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Pudendal Nerve Entrapment

Any males out there dealing with this? My pain is confined to my right testical. I have disc problems for L1 thru S1. Foraminal stenosis and nerve root encroachment on exiting L4 and L5 Nerve roots. Diagnostic Imaging was MR using a 3 Tesla magnet.
Comparison was against a previous MR taken two years ago.
I just came off OxyContin 4 weeks ago following a total right hip replacement caused by OA and FAI. I am walking fine now but it feels like my scrotum is going to blow off. I have had this pain off and on for 8 years. It is not epidimidis. Already taken the rounds of Amoxy and Cipro
I dug out an old Rx of Tramadol and it has taken the edge off the pain, however, this pain is starting to effect my job.
I would like to hear from any males that can weigh in on this topic.


  • Sad to hear you are in pain. Happy to find someone to discuss this with. My PT believes I have predendal nerve entrapment. My pain management doc told me he has never had a case and is not familiar with it. I go back to him next week so I am hoping he did a little homework. My symptoms include pain and tingling that goes from my left butt cheek to the back of my scrotum. When laying down and sitting the muscles around the anus and in the perineum will want to contract on their own. I also have difficulty urinating, because I find I cannot relax my bladder to pee. This comes and goes and varies in intensity. Taking anti-inflammatory meds will help control this. Also, the more active I am the less it bothers me. I am 57 year old male with sever DDD in all 5 lumbar discs and foraminal stenosis L3 thur L5. Both SI joints are dysfunctional and the left piriformis muscle is enlarged. The SI joint or the piriformis muscle is probably where the entrapment stems from. I think I covered everything, hope this helps.
  • DogLover247DDogLover247 Posts: 27
    edited 12/23/2013 - 6:58 PM
    Your symptoms sound exactly like mine. In Fact, I am 56 with severe DDD in all 5 lumbar discs AND the foraminal stenosis on L4 and L5 with nerve root compression on exiting roots. As I may have mentioned I took myself off OxyContin about a month ago (had worked up to 20 mg twice per day). I needed to do this to have my pain managed for total hip replacement done 10/30/2013. I am glad I am off the oxy but my right "boy" is very angry. My surgeon phoned me in a Steroid pack for inflammation and 10 mg hydrocodone (to take every 4 hours). I got a visit with an alternate PT, Rehab place today and had a nice chat with him about my problem. Took him my MRI's to review over the holidays but he said my testicular pain is coming from the T4 nerve root deal. I let him put me on a decompression device for 10 minutes. It seem to only slightly reduce the pain and only for a few minutes < 15 minutes at best. I have read that an enlarged prostrate can cause these symptoms but I have my prostrate size under control via proscar and tamsulosin. Peeing is sometimes difficult for me as well. I did find this additional site very helpful for anatomy and pain of the pundendal nerve. Lot of women posting here but some men as well. Check it out. HOPE.org. (I hope I got it right) You can find in by going to www.neurology.org/pudendal. I feel what we have is called Alcock's syndrome. I would like to share our notes frequently because it seems we suffer from identical disease symptoms. It is rare to find someone so quickly with the identical symptoms.
    All the best
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  • The pain I get is mostly in the perineum , it goes into the scrotum but not into the testicles. The PT I was going to was in fact a pelvic floor specialist at a women's health clinic. I got some strange looks going in for treatment but if it reduces the pain I couldn`t care less. My last session with them is Thur. I am stopping treatment with them to see if their treatment is whats working as I am trying other things. I signed up for water aerobics with the local park district because being in my pool takes the compression off of the spine and I feel better. Seeing that it is -1 degrees out here today the pool is not an option. You might want to try an inversion table, you hang upside down, it is sort of like being in traction. I did try to go to a urologist, he insisted that it must be some sort of physical blockage which is causing the urination problems. This is not the case because I will go from not be able to pee, to peeing normally within an hour of taking meds or movement. Are you sure the doctor told you the cause was the T4 root? If you check a dermatome map, the T4 level is the upper chest. I have tried all the meds that are given to spine patients but now I am taking only flexeril for the spasms and up to 24mg of dilauid for the pain. The steroids should help you. When the pain gets real bad I take predisone and that helps a lot. I had my right hip and achilles tendon replaced in 05 and my left knee in11. The changes to your gait from your hip could be the cause of the predendal entrapment as other muscles take over to help you walk. Take care of yourself and have a good holiday. Stay in touch.
  • I intended to say L4 not T4. I have numbness on the inner RT Thigh as well as around the anal area. (comes and goes). Interesting point you make about gait. Mine has improved but it is a change, and I noticed the corns that had developed on RT foot have loosened and pulled out easily. My brother mentioned using his inversion table. Like you, I am going to try a few different options. I actually need to go back to a spine specialists. I have not seen one in years. My updated MR for lumbar was at my request to see if my back could handle the PT/Rehab that would follow.
    One question I have is about your hip. 1. How long before you felt like no surgery was done? And 2. I have always worn Clark Brand shoes relatively "heel-less" but I wore a pair of my hiking boots with a moderate heel height for about an hour in a grocery store. My lumbar was aching real bad before I left the store and it was on my right side (Total hip replacement side). Which type of shoe work(s) for you? I have an appointment on Monday afternoon CST USA for the therapist to go over my images. I will share with you what he says. I keep a note book on all my visits, i.e. dates, treatment, outcome...
    Thank you for sharing.
  • difficulties when it comes to the anal sphincter, and bladder and bowel issues. The symptoms are also found in a spine condition called Cauda Equina Syndrome. Cauda Equina syndrome symptoms include increased pain, increased numbness or tingling , especially in the inner thighs and groin area, and can include difficulties with erections or gentalia for women , the lack of ability to either empty or hold urine or fecal matter, a change in the way the toilet paper feels.
    If you are experiencing these types of symptoms, CES is considered to be an emergency condition so it is very important that you discuss these symptoms with your surgeon immediately.
    If you wait too long, the compression of the lumbar nerve bundles can result in permanent problems if left untreated for too long.
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  • I have had most of the tests and treatments and taken 90% + of the steps you mention. My problem with lumbar, scrotal and inner thigh numbness came back when my pain management doctor started taking most if not all of his patients off OxyContin. I was 20 mg twice per day but was advised to come off it prior to total hip replacement as I mentioned so that my pain could be controlled during and after surgery. I did taper off and stop the medication.
    In my opinion and according to what I read in the local news paper is that most Tennessee Pain Management Clinics, are under pressure by stop prescribing this medication listed above.
    I have had discogram, MRIs. LESIs, TENS unit, etc.
    For me, it is time for another doctor to actually look at my MRI images taken in October this year. It is not always the patients failure to follow course. I am diagnosed with Moderate to Severe DDD with the L4 L5 foraminal stenosis and nerve root encroachment. and endplate changes. The lack of concern by my current is very bothersome to me and quite a mystery. I am getting an immediate referral to a SPINE SPECIALIST to evaluate my condition.
    Once again, thank you for your repost and reply.
  • Doglover, Hope you are having a great Christmas. It is truly amazing how similar our medical problems are, everything you have stated I have experienced. In Sept 05 I had my right Achilles tendon replaced, in Nov 05 the right hip was replaced, so I was going through quite a bit of therapy to rehab both at the same time. I do remember, that 6 weeks after my hip surgery, I played 9 holes of golf with very little pain, I did get tired though, and actually shot fairly well. I went back to work in April of 06 with some tightness and weakness for another 2 or 3 months. But by June I was doing heavy concrete construction again pain free. After that I wish everything felt as good as my hip. I tried every work shoe there is, what worked for me were work boots by B.A. Mason, a mail order company , and hiking shoes from New Balance. Try to find boots with a soft sole that gives a lot of cushioning, or double up on the insoles inside the boot to offer maximum shock resistance. Good luck finding a caring doctor, there is a lot of indifference out there especially with difficult cases like ours. Print out subjects that you think apply to you and ask for explanations why they do or do not fit your problems. Get two or three opinions on any surgery that includes fusion, multi-layer fusion for DDD has a VERY low chance of success. Good Luck. Sandi, Thanks for the input. What you said is very true, and my mdi does show mild CES. However, an enlarged Pirifomis muscle, and pudendal nerve entrapment will give similar symptoms. If I ever experience incontinence or numbness that won`t go away I am running to the ER. The biggest problem I have found is that the conditions we are discussing are somewhat rare and not every doctor will recognize your symptoms. Doctors tend to have tunnel vision when it comes to their specialties. The Urologist I saw kept looking for problems with my bladder and prostate and not so much as to the nerves that control them because thats not what he sees. After a lot of tests and office visits you are told he can`t find anything wrong with you. The same goes for the spine specialist. It is a struggle to find the doctor who deals with the area in between. Hope some of this helps. Merry Christmas to all.
  • I have printed out a lot of articles on pain location and possible causes. I hope going to a new doc, armed with all my CD's and articles, that I get someone interested in taking a closer look. I want to ovoid fusion and any back surgery at all.
    All the best
  • OZGolferOOZGolfer Posts: 1
    edited 01/29/2014 - 11:27 PM
    I am currently recovering from this condition and thought I would give you my 2 cents worth.

    My battle with this condition started approx 2 years ago after I initially flared up after a gym session. My testicles and perineum area swelled and was a bright red from the tip of my penis all the way to my anus, I had a slight sitting discomfort and it never went away, the only relief I got was lying down and not putting any pressure on the area (like sitting)

    I had to travel to Europe (from Australia) for work for a couple of weeks after this flare up with some 24 hours each way of sitting turned this into the most horrific pain.

    Long story short, saw a lot of gp's, specialist's, physic, chiro's etc all of them were scratching their head at my condition. What did help me was finding a good physio that specialised in the pelvis and a drug called Endep (I am sure it has another name in the states) this drug is a muscle relaxant and helped relieve the muscle spasms.

    12 months later and I got my pain down from a 8/10 to a 4/10 with the right physio but I could not get it any better it was so frustrating. My physio then referred me off to a Professor here in Sydney that specialized in the pudendal nerve. First thing was to go off and get a specific MRI of the area (I had previous MRI's which showed nothing) but they have to be trained specifically to find it. My MRI showed the pudendal was trapped on the left and nothing on the right. I then had a Nerve block which was diagnostic only (48 hours only) but it relieved me of my condition, I could sit down without any pain.

    With these 2 positive indicators for Pudendal nerve entrapment I decided to go ahead with the surgery and I am glad I did, on the left instead of the nerve being trapped it actually was growing through the ligament, which I guess you could say was a birth defect. On the right even though it did not show an entrapment I opted for them to open me up to take a look, they found that my pudendal nerve branched off too early around the ligament which was also contributing to my pain in my anus.

    So to resolve the above mentioned issues they had to take out 4 ligaments (2 x sacrotuberous / 2 x sacrospinous), currently recovering from it but 3 weeks later I am already feeling a lot better, but it is a long recovery.

    Anyway hope that helps, my case is rare, you can have the symptoms without the entrapment, first thing I would suggest is find a good physio that specialises in the pelvis and give it time. Look at drugs that will relieve tension in the area and when possible try not to sit. If all else fails google the condition and find out if there is a pudendal nerve specialist is near you, there are not many specialist in the world that focus on this condition and surgery is the last option after giving everything else a solid go.
  • I got 2 nerve blocks on 2/26/2014 that relieved the pain instantly. Although the injections were numbing with steroids and part diagnostic part therapeutic, the next step is to "burn" the nerve endings. Thanks for you reply OZ. It seems like we have to part diagnosis ourselves and educate these physicians at the same time. It seems the right testicle is starting to ache and burn again.
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