Pudendal Nerve Decompression Surgery.

Surgery is considered only when the diagnosis is clear and non-surgical care has been genuinely tried. Suitable candidates typically share the following features:

• Persistent perineal, genital or anal pain — often burning, stabbing or electric — that is worse on sitting.
• Symptoms present for more than several months despite structured conservative treatment (pelvic physiotherapy, medication, lifestyle changes).
• One or more diagnostic pudendal nerve blocks that meaningfully — even if temporarily — relieve pain.
• Clinical and, where relevant, imaging findings consistent with pudendal nerve entrapment.
• Other causes of pelvic pain (urological, gynaecological, colorectal, spinal) have been ruled out or addressed.
• General health suitable for laparoscopic surgery under general anaesthesia.

Surgery is not the first step for pudendal neuralgia. Before considering it, we review your history in detail and confirm that the pudendal nerve is the dominant source of pain — see our page on pudendal neuralgia for the full evaluation pathway.

1. 1

   Pre-operative planning

   A detailed case review, imaging when indicated, and confirmed response to diagnostic nerve blocks. You meet the surgical team, discuss expectations, and complete standard pre-anaesthetic checks.

2. 2

   Anaesthesia and positioning

   The operation is performed under general anaesthesia. You are positioned to allow safe laparoscopic access to the deep pelvis.

3. 3

   Laparoscopic access

   Several small (5–12 mm) incisions are made in the lower abdomen. A high-definition camera and fine instruments are introduced through these ports.

4. 4

   Nerve identification

   Under magnified vision, the pudendal nerve is carefully identified along its course through the pelvis — between the sacrospinous and sacrotuberous ligaments and into Alcock's canal.

5. 5

   Decompression

   Depending on the pattern of entrapment, the sacrospinous ligament, fibrous bands, or the fascial roof of Alcock's canal are released. The nerve is freed without being cut.

6. 6

   Closure and recovery

   Ports are closed with dissolvable stitches. Most patients stay one night in hospital and are walking the same day.

Nerve tissue heals slowly. Most patients experience recovery in phases rather than as a single moment. The timeline below is typical — your surgeon will tailor it to your case.

Pudendal nerve decompression is a specialised operation. Overall it is safe in experienced hands, but — as with any surgery — carries risks that must be weighed against the potential benefit.

• General surgical risks: bleeding, infection at port sites, reactions to anaesthesia, venous thromboembolism.
• Temporary numbness or altered sensation in the perineum, genitals or buttock while the nerve recovers.
• Transient increase in pain during the early healing phase before improvement.
• Incomplete relief: some patients experience partial improvement rather than complete resolution of symptoms.
• Rare but important: direct nerve injury, urinary or bowel symptoms, or the need for further intervention.

Risks are minimised by careful patient selection, meticulous surgical technique, and structured follow-up. Every candidate has a detailed informed consent discussion before scheduling surgery.

Realistic expectations are essential. In well-selected patients — those with clear pudendal nerve entrapment, positive nerve blocks, and no untreated alternative pain sources — outcomes after laparoscopic decompression are typically as follows:

• Meaningful pain reduction in a majority of well-selected patients, often unfolding over 6 to 12 months.
• Improved tolerance to sitting, walking and daily activities.
• Improvement in associated urinary, bowel and sexual symptoms in a proportion of patients.
• Better response to concurrent pelvic physiotherapy after the nerve is decompressed.
• A small group of patients may experience partial improvement or persistent symptoms, and continue with multimodal pain care.

Improvement is gradual. Nerve fibres regenerate at roughly one millimetre per day, and the pattern of relief usually reflects that biology rather than an immediate change.

• Focused practice: chronic pelvic pain and pudendal nerve conditions are our primary work — not an occasional add-on.
• 600+ pelvic procedures performed by Dr Renaud Bollens, Professor of Urology, internationally recognised in pelvic nerve surgery.
• Laparoscopic approach: minimally invasive access designed to reduce tissue trauma, shorten hospital stay, and speed early recovery.
• Integrated pathway: nerve blocks, imaging, surgery and structured pelvic physiotherapy coordinated by one team.
• Two centers, one standard of care: consultations and surgery available in Dubai and Belgium, with online consultations for international patients.
• Honest evaluation: many patients we see are advised against surgery. We only recommend an operation when the evidence for pudendal compression is clear.

Considering surgery often brings many questions, especially when pain has been persistent or difficult to diagnose. These answers cover the essentials of pudendal nerve decompression so you can feel supported and well-informed.