The pudendal nerve anatomy
The anatomy described in this figure is the result of the confrontation between the litterature and dissections done by members of the Groupement Européen de Périnéologie
Videos of dissections are presented on www.Perineology.TV
 | Legend: 1. Sacro-spinal ligament 2. Sacro-tuberous ligament 3. Alcock's canal with the pudendal nerve 4. Nerve of the clitoris (not in the Alcock's canal) 5. Perineal branch of the pudendal nerve 6. Inferior rectal nerve 7. Arcus tendineus fascia pelvis 8. Obturator muscle 9. Piriformis muscle S2, S3 and S4: sacral roots forming the pudendal nerve |
The rectal nerve is separated from the pudendal nerve between the ligaments in 50 % of the cases and is going through the sacro-spinal ligament in 15 % of the cases (Mahakkanukrauh et coll.).
When it is separated form the pudendal nerve, the rectal nerve passed through the posterior fibers of the sacro-spinal ligament at a mean distance of 19 mm from the ischial spine. The pudendal nerve passed posterior to the sacro-spinal ligament at a mean distance of 6 mm in 80 % of the cases and under the ischial spine in the remaining 20 % (Grigorescu, IUGA meeting Athens 2006).
The levator ani nerve originates from S3 and S4. It runs on the levator plate from 3 to 20 mm medial to the ischial spine (Wallner et coll.). It is partly responsible of the innervation of the levator plate. The integrity of this muscle is necessary to avoid perineal descent and its sides effects.
http://www.perineology.com/files/weiss-athens2006.pdf
TREATMENT OPTIONS FOR PERSISTENT PAIN FOLLOWING PUDENDAL NERVE DECOMPRESSION SURGERY
TREATMENT OPTIONS FOR PERSISTENT PAIN FOLLOWING PUDENDAL NERVE DECOMPRESSION SURGERY
Jerome M. Weiss, M.D.
Pacific Center for Pelvic Pain and Dysfunction San Francisco, California
In general, patients expect some pain following decompression surgery. However, six months later when they continue to have severe flares that may eclipse their preoperative symptoms, they suffer desperation and depression. When nerve blocks provide no significant long term relief, we must look “outside the sensitive nerve” or “outside the box” for treatment answers. After evaluating and treating more than thirty post operative patients and approximately 200 that did not require surgery, some of these answers to the treatment questions have emerged.
Many of these post operative pain generators were actually preexisting myofascial dysfunctions that predisposed the nerve to injury and then remained a dominant problem following surgery. Others developed because of the effect that the sensitized nerve and/or surgical trauma had on the surrounding connective tissue, muscles, and ligaments. It is only after these extra neural causes are identified and treated that significant pain relief can be achieved.
More from the link above, sacro-iliac joint dysfunction Love Sharon xx soft hugs xx
In conclusion, successful treatment of persistent post decompression pain requires comprehensive multidisciplinary therapy. The level of pain a patient experiences is the sum total of nerve injury, regional myofascial trigger points, connective tissue restrictions and adverse neural tension, deficient pain modulators and stress. To further complicate the picture, all of these aforementioned factors can perpetuate symptoms by initiating a vicious pain cycle. Some pain flares during the recovery phase can be attributed to the failure to address all of the issues that comprise the whole. An analogy is that of cutting one fiber in a spider’s web which will not release its prey any more than treating one pain component will release the patient from the web of pain. Freedom from pain can only occur when all of the links are severed, since treatment of every component is essential in decreasing the underlying central sensitization.
Pacific Center for Pelvic Pain and Dysfunction San Francisco, California
In general, patients expect some pain following decompression surgery. However, six months later when they continue to have severe flares that may eclipse their preoperative symptoms, they suffer desperation and depression. When nerve blocks provide no significant long term relief, we must look “outside the sensitive nerve” or “outside the box” for treatment answers. After evaluating and treating more than thirty post operative patients and approximately 200 that did not require surgery, some of these answers to the treatment questions have emerged.
Many of these post operative pain generators were actually preexisting myofascial dysfunctions that predisposed the nerve to injury and then remained a dominant problem following surgery. Others developed because of the effect that the sensitized nerve and/or surgical trauma had on the surrounding connective tissue, muscles, and ligaments. It is only after these extra neural causes are identified and treated that significant pain relief can be achieved.
More from the link above, sacro-iliac joint dysfunction Love Sharon xx soft hugs xx
In conclusion, successful treatment of persistent post decompression pain requires comprehensive multidisciplinary therapy. The level of pain a patient experiences is the sum total of nerve injury, regional myofascial trigger points, connective tissue restrictions and adverse neural tension, deficient pain modulators and stress. To further complicate the picture, all of these aforementioned factors can perpetuate symptoms by initiating a vicious pain cycle. Some pain flares during the recovery phase can be attributed to the failure to address all of the issues that comprise the whole. An analogy is that of cutting one fiber in a spider’s web which will not release its prey any more than treating one pain component will release the patient from the web of pain. Freedom from pain can only occur when all of the links are severed, since treatment of every component is essential in decreasing the underlying central sensitization.