How do I know if I have a true entrapment?

[Bananerd]

My pudendal nerve is compressed between the sacrotuberous and sacrospinous ligaments on both sides due to childhood hip surgery. I’m reading that a true entrapment likely can’t be fixed without surgery. What exactly makes it a true entrapment vs something else?

[Violet M]

If there's a structure such as ligaments that are compressing the nerve, that would be different than having tense muscles that are irritating the nerve.

Some examples of an entrapment are if the nerve is compressed between ligaments, encased in scar tissue, or trapped in fascia. The most likely places of pudendal nerve entrapment are between the ST and SS ligaments, in Alcock's canal, and sometimes at the falciform process of the ST ligament. Sometimes if there is an enlarged muscle such as an enlarged obturator internus muscle it can impinge on the nerve so, according to what one surgeon told me, sometimes the muscle has to be trimmed away a bit.

Violet

[Bananerd]

So my case cannot be helped without surgery? The surgery just sounds really brutal

[Violet M]

I can't say if surgery is your only option but if your nerve is compressed between two ligaments and is constantly being irritated you can experience significant damage over time. You could try pudendal nerve blocks to see if it causes any possible swelling or inflammation to decrease so the nerve can glide freely, but honestly, I don't know of many people who got long-term relief from nerve blocks. Or you could additionally try lifestyle changes if you are an active person, to see if resting and letting the nerve heal helps, but if it is entrapped sometimes waiting too long can make the surgery less successful. And you might have to be careful the rest of your life. What does your doctor recommend?

There are different surgical approaches so you may want to research them to see which seems right for you. Some are slightly less invasive than others, and some don't severe the ST ligament or cut through the gluteal muscles like the TG approach -- but those approaches also don't have as good of a visualization of the nerve. So there are pros and cons to each approach.

Violet