through your pelvis and your buttock area.
- It passes through an opening in your pelvic bone called the greater sciatic foramen.
- Then, it goes through a smaller opening, the lesser sciatic foramen.
- It travels alongside the pudendal artery and vein through a little tunnel called the pudendal canal (or Alcock canal).
- Finally, it splits into smaller branches, each with a specific job:
- Inferior rectal nerve: This one handles your anal sphincter muscle and sensation in that area.
- Perineal nerve: This branch takes care of some pelvic floor muscles, your urethral sphincter, and sensation for the perineum and the labia (in women) or scrotum (in men).
- Dorsal nerve: This is the sensory specialist for the skin of the penis or clitoris, playing a big role in sexual sensation and helping with erections.
It’s quite the intricate network, isn’t it?
When Things Go Wrong: Pudendal Nerve Problems
Sometimes, this hardworking nerve can get into trouble. If it gets squeezed or damaged, it can lead to pain or what we call neuropathy (nerve damage).
One specific condition is pudendal nerve entrapment syndrome, or PNE. This is when something puts pressure on the pudendal nerve, often causing a chronic, sharp, stabbing kind of pain called pudendal neuralgia. It’s not super common – affecting maybe 1 in 100,000 people – but for those who have it, it can be really tough. I’ve seen patients who find even sitting down incredibly painful.
What Can Irritate the Pudendal Nerve?
Several things can lead to pudendal nerve issues:
- Accidents or direct trauma to the pelvic area.
- Complications after pelvic surgeries, like a prostatectomy (prostate removal) or surgery to fix pelvic organ prolapse.
- Diabetes, especially if it’s led to diabetes-related neuropathy elsewhere in the body.
- A difficult labor and delivery during childbirth.
- Prolonged pressure on the nerve. This is something we sometimes see in avid cyclists, for example, from the bike seat.
- Radiation therapy to the pelvic region.
- Less commonly, tumors or cysts pressing on the nerve.
A Helping Hand During Childbirth: Pudendal Nerve Blocks
On a more positive note, we can sometimes use the pudendal nerve to help manage pain. A pudendal nerve block is an injection of local anesthetic that numbs the nerve.
Healthcare providers might offer this during childbirth, especially if an epidural isn’t an option or if extra pain relief is needed for the pushing stage or if an episiotomy (a small cut to widen the vaginal opening) is necessary. It works pretty quickly but mainly numbs the vaginal and perineal area; it doesn’t usually take away the pain of contractions.
Taking Care of Your Pudendal Nerve (and Your Nerves in General!)
While you can’t always prevent nerve issues, there are definitely things you can do to support your overall nervous system health, which includes your pudendal nerve:
- Avoid sitting for super long stretches. If you have a desk job, get up and move around regularly.
- If you’re a cyclist, take breaks and consider a bike seat designed to reduce pressure in that area.
- Manage stress. Chronic stress isn’t great for any part of your body, including your nerves. Things like meditation, gentle walks, or whatever helps you unwind can make a difference.
- Eat a balanced, nutritious diet and try to maintain a healthy weight.
- If you have conditions like diabetes or high blood pressure, work with your doctor to keep them well-managed. These can affect nerve health.
- Think about quitting smoking. Tobacco use can reduce blood flow to nerves, which they really don’t like.
When Should You Chat With Your Doctor?
It’s important to listen to your body. If you’re experiencing any of these, it’s a good idea to make an appointment:
- Chronic pain in your pelvic region, genitals, or rectal area.
- Pain that noticeably gets worse when you’re sitting down.
- Any new or unexplained sexual dysfunction.
- Problems with urinary incontinence (leaking pee) or fecal incontinence (leaking poop).
These symptoms can be unsettling, I know. But there are ways we can investigate and help.
Take-Home Message: Understanding Your Pudendal Nerve
Here are the key things I hope you’ll remember about the pudendal nerve:
- It’s a vital nerve for sensation and muscle control in your pelvic area, including your genitals and sphincters.
- Damage or pressure on this nerve can cause pain (like pudendal neuralgia) and affect bladder, bowel, or sexual function.
- Things like prolonged sitting, cycling, childbirth, or pelvic surgeries can sometimes lead to pudendal nerve issues.
- Lifestyle choices like managing diabetes, maintaining a healthy weight, and avoiding prolonged pressure can help protect it.
- If you have persistent pelvic pain, especially when sitting, or changes in bowel/bladder/sexual function, please see your doctor.
You’re not alone if you’re dealing with these kinds of symptoms. We’re here to help figure things out and find the best path forward for you.
