Giving birth by way of vaginal delivery can cause pudendal nerve damage. In this article we explore what the pudendal nerve is, why it is harmed during childbirth and what the consequences might be.
What is the pudendal nerve?
The pudendal nerve is a large nerve found in the pelvic region. It runs from the sacral plexus in the lower back all the way down to the perineum and buttocks. The pudendal nerve enables sensation and motor/autonomic function in the genitals, urethra and anal region. This means that amongst other things the nerves maintain pelvic support, urinary continence and faecal continence.
Pudendal nerve damage during vaginal delivery
The anatomical position of the pudendal nerves make them particularly vulnerable during a vaginal delivery. This is particularly true during the second stage of labour when the perineum descends. The nerves cannot descend along with the perineum due to them being fixed in the region of the ischial spine. As a result they get stretched and damaged.
The chance of pudendal nerve damage increases with a prolonged second stage of labour, a larger than average baby and assisted instrumental delivery – for example, with forceps. Nevertheless, it is well recognised that every vaginal delivery is associated with a degree of pudendal nerve injury. The more vaginal deliveries a woman has, the worse the injury to the pudendal nerve becomes.
Consequences of pudendal nerve damage
Pudendal nerve damage can affect both motor and sensory function. This can result in upsetting consequences such as:
- Urinary incontinence, especially stress incontinence (i.e. upon sneezing or coughing)
- Anal incontinence with faecal urgency, seepage and incontinence of faeces/wind
- Genital prolapse
- Loss of sexual sensation
- Pelvic floor dysfunction
The motor function does have some powers of recovery. Normally innervation will be made in the first six months after the birth, after which the injury will not improve any further.
A woman’s symptoms may subsequently become worse with the ageing process. This happens because the menopause is associated with a loss of oestrogen, which in turn weakens the muscles, including the anal sphincter.
Other causes of incontinence after childbirth
Incontinence after childbirth can also be caused by perineal tears. In particular, third and fourth degree tears extend to the anal sphincter complex, creating a defect in the anus that may never fully recover. Full function may be regained if a competent repair is carried out, although there is not a 100% success rate.
Complications are much more likely to affect those who have an unrepaired tear, something which can happen if medical practitioners fail to make a diagnosis. This does amount to medical negligence. If you have developed incontinence because of an unrepaired tear, you need to talk to a solicitor about claiming compensation.