An Alternative Approach to Pudendal Nerve Stimulation

Idiopathic chronic pelvic pain and tenesmus are challenging for healthcare providers owing to their unknown aetiology and poor response to treatment.1 Neuromodulation of pudendal and sacral nerves (S3) with laparoscopically implanted electrodes is an invasive treatment option used for these conditions.2 Electroacupuncture (EA) provides a less invasive method of stimulating the pudendal and sacral nerves and has been used for lumbar spinal canal stenosis.3 In our experience EA can also be used to treat chronic pelvic pain and recurrent tenesmus. The usual approach to pudendal nerve stimulation involves finding the inferior border of the piriformis muscle and needling at an angle towards the midline, avoiding the sciatic nerve (figure 1). This is a difficult approach that is not easily reproducible and often stimulates the gluteus maximus, resulting in robust gluteal contraction. …