Health Organization for Pudendal Education

Hello everyone. I recently underwent a neurography due to symptoms related to the pudendal nerve: urinary frequency, delay in starting and weakness in continuing the urinary flow, contractions in the pelvic area when urinating and defecating, calf and foot sole pain if I spend too many hours sitting.

Findings are as follows:

"The neurovascular bundle in Alcock's canal appears as a hypointense linear band just medial to the inner border of the internal obturator muscle, in an oblique axial STIR sequence with faint high intensity of the signal from the fibers of the bilateral pudendal nerve in close contact with prominent vessels predominantly on the right side, compatible with irritation and edema related to neuritis, according to the clinical presentation.

Conclusion

Findings related to mild edema of the bilateral pudendal nerve, predominantly on the right side, with close contact to prominent vessels, consistent with neuritis, according to the clinical presentation. No space-occupying lesions, nodular images, or focal signal intensity alterations of solid or cystic nature are identified."

Do you think this diagnosis is the cause of the urinary symptoms? Is there anyone in the forum who has experienced this and is undergoing treatment?
For now, it's only an irritation/edema of the pudendal nerve classified as neuritis. However, I'm not sure if it's being caused by the internal obturator muscle or the blood vessels.
If anyone can help me with this interpretation, I would appreciate it.

Hi SrPudendo,

I don't know enough about anatomy to follow the description of what the radiologist found, but I will say that my MRI showed edema on the left side near the intersection of the SS and ST ligaments, exactly where it seemed like the pain originated. And that asymmetric edema was, in my MRI, thought to be a sign of pne. It sounds like your symptoms are largely urinary, but if the edema is creating pressure on the pudendal nerve and/or bladder, I guess it makes sense that you'd have urinary frequency. What did the ordering doctor think? Did they see a connection?

April

SrPudendo wrote: ↑Sun Jun 16, 2024 11:46 pm Do you think this diagnosis is the cause of the urinary symptoms? Is there anyone in the forum who has experienced this and is undergoing treatment?
For now, it's only an irritation/edema of the pudendal nerve classified as neuritis. However, I'm not sure if it's being caused by the internal obturator muscle or the blood vessels.
If anyone can help me with this interpretation, I would appreciate it.

The diagnosis could potentially be the cause of the urinary symptoms because the pudendal nerve innervates one of the bladder sphincters. I experienced urinary symptoms, and I underwent PNE surgery because it was quite evident that I had a nerve entrapment, but I don't know if you have a nerve entrapment or not. This article lists the criteria for determining if you have a nerve entrapment. https://www.pudendalhope.info/wp-conten ... iteria.pdf
Capricorn recently posted a great article with an overview for determining if you have a nerve entrapment. https://www.ncbi.nlm.nih.gov/books/NBK544272/

Your neurography report is very detailed but the question is, what is causing the edema/neuritis? The neurography report doesn't answer that question. I have seen MRN reports that showed a back-up of blood in some of the blood vessels which is suggestive of a nerve compression that is causing the blood to pool in the vessel, but I don't know if that is what is causing the neurovascular bundle (blood vessels and nerves) in Alcock's canal to be hyperintense on your report. That would be my suspicion just based on what I've read and learned over the years, but I'm not a physician. Hopefully your doctor can tell you, as April suggested. Have you had any other diagnostics such as pudendal nerve blocks or PT evaluation? If you just have tense muscles, maybe pelvic floor PT would help. But, if the nerve and blood vessels are encased in the muscle fascia or if the muscle is enlarged, some doctors will release the nerve from the fascia via surgery or they will cut away some of the muscle. Or if the nerve/blood vessels can potentially be compressed between ligaments causing a back-up of blood in the blood vessels.

Violet