Hypogastric vs Pudendal

[desperate]

Hey Guys,

I wanted to start this thread to go over the differences between these two pelvic pain syndromes.

The superior hypogastric plexus is a collection of nerves located in the retroperitoneal space at the bifurcation of the aorta and lies directly in front of the L5/S1 intervertebral disc. It contains afferent and efferent fibers from the SNS, and to a lesser extent carries parasympathetic information to the structures of the pelvis as well. Overall, it provides innervation to most, if not all, structures of the pelvic region:

Bladder
Urethra
Vagina
Vulva
Prostate
Uterus
Ureter
Pelvic Floor (Perineum)
Penis
Ovaries
Penis
Testicles
Descending Colon and Rectum

The pudendal is the main nerve of the perineum. It carries sensation from the external genitalia of both sexes and the skin around the anus and perineum, as well the motor supply to various pelvic muscles. Anyway I am sure we are all familiar with the pudendal nerve by now. The symptoms can reside in the rectum, anus, urethra, perineum, and genital area. In women this includes the clitoris, mons pubis, vulva, lower 1/3 of the vagina, and labia. In men this includes the penis and scrotum.

Anyways, I wanted to start a thread and keep this topic open to people who tried the pudendal blocks, and compare this to people that tried hypogastric blocks.

Also, if the hypogastric nerve can incur pain in all the locations at the top can it not in a sense also have a lot of the classical PNE symtoms too?

I was just wondering about the hypogastric plexus for too long and somehow I have been always thinking there is something wrong with mine. However, I have all classical PNE symtoms so no Pain doc wants to take this hypogastric thing seriously. The reasons why I say this is 1) I have absolutely NO urge to urinate. My sensory nerve is almost not working. I don't know when my bladder is full. 2) I have mild narrowing by L5-S1 3) I have a minor compression by the left common illiac artery by the right common illiac vein (which is right by the bifurcation of the aorta). As well as I have had digestion issues my whole life. What sits directly in front of the plexus, colon/intestines. I just have too much pointing to the plexus but I do have classical pne symptoms though.

Does anyone have any classic symptoms of hypogastric, have had relief from hypogastric blocks orrrrr also have any comments to add about the added above? If not, I guess I just wasted 10 mins just venting

-Dom

[I_miss_sitting_down]

Hey Dom,
I have odd symptoms which no doctor or PT has ever wanted to classify as pudendal.

I held in my pee for too long (I know, stupid trigger) and felt something tense up in my abdomen. Ever since, I can no longer feel urinating/having a bowel movement like I used to. Like, I can feel the urine when it comes out but for some reason that sensation that I had internally is no longer there at all (same with bowel movement). The worst is, not being able to feel my vagina like I used to anymore. It's not pain, it's literally like feeling 5% of what it used to be. Also, I have a lot of gases all the time which increase when I sit down. Do any of these symptoms seem relatable?

I've been looking into PPOD and perhaps going to a chiropractor to see if that helps. It's like I know that something very mechanical happened but no one can help me.

I'll look into the hypogastric nerve. Thanks.

[April]

I-miss,

If you are numb in the areas that touch a saddle (called saddle anesthesia), it could be the cauda equina syndrome. This is caused by compression of the nerves along the lumbar or sacral part of the back. It can happen due to trauma to the back or a very large, central herniation. (I have a large central herniation at L4-5, so I've read a bit about it). There's a brief summary of it on this site, but the wikipedia description is more detailed and also has a picture of the saddle area. It's rare, but it is considered an emergency, so if really you do think you have it, I would get it checked out immediately.

April

[desperate]

Hey,

So I'm glad I found someone with no urge to urinate like myself. It honestly sounds more like hypogastric nerves rather than pudendal. I could be wrong though. There are many conditions that mimic pne so maybe it's worth checking out for yourself also.

I do have the urge to go empty my bowels. Just not urine. Regardless there's something going on that's similar in both our cases. I'd be interested to know if a hypogastric plexus block works for you. Give it a shot. You'd probably get it a lot quicker than I can that's forsure. My pain doctors are idiots over here.

Do you have other classic pne symptoms or that's it ?

[desperate]

Oh and the gas sounds more like hypogastric as well. The hypogastric does effect digestion.

[I_miss_sitting_down]

Hey sorry for the late reply.
Yeah I'm always baffled as to why there aren't more people with numbness rather than pain symptoms on the forum as the definition given for pudendal neuralgia is pain or numbness. We may have a milder case of it?

I actually do feel the urge to urinate but it has massively decreased although I may have had an overactive bladder to begin with so I am not sure if my urge to urinate is now regular. What has significantly changed is the feeling of urine passing internally. I told my doctor this and she said "well you normally can't feel the inside" to which I replied "are you not supposed to feel urine passing through the urethra?" and she was like "oh yes, that's true". I've realized sometimes you have to remind doctors that specialize in this of what they feel in order for them to relate.

I actually did start getting more typical symptoms like burning/tingling sensation in the perineal and hamstrings which is normally fixed by stretching and is probably also related to sciatica but it still comes back as soon as I sit down for more than 2 minutes. Dr. Marvel didn't think I had pudendal neuralgia (I was diagnosed with pelvic floor myalgia/levator ani). What's frustrating is that all of the PTs that have treated me for pelvic floor myalgia (and most have been very knowledgeable) have never heard of someone not being able to feel the vagina, rectum and urethra. And yet (THANK GOD) my clitoris is fine. I think that you're a guy so this may not seem relatable but from what I hear a lot on this forum is that symptoms are external and yet mine (at least the genital ones) are VERY internal and relate to desensitized (not painful) symptoms and I think it's cause it's different nerves.

I've actually been doing more research now that I've taken a break from work and I'm looking into the sympathetic nervous system and the possibility of getting "stuck" in it including the hypogastric nerve. So I have a bit of a weird story, I used to hold in my pee all the time and at one point I actually felt something move/shift in my abdomen and boom had a decreased sensation and felt uncomfortable sitting down. From what I've been reading on this forum, I think there's a possibility that my pelvic muscles got stuck in this tense position due to the sympathetic nerve system being overused all those times I was holding in my pee, plus I was going through a stressful time, plus I was very sedentary at the time, etc. all the right components happened so that I know have tense pelvic muscles that don't seem to relax. It feels almost like my stomach has this permanent butterfly feeling that really won't allow me to relax. Do you feel any muscle tension/constriction with your symptoms at all?

I'm convinced that my body is stuck in this sympathetic state and while people seem to have success with mind body techniques (some of which sound really interesting), I read of someone getting better from taking propranolol. The difference I've been reading on medications I've taken like valium and cyclobenzaprine and propranolol is that propranolol is a beta blocker (according to wikipedia: Beta blockers block the action of endogenous catecholamines epinephrine (adrenaline) and norepinephrine (noradrenaline) -in particular on adrenergic beta receptors, of the sympathetic nervous system, which mediates the fight-or-flight response). BOOM.

I'm seeing my doctor in a couple of weeks and I'll ask about the beta-blocker medication and see if I can get it prescribed to test it out. I don't like the idea of getting a block done unless I've gone through all the non invasive treatments available nor do I know if the hypogastric nerve is really being affected.

Also if you can feel the sensation on your skin like on the saddle area just fine then it's not cauda equina but thanks for the heads up!

[Violet M]

I hear a lot on this forum is that symptoms are external and yet mine (at least the genital ones) are VERY internal and relate to desensitized (not painful) symptoms and I think it's cause it's different nerves.

My symptoms were mostly internal -- although it was pain, not desensitization. The pudendal innervates the lower 3rd of the vagina. Is that where your desensitization is? I don't know...I guess it could be hard to tell.

Violet

[chenonceau]

@I_miss_sitting_down : any updates on your case ? I have the same kind of internal numbness symptoms.

[hove131]

Hey,

So I'm glad I found someone with no urge to urinate like myself. It honestly sounds more like hypogastric nerves rather than pudendal. I could be wrong though. There are many conditions that mimic pne so maybe it's worth checking out for yourself also.

I do have the urge to go empty my bowels. Just not urine. Regardless there's something going on that's similar in both our cases. I'd be interested to know if a hypogastric plexus block works for you. Give it a shot. You'd probably get it a lot quicker than I can that's forsure. My pain doctors are idiots over here.

Do you have other classic pne symptoms or that's it ?

Any update on your loss of urge to urinate?

[prakashkkr7]

I have the same problems, absolutely no urge to urinate even with full bladder, can this be neurogenic bladder or hypogastric nerve problem