Abstract
Pudendal nerve entrapment (PNE) also named as Alcock canal syndrome is an unusual origin of chronic pain in which the pudendal nerve is involved that is located in the pelvis. This can affect both the sexes associated with severely disabling and neuropathic pain. This nerve runs from the lower back from S2, S3, S4 roots ventral ramus of the sacral plexus, along with pelvic floor muscles and out to the perineum. This nerve supplies to the muscles of urethra and anus as well as skin between anus and clitoris This condition is mostly misdiagnosed, improperly treated that results in nugatory disturbance in quality of life. In this article, we are going to discuss the highlights of Pudendal nerve entrapment syndrome and also the effective management of this disease by marvellous Ayurvedic herbs
Introduction
Pudendal nerve entrapment resulted by pudendal neuralgia defined as the pain related to the respective nerve, which is the main nerve running between the pubic bone and tailbone, it might be felt like deep pelvic pain. Pudendal neuralgia occurs when this nerve is over exposed to repeated traumas that leads to irritation and compression of pelvic floor muscles or tight ligaments. Injuries to the pudendal nerve cause sensory deficits more than motor deficits.
Anatomy of pudendal nerve
- The pudendal nerve passes from the piriformis and coccygeus muscles and departs from the pelvic cavity from the greater sciatic foramen.
- Then to re-enter the pelvic cavity it passes medially to the sacrospinous ligament and ventral to the sacrotuberous ligament where it is commonly entrapped.
- Pudendal nerve then courses in the pudendal canal which is named as Alcock canal.
- The three terminal branches go to ischioanal fossa and generate inferior rectal branches, perianal branches, dorsal sensory nerve of the penis and clitoris.
This nerve can entrap into these positions and show various symptoms according to the underlying cause.
Causative factors
This condition can arise from mechanical and non-mechanical injury.
Mechanical injuries - can be due to compression of nerve, stretching the nerve.
Non-mechanical causes - are viral infections, diabetes mellitus, multiple sclerosis and many others.
Some of the major causes of pudendal neuralgia are
- Surgeries - surgeries that are used to combat the prolapsed pelvic organs are the most common cause behind the pudendal neuralgia. The condition gets more prone when there is a mesh placement surgery. This condition may persist with hysterectomy, mid-urethral sling surgery etc.
- Direct trauma that hits the buttocks or lower back.
- Vaginal deliveries causes consequent stretch to pelvic floor muscles which also damage the respective nerve
- Constipation or other GI Tract related diseases.
- Chronic perineal microtrauma caused by excessive cycling etc.
- Sitting for prolonged time may also cause this condition
Symptoms
Patients may usually feel pain in genitals or perineum. Characteristics of pain
- A sharp or burning pain sensation
- The area becomes more sensitive
- Pin pricking like sensations or numbness
- Swelling felt on the affected part
These symptoms worsens when the patient is sitting and these symptoms may refer to the belly, buttocks or legs.
Some other symptoms may be associated with pain
- Sudden urge to go to washroom
- Pain or difficulty during intercourse
- Erection disabilities
Diagnosis
Diagnosis can be made by physical examination.
MRI scans can also be helpful.
Treatment
- Muscle relaxants
- Anti - depressants
- Anti - epileptic
In modern Science if these medications don't work they try to numb the nerve or lower the inflammation which reduces the pressure and shows its effects after several weeks. In rare cases, allopathy physicians also recommend surgery in which they will remove that part that puts the pressure on the nerve. But in Ayurvedic pathology we don't go for surgeries, we help it by supporting the neuromuscular system and eliminate these symptoms by using traditional ayurvedic herbal remedies. These herbal formulations are helpful in maintaining our nervous system properly and also heals any type of trauma that affects the nervous supply or can reduce compressions also.
Herbal remedies for Pudendal nerve entrapment by Planet Ayurveda
Planet Ayurveda is a GMP certified herbal formulations company that manufactures 100% natural products that are totally free from side-effects, fillers, dyes, or any type of chemical preservatives. These herbal formulations are prepared by the traditional methods described by different Acharyas in their respective samhitas. These products are widely distributed in India or even outside of India. Products that are used to stabilise the Pudendal nerve entrapment are
- Hakam Churna
- Boswellia+curcumin
- Kaishore Guggul
- Vikramprash
PRODUCTS DESCRIPTION
1. Hakam Churna
This is a natural herbal formulation given by Planet Ayurveda consists of age old herbs described in ancient ayurvedic texts consisting of Chandershoor (Lepidium sativum), kalonji (Nigella sativa) etc. This formulation can help to balance the all three doshas and supports the digestive tract, heals any kind of traumas and reduces painful sensations.
Dosage : Take 3-5 gm of powder with hot water twice daily
Boswellia Curcumin
This is a herbal formulation given by planet Ayurveda to support the blood detoxifying processes. It consists of shallaki (Boswellia serrata), haridra (Curcuma longa). These both are pitta shamak and also helpful in vata rogas too, strengthens the body to maintain the neuro-muscular system and relaxes the stress generating factors.
Dosage : 1 capsule twice daily, after meals with plain water
Kaishore Guggul
This is a polyherbal formulation mentioned in Ayurvedic textbooks consisting of Amalaki (Emblica officinalis), bibhitaki (Terminalia bellerica) etc. Kaishore Guggul is used to pacify the vata and pitta dosha and that's why it helps to rejuvenate the nerve damage as well as is a good muscle relaxant that causes compression on the affective nerve and relieves from pain.
Dosage : 1-2 tablets twice or thrice daily with lukewarm water
Vikramprash
This marvellous herbal formulation given by planet Ayurveda to combat this condition effectively. This herbal formulation consists of bilva (Aegle marmelos), Agnimantha (Premna mucronata) etc. These herbs are helpful in maintaining doshas and dhatus in our body. This formulation helps to support the neuromuscular system by ancient traditional methods, it can also relieve the compression and other genital disorders.
Dosage : 1-2 teaspoonfuls, twice to thrice daily, preferably with milk
Conclusion
Pudendal neuralgia due to PNE is a rare neuropathic condition, it also causes the consequences in the quality of life. This condition is difficult to diagnose and patients get managed for different issues. So one must go with a well-coordinated healthcare team that can help the patient to get relief from this condition by using minimum means of medications. A good Ayurvedic practitioner can help the patient to physically rehabilitate in this challenging neuropathic syndrome.
DR. Vikram Chauhan, MD - AYURVEDA is an expert ayurvedic doctor based in Chandigarh, India and doing his practice in Mohali, India. He is spreading the knowledge of Ayurveda - Ancient healing treatment, not only in India but also abroad. He is the CEO and Founder of Planet Ayurveda Products, Planet Ayurveda Clinic and Krishna Herbal Company. Write at - [email protected], Contact at - +91-172-521-4030 Websites - www.planetayurveda.com, www.alwaysayurveda.com
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- The pudendal nerve passes from the piriformis and coccygeus muscles and departs from the pelvic cavity from the greater sciatic foramen.
- Then to re-enter the pelvic cavity it passes medially to the sacrospinous ligament and ventral to the sacrotuberous ligament where it is commonly entrapped.
- Pudendal nerve then courses in the pudendal canal which is named as Alcock canal.
- The three terminal branches go to ischioanal fossa and generate inferior rectal branches, perianal branches, dorsal sensory nerve of the penis and clitoris.
- Surgeries - surgeries that are used to combat the prolapsed pelvic organs are the most common cause behind the pudendal neuralgia. The condition gets more prone when there is a mesh placement surgery. This condition may persist with hysterectomy, mid-urethral sling surgery etc.
- Direct trauma that hits the buttocks or lower back.
- Vaginal deliveries causes consequent stretch to pelvic floor muscles which also damage the respective nerve
- Constipation or other GI Tract related diseases.
- Chronic perineal microtrauma caused by excessive cycling etc.
- Sitting for prolonged time may also cause this condition
- A sharp or burning pain sensation
- The area becomes more sensitive
- Pin pricking like sensations or numbness
- Swelling felt on the affected part
- Sudden urge to go to washroom
- Pain or difficulty during intercourse
- Erection disabilities
- Muscle relaxants
- Anti - depressants
- Anti - epileptic
- Hakam Churna
- Boswellia+curcumin
- Kaishore Guggul
- Vikramprash
