Pudendal Neuralgia

ABSTRACT

Pudendal neuralgia (PN) involves sharp pain along the course of the pudendal nerve.It is often aggravated with sitting. Many current therapies which include medication management, decompression surgery, nerve blocks , and neuromodulation. The management for PN has not been determined. This nerve is responsible for sensation from external genitalia in both male and female.This nerve is responsible for allowing signals around the fascia or skin of anus and thus able to supply motor conduction in both external and internal sphincters.Ayurveda is an ancient science which focuses to cure any disease through herbal remedies and diet plan. Let’s discuss Pudendal nerve entrapment and its herbal treatment Planet Ayurveda, so as to cure this condition completely.

Pudendal Neuralgia

INTRODUCTION

We begin our discussion with pudendal neuralgia and Anatomy of pudendal nerve so as to get a basic idea about Pudendal nerve entrapment and its types to understand its severity. Pudendal neuralgia is caused by pudendal nerve entrapment (PNE).It is a chronic disease and is termed as neuropathic pain syndrome. It is present in the pudendal nerve region. Both male and females are affected by it. Due to unawareness and undiagnosed conditions it affects the purpose of healthy life.

Anatomy of the Pudendal Nerve

The pudendal nerve arises from the S2, S3, and S4 roots of ventral rami of the sacral plexus. It carries motor, sensory and autonomic fibers.  But an injury to the pudendal nerve may generally affect the sensory nervous system more than motor nervous system. Piriformis and coccygeus muscles are the two muscles  where its branches may pass and are generally present between these two muscles. It exits the pelvic cavity through the greater sciatic foramen which is ventral to the sacrotuberous ligament. Later it  traces  medially to and beneath  the sacrospinous ligament at the ischial spine level so as  to enter in  the pelvic cavity through a lesser sciatic foramen. The pudendal nerve  then passes in the pudendal canal,  also called the Alcock canal. The pudendal nerve ends  in the ischioanal fossa.

The pudendal nerve entrapment syndromes is subdivided into four types which is  based on the level of compression.

Type I – It is an entrapment below the piriformis muscle.Here the pudendal nerve makes a path for existence from the greater sciatic notch.

Type II – It is the most common cause of nerve entrapment.It is present  between sacrospinous and sacrotuberous ligaments .It is the most common cause of nerve entrapment.

Type III – It is an entrapment in the Alcock canal.

Type IV – It is an  entrapment of terminal branches of the pudendal nerve.

WHAT ARE THE CAUSES OF PUDENDAL NERVE ENTRAPMENT?

Pudendal nerve entrapment can occur from mechanical or non-mechanical type of injury.

The mechanical type of injury can be due to transaction,compression, or stretching.

The  compression caused by PNE is the most common cause amongst the mechanical type of injury. Viral infections such as  (HIV, herpes zoster )  diabetes mellitus, multiple sclerosis are the non mechanical cause of pudendal nerve entrapment.

The first  case of pudendal neuralgia occurs due to cycling. It  results due to a constant  pressure on the Alcock canal.

Here are the causes of pudendal neuralgia are:

  • Pelvic surgery –  It is the most common cause of pudendal neuralgia. Here the incidence increases if there is a mesh placement surgery .  In cases of chronic persistent pain ,there is a need for mesh replacement.
  •  In Childbirth normal  vaginal delivery causes a stretch of pelvic floor muscles by the fetal head, which  ultimately results in pudendal nerve damage.
  • It is generally seen in cases of chronic constipation.
  •  It is generally seen in Excessive cycling. Here the condition occurs because of chronic perineal microtrauma.This may result from fibrosis in the pudendal canal and it also affects the sacrotuberous and sacrospinous ligaments.
  • It is generally seen in those people who constantly sit ,which help to contribute to such a condition.

WHAT ARE THE FEATURES OF PUDENDAL NERVE ENTRAPMENT?

  1. It causes numbness, pain and dysfunction where there is a course of the pudendal nerve .It includes genitalia, rectum, and terminal urinary tract.
  2. Sexual dysfunction, including dyspareunia, and male impotence experienced by male patients.
  3. Patients may feel Sphincter dysfunction presenting as fecal incontinence and urinary hesitancy.
  4.  Patients may feel foreign body sensation in the anus, rectum, urethra, or vagina.

WHAT ARE THE PHYSICAL EXAMINATION OF PNE?

  • The physical examination in PNE patients is normal. Exception is for pain production in PNE patients. Here the symptoms depend on the location of entrapment.
  • If the pudendal nerve gets entrapped at the sacrospinous ligament or ischial spine then it causes pain medial to the ischium part of pelvic bone.
  • Patients may experience   tenderness over the greater sciatic notch which results in the nerve entrapment at the greater sciatic notch.
  • Generally patients may experience entrapment at the piriformis which leads to   tenderness and spasm of piriformis muscle.
  • Lastly, the patients may experience entrapment at the Alcock canal and obturator internus which results in spasm and tenderness of the obturator internus muscle.

WHAT ARE THE SIGNS AND SYMPTOMS OF PUDENDAL NERVE ENTRAPMENT?

These are the following signs and symptoms which are observed by patient during PNE:

  1.  The patient may feel pain in the buttock region.
  2. The patient may experience pain in the medial thigh (which indicates obturator nerve)
  3. The patient may experience pain in the suprapubic region.
  4. The patient may experience increased frequency of urine as well as  pain during urination.
  5.  The patient may experience pain after ejaculation.
  6. The patient may experience Pain which worsens after sexual intercourse.
  7. Erectile dysfunction can be seen in male patients.

WHAT ARE THE DIAGNOSTIC TESTS FOR PUDENDAL NERVE ENTRAPMENT?

The following tests can help in the diagnosis of Pudendal nerve entrapment

  1. Diagnostic blocks
  2. Quantitative sensory
  3.  High-frequency ultrasonography
  4. MRI (magnetic resonance imaging)

ACCORDING TO MODERN SCIENCE WHAT ARE THE TREATMENT FOR PUDENDAL NERVE ENTRAPMENT?

  1. Conservative
    It is one of the utmost important parts of the treatment. Moreover if cycling causes pain, the patient should use proper padding or stop the cycling. Patients who present with pain on prolonged or constant sitting work. He/she should adopt lifestyle modifications to minimize constant  sitting habits.
  2. Physical therapy
    Physical therapy helps in the relaxation of pelvic floor muscles and thus  by releasing muscle and spasm lengthening.
  3. Pharmacologic therapy
    The drugs  which are used for pudendal nerve entrapment are muscle relaxants, analgesics, and anticonvulsants (including  pregabalin and gabapentin).
  4. Pudendal nerve block
    The most common technique to diagnose Pudendal nerve entrapment is  CT scan.

WHAT IS THE CONCEPT OF PUDENDAL NERVE ENTRAPMENT ACCORDING TO AYURVEDA?

Nirukti (ORIGIN)

According to Ayurvedic shabdakosha (dictionary)  the sanskrit word “avarana”justifies avarodha gatinirodha. It means resistance or obstruction or friction to the normal movement  of vata. Vata dosha is the gatyatmak dravya  ( denotes movement) within the body. Thus  its normal movement  is vitiated or hampered thus vata dosha  becomes avrita. C.Chi. 28/4 reference

According to Charak chikitsa Acharya Charak Avyahatigati (movement
of Avyahatigati ) explains the normal state  of vata dosha and whenever vata dosha remains in prakritawasta (normal status)then  the person lives a healthy life for a hundred years.
C.Chi.28/60

WHAT ARE THE CAUSES OF VATA PRAKOPA?

Vata prakopa is mainly due to dhatu kshaya or avarana of marga (blockage of channels). Acharya Chakrapani named it as pratibanadha. Vata is a sukshma margaanusari and preraka. So when the natural actions of vata are hampered then there is elevation of vata dosha.

WHAT IS THE CONCEPT OF GATAVATA (MOVEMENT) AND AVARANA IN AYURVEDA?

If we want to understand Aavarana  then the following concept should be kept in mind. There are two types of Dhatu (Body tissues) that can be classified into two types: Asthayi  dhatu and Sthayi dhatu. Asthayi dhatus (Unstable body tissue ) are  dravaswaroop (in liquid state) and  they are generally get  into  conversion state   and they are being vikshepita ( in movement )  from their mulasthan  (origin) throughout the sharir (body) for the purpose of poshan (nourishment) of the sthayi dhatu  (stable body tissue).This process  takes place in marga which are known as srotas channels and  hence marga (channels) is one of the synonym used for srotas channels). Many synonyms are used for srotas known as  sira, dhamani,  rasavahini , rasayani,  nadi for avarana.

WHICH TYPE OF AVARANA IS CORRELATED WITH PUDENDAL NERVE ENTRAPMENT?

It refers to Kaphaavrita vata (Kapha dosha hampers vata dosha).Here Kapha obstructs vata dosha.

WHAT ARE THE SYMPTOMS OF KAPHA AVRITA VATA?

Here are the following symptoms of kapha avrita vata.

  • Reference charak chikitsa 28/62
  • The patient may experience coldness
  • The patient may experience heaviness in the body.
  • The patient may experience pain in the body.
  • Its symptoms reduce consumption of hot foods,sour ,salty taste and pungent food.
  • The patient may desire to starve.
  • The patient may eat light foods and exercise.
  • The patient may try to consume dry and hot foods.

HERBAL REMEDIES PROVIDE BY PLANET AYURVEDA.

Planet Ayurveda provides 100% pure, non toxic, no preservative medicine.
Ayurveda is an ancient science .Planet ayurveda provides the following herbal remedies with the help of qualified MD doctors.
Let’s discuss it.

1. HAKAM CHURNA

It has an ability to retrieve the normal digestion thereby putting a stop to vata disturbance.It contains seeds Chandershoor (Lepidium sativum)diminishesKapha dosha and increases  pitta dosha in the body. Moreover it also contains seeds of  Kalonji (Nigella sativa), Methi (Trigonella foenum graceum) and seeds of Ajwain (Trachyspermum ammi).So it helps in weight loss by balancing kapha dosha.

DOSAGE: 1 teaspoonful once or twice daily.

2. BOSWELLIA CURCUMIN

This herbal formulation is made from two herbs  called Shallaki (Boswellia serrata), and Haridra (Curcuma longa).Both the herbs show an excellent result in minimizing the swelling near genital area.

DOSAGE: Two capsules twice daily after a meal with warm water.

3. KAISHORE GUGGUL

These herbal formulation contains the following herbs such as:

  1. Guduchi (Tinospora cordifolia)
  2. Pippali (Piper longum)
  3. Ginger (Zingiber officianle)
  4. Guggul (Commiphora mukul), etc.

Kaishore Guggul helps in balancing Vata pitta reduction.It is useful  in a case of Pudendal neuralgia.

DOSAGE:Two Tablets twice daily after meals with water.

4. Vikram prash jelly

It is a type of herbal remedies which is known as rasayan.It contains Herbs such as Bilva (Aegle marmelos) balances kapha and vata dosha.Moreover it contains herbs such as Agnimantha (Premna mucorata),Shalparni (Desmodium gangetium) help to cure Pudendal nerve entrapment by subsiding Vata and kapha dosha in the body.

DOSAGE: 1 -2 Teaspoonful Twice daily ,preferably with milk.

CONCLUSION

Pudendal Nerve entrapment is easily curable with the help of Planet Ayurveda herbal remedies and diet plan. People don’t understand the importance of Ayurveda and generally relies on Allopathic medicine leading to many side effects. Hence to cure this disease from any side effects, it is necessary to understand ayurvedic concept which is responsible for PNE. Lastly, PNE patients understand the importance of Ayurvedic science which can cure any disease without any side effects.