Self-Care for Pudendal Neuralgia-Surgery
Pudendal Nerve Decompression
By Stanley Antolak, MDA Brief Explanation
Over the past 10+ years about 30% of patients with pudendal neuropathy required surgical decompression when the nerve protection program (self-care) and the series of pudendal nerve blocks do not relieve pelvic pain due to pudendal nerve irritation and compression. Surgery can be very effective. Some patients have no pudendal pain after surgery. More often, the pain resolves over many months. The French neurosurgeon who developed the procedure noted that 9-24 months are needed for pain relief. Pain may require additional treatments after surgery. The surgeon can only decompress the nerve whereas time and Mother Nature heal it. I have decompressed the nerves in patients aged 22 to 81 years with good success that is measured using pain scores over as long as 5 years.
Self-Care for Pudendal Neuralgia-Description of procedure
You will receive general anesthesia and then a catheter will be placed into the bladder. You will be turned over to lie on your stomach. An incision will be made at an angle approximately where a back trouser pocket would be. One incision is made on each side. We spread the muscles and open a ligament along its center (much like unzipping a zipper). We identify the nerve in front of that ligament. We follow the nerve up to where it is compressed along its pathway. We divide an inner ligament that is compressing the nerve. We follow the nerve deep into the pelvis opening the structure called the Alcock canal (pudendal canal).
After freeing the nerve from all constricting tissues, it is positioned into a new pathway without tension on the nerve. We protect the nerve with a chemical film that hopefully will prevent adhesions so that the nerve will slide smoothly through the tissues as you walk, etc. At the end of the procedure, a mixture of local anesthetics and steroids medications are placed around each nerve to assist healing and pain control. We leave a drain tube inside that would drain any tissue fluid for the first 24 to 36 hours. After that is removed, you can have a shower. Stitches are placed under the skin and Steristrips keep the edges together.
Success rates of surgery
Around the world, about 60-70% of patients having this surgery are cured or improved; i.e. take minimal or no medications. That means that about 30% fail. Often those failures are predictable ahead of time because they do poorly with injections, have long-standing, serious pain issues, and often had multiple previous pelvic operations.
Self-Care for Pudendal Neuralgia-Hospital stay
Hospital stays is usually two nights. We ask out-of-town patients to stay locally for 2 additional days. You may walk and stand as much as possible before or during plane flights. French surgical pioneers noted that HEALING to a pain-free state is usually between 9 and 24 months. Two of my Mayo Clinic patients, operated in France in 2000, required 4 and 5 years to be completely pain free. My personal surgical data from 2004 and 2005 indicate that the averages of patient pain scores become normal between 18 to 24 months.
You may walk as much as you choose without causing pain (some people overdo it). You will do gliding exercises for 2 years. We try to see local patients after one month. Out-of-state patients can contact Dr. Antolak at one month intervals for the first three months.