What is Pudendal Nerve Compression (Alcock Duct Syndrome)?
Pudendal nerve compression is an important cause of chronic pelvic pain that is rare and difficult to diagnose. It is also known as Alcock Duct Syndrome. Pudendal nerve compression refers to a pathological, very severe pain that occurs when the pudendal nerve is compressed within its anatomical path. It can often get stuck while passing between the ligaments (Sacrospinosis and Sacrotuberous ligament). If it gets stuck while passing through the Alcock Canal, also called the Pudendal canal, this is called Alcock Canal Syndrome.
What are the complaints in patients?
This pain is seen in the areas stimulated by the pudendal nerve or its branches. These areas are the clitoris, mons pubis (where genital hair is located), vulva, lower 1/3 of the vagina and lips in women. However, although the pain is usually unilateral, it can be felt in the entire pelvis.
Symptoms may start suddenly or increase over time. Typically, the pain gradually increases throughout the day and worsens with sitting. Pain may be unilateral or bilateral, depending on which nerve branches are affected. However, clinically it usually presents as unilateral somatic pain. The skin in these areas may also be very sensitive to touch and pressure.
Possible symptoms include burning, numbness, tenderness, electric shock or stabbing pain, foreign body or obstruction in the vagina and rectum. Lump sensation, bending, squeezing sensation, constipation, pain during bowel movements, burning during urination, pain during sexual intercourse, sexual dysfunction and loss of sensation may be present.
What is the Cause of This Painful Disease?
The reasons include repetitive mechanical trauma in the pelvic area (sitting for long periods of time, cycling for many years, lifting weights), heavy pregnancy, difficult These include childbirth, inflammatory or autoimmune disease, endometriosis, recurrent infection, accident-fall or surgery affecting the pelvic area. However, it can also occur without any obvious clinical history.
How is the diagnosis made?
Pudendal nerve definitive diagnosis of compression There is no test that makes a diagnosis. Diagnosis is made by determining the patient's history, symptoms, conditions that reduce or increase pain, and a good neuropelveological examination. There are very few doctors in the world who receive this training. During the examination, the affected nerve root is examined for pain and loss of function. The functions of the nerves in the entire pelvic region can be investigated by MRI and CT, as well as the presence of a mass that may cause pressure on the nerve. The most important imaging method used in diagnosis today is 3 Tesla MRI and tractography. PNMLT (pudendal nerve motor latency test) is a test similar to EMG that helps evaluate the nerve.
What is Pudendal Nerve Blockage? How is it done?
Local anesthesia applied around the nerve using a very thin and long needle is used to reduce the pain that develops as a result of pressure on the nerve by anesthetizing it. The block is usually applied vaginally to the area of the ischial bone prominence where the nerve between the sacrospinous ligament and the sacrotuberous ligament is compressed, and for this purpose, this area is controlled with a finger and local anesthetic is administered. The disappearance or decrease of pain during the effect of the local anesthetic agent suggests that there is compression at some level of the pudendal nerve. Pudendal nerve blockade is a very safe procedure in experienced hands. This should be done by people who have received training.
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