“I thought this pain would never go away.”

These were the heartfelt words of a woman in her 70s who had been living with severe perineal pain for years.

She had undergone various treatments without success. Sitting was unbearable, outings were difficult, and her quality of life was significantly affected.

An Overlooked Cause: Pudendal Nerve Entrapment

Through careful examination and testing, it became clear that she likely suffered from pudendal nerve entrapment (PNE). The pudendal nerve passes through a structure in the pelvis called Alcock’s canal, where it can become compressed by surrounding fascia and ligaments, leading to chronic pain in the perineal region.

Surgical Decompression as a Therapeutic Option

At Kameda Medical Center , surgical decompression of the pudendal nerve was performed by opening Alcock’s canal by laparoscopic surgery . Postoperatively, the patient experienced temporary difficulty walking, though the cause was unclear. However, early intervention with physical therapy led to rapid recovery—within a few days, she was able to walk up and down stairs.

Most importantly, her pain—rated as 10/10 before surgery—dropped to 1/10 after the procedure.

She told us, “It’s easier to walk now, and I feel so much lighter.”

International Evidence Supporting Surgical Treatment

Though still uncommon in Japan, surgical treatment of pudendal nerve entrapment is gaining recognition overseas. Several key studies support its effectiveness:

1. Pudendal Nerve Entrapment: Efficacy of Surgical Decompression in Alcock’s Canal or Sciatic Outlet

A retrospective study from 2022–2024 involving 51 patients (68 procedures) showed significant symptom improvement in 71.5% of patients after decompression surgery. Nerve conduction studies also demonstrated measurable improvement.

2. Robot-Assisted Exploration of the Alcock Canal

This study introduced a novel robotic surgical approach for safe and reproducible decompression of the pudendal nerve.

3. Pudendal Nerve Entrapment Syndrome – StatPearls

This comprehensive review identifies surgical decompression within Alcock’s canal as one of the most effective long-term treatment strategies for PNE.

When All Else Fails, Surgery May Offer Hope

Surgical treatment is not appropriate for all cases of perineal pain.

However, for patients who have not found relief through conventional methods, pudendal nerve decompression may be a promising option.

“Reclaim your life—starting from the pelvic floor.”

We are committed to helping patients find light where there was once only pain.