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Evidence for the Innervation of Pelvic Floor Muscles by the Pudendal Nerve

From the Departments of ¹Reproductive Medicine, ²Internal Medicine, ³Radiology, and ⁴Neurology, The Pelvic Floor Function and Disorder Group, University of California, San Diego, San Diego, California.

OBJECTIVE: To evaluate whether the pudendal nerve innervates the levator ani muscles by assessing the effect of pudendal nerve blockade on pelvic floor muscle function.

METHODS: Eleven nulliparous women without symptoms of anal or urinary incontinence were studied before and after pudendal nerve blockade with vaginal manometry, electromyography of the external anal sphincter and puborectalis muscle, and 3-dimensional transperineal ultrasound imaging of the urogenital hiatus during rest and squeeze.

RESULTS: After pudendal nerve blockade, mean vaginal resting pressures decreased from 19 ± 10 mm Hg to 15 ± 10 mm Hg (P < .05), and mean vaginal squeeze pressures decreased from 61 ± 29 mm Hg to 37 ± 24 mm Hg (P < .05). After pudendal nerve blockade, the anterior–posterior length of the urogenital hiatus increased from 51 ± 4 mm to 55 ± 5 mm at rest (P < .05) and increased from 47 ± 3 mm to 52 ± 5 mm during squeeze (P < .05). Resting and squeeze electromyography amplitude of the external anal sphincter and puborectalis muscle was markedly reduced by pudendal nerve blockade.

CONCLUSION: Pudendal nerve blockade decreases vaginal pressures, increases length of urogenital hiatus, and decreases electromyography activity of the puborectalis muscle, all of which suggest that the pudendal nerve does innervate the levator ani muscle.

LEVEL OF EVIDENCE: II-2

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