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    all perineal muscles are innervated by branches of which nerve?

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    Perineal Nerve

    Perineal Nerve

    Perineal Nerve Related terms:

    Sacral NervesNeuropathic PainNerve RootPudendal NerveSacral PlexusPelvisInnervationNeuronal Nitric Oxide Synthase

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    Lower Limb Nerve Supply

    Paul Rea MBChB, MSc, PhD, MIMI, RMIP, FHEA, FRSA, in Essential Clinically Applied Anatomy of the Peripheral Nervous System in the Limbs, 2015

    3.3.5 Perineal Nerve

    In the pudendal canal, the perineal nerve gives off both deep and superficial branches. The deep branch of the perineal nerve pierces the medial wall of the pudendal canal and goes on to innervate the levator ani and the external anal sphincter. After this, the deep branch passes to supply the bulbospongiosus, ischiocavernosus, superficial transverse perineal muscle, and bulb of the penis.

    The superficial branch of the perineal nerve divides into the posterior scrotal, or labial nerves, which are medial and lateral. Both of these divisions pierce the superficial and deep perineal fascia passing anterior with their corresponding arteries to pass to the scrotum or labia majora.

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    Sphincter Disorders and the Nervous System

    Michael Swash, in Neurology and General Medicine (Fourth Edition), 2008

    Pudendal and Perineal Nerve Terminal Motor Latencies

    The terminal motor latency in the pudendal and perineal nerves is a measure of function in the distal parts of the nerve supply of the external anal sphincter and periurethral striated sphincter muscles (Fig. 33-2). The evoked compound action muscle potentials (CMAPs) in these muscles can be recorded after stimulation of the pudendal nerves in the pelvis66–69 using a finger-mounted array of recording and stimulating electrodes with fixed interelectrode distances (3.5 cm). The two stimulating electrodes are mounted at the tip of the finger, with the cathode arranged distally; the recording electrodes are mounted side by side at the base of the finger so as to be in a suitable position to pick up the response in the external anal sphincter muscle. Stimulation of the pudendal nerves is achieved on either side of the pelvis by directing the exploring finger in the rectum toward the lateral rim of the pelvis (i.e., toward the ischial spine). The onset of the stimulus is used to trigger the oscilloscope. Stimuli of square-wave pulses, 0.1 msec in duration and about 50 V (but always supramaximal), are used to find the shortest latency of the response in the external anal sphincter muscle. The perineal nerve terminal motor latency (Fig. 33-2) can be measured with a similar technique, recording the response with a pair of catheter-mounted recording electrodes placed in the urethra. Normal values for terminal motor latencies in these nerves are published elsewhere.70

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    ANESTHETIC COMPLICATIONS IN UROLOGIC SURGERY

    George T. Vaida MD, Sudheer K. Jain MD, in Complications of Urologic Surgery (Fourth Edition), 2010

    Penile Block

    Thorough understanding of pudendal nerve anatomy is essential to the penile block. Terminal branches of the pudendal nerve innervate the rectum, the perineum, the scrotum, and the penis.

    Perineal Nerve

    After emerging from the pudendal canal, the perineal nerve courses downward for 2 to 3 cm and gives rise to two terminal divisions: a lateral scrotal branch and the medial striated urethral branch.35,36 The scrotal branch unites with the inferior rectal nerve to form the common scrotal branch, which innervates the posterior aspect of scrotum.

    Deep Dorsal Nerve of Penis

    This is one of the two branches of pudendal nerve leaving the pudendal canal. It courses forward along the inferior pubic ramus, along the end of the ischiorectal fossa, into the deep perineal pouch. The nerve courses forward into the suspensory ligament of the dorsum of penis, sending terminal branches to the entire dorsum.37 It is noteworthy that very often a well done dorsal penile block spares the anterior lower part of the penis, which is innervated by rami of the perineal branch of the pudendal nerve as well.38 By contrast, the circumferential block done at the base of the penile shaft is a complete block of the dorsal nerve of penis and the perineal branches of the pudendal nerve, which provide sensory innervation to the midanterior aspect of the penis all the way up to the frenulum.39

    Indications of Penile Block (Adults Only)

    Although circumcision is performed on an estimated one in six newborn males worldwide and about 60% of newborn males in the United States,40 adult circumcision is much less frequently performed. The usual indications for adult circumcision are social, personal, or medical, including the following: phimosis, paraphimosis, acute paraphimosis (emergency), recurrent infections such as balanitis and posthitis, or preputial neoplasms. General anesthesia, penile block, or a combination of both is used in the majority of these cases.

    The penile block is always done before the surgery begins, preferably using long-acting local anesthetics (e.g., 30 mL bupivacaine 0.375% or 0.5% provides 8-15 hours analgesia). Because the penis is an organ with terminal circulation, the local anesthetic used for penile block must never contain epinephrine. See “Penile Ischemia and Necrosis,” later. The block is intensely painful; therefore, it should be done under a TIVA using continuous propofol/fentanyl technique, with the patient spontaneously breathing oxygen by mask. This technique may be continued throughout the entire surgical procedure, as a light or medium sedation. See “Propofol Total Intravenous Anesthesia for Postoperative Nausea and Vomiting,” earlier.

    Source : www.sciencedirect.com

    Perineal nerve: origin, course and function

    Perineal nerve is a terminal branch of the pudendal nerve. Learn more about its anatomy now on Kenhub!

    Perineal nerve

    Author: Roberto Grujičić MD • Reviewer: Jana Vasković MD

    Last reviewed: February 22, 2022

    Reading time: 5 minutes

    Perineal nerve Nervus perinealis 1/1

    The perineal nerve is a large terminal branch of the pudendal nerve. It usually originates from the pudendal nerve during its course through the pudendal canal or right after the nerve exits the canal. The pudendal nerve runs towards the perineum and terminates by bifurcating into two terminal branches: the superficial perineal nerve (superficial perineal branch) and the deep perineal nerve (deep perineal branch).

    It is a common confusion between the terms and ; note that the term refers to the structures located in the outer side of the calf, whiledescribes the structures located in the area below the pelvic diaphragm.

    The perineal nerve is a mixed nerve. Its sensory fibers are delivered via its superficial (sensory branch) while its motor fibers travel via its deep (motor) branch. The main function of this nerve is to provide sensory and motor supply for the structures of the urogenital triangle in both sexes.

    This article will discuss the anatomy and function of the perineal nerve.

    Key facts about the perineal nerve

    Table quiz

    Origin Pudendal nerve

    Branches Superficial perineal nerve, deep perineal nerve

    Sensory supply In males: Skin over the perineum, posterior scrotal skin

    In females: Labia minora, vaginal vestibule, inferior portion of vaginal canal, posterior aspect of the labia majora

    Motor supply Muscles of urogenital triangle (bulbospongiosus, ischiocavernosus and superficial transverse perineal muscle), external urethral sphincter, external anal sphincter, levator ani muscle

    Contents Origin and course

    Branches and innervation

    Superficial perineal nerve

    Deep perineal nerve Clinical relations

    Perineal nerve injury

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    Recommended video: Neurovasculature of the female perineum

    Arteries, veins and nerves of the female perineum.

    Origin and course

    Perineal nerve Nervus perinealis 1/2

    The perineal nerve is the terminal branch of the pudendal nerve. It typically originates in the last portion of the pudendal canal (within the Alcock's canal) or just as the pudendal nerve exits the canal. It runs anteriorly through the perineum, accompanied by the perineal artery. Soon after exiting the pudendal canal, the perineal nerve terminates in a bifurcation.

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    Branches and innervation

    The perineal nerve gives off two terminal branches. These branches include:

    The superficial perineal nerve

    The deep perineal nerve

    Superficial perineal nerve

    The superficial branch provides a sensory supply to the majority of the skin that covers the urogenital triangle. Additionally, it innervates the posterior scrotal area in males, and the labia minora, vaginal vestibule, and the posterior aspect of the labia majora and in females.

    Deep perineal nerve

    The deep perineal nerve is also known as the muscular or motor branch of the perineal nerve. This branch supplies the muscles of the urogenital triangle (bulbospongiosus, ischiocavernosus and superficial transverse perineal muscle), the external urethral sphincter and the anterior parts of the external anal sphincter and levator ani. This way the deep perineal nerve facilitates the act of micturition and sexual function (i.e. erection and ejaculation).

    Additionally, this branch carries somatic sensations from all structures in the male and female superficial perineal space, i.e. erectile, muscular or glandular tissues, as well as the lower fifth of the vaginal canal.

    Neurovasculature of the female perineum

    Source : www.kenhub.com

    The Pudendal Nerve

    The pudendal nerve is a major somatic nerve of the sacral plexus. Nerve roots: S2-S4. Sensory: innervates the external genitalia of both sexes and the skin around the anus, anal canal and perineum.

    The Pudendal Nerve

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    Original Author(s): Mark GerlisLast updated: December 4, 2019Revisions: 19

    Contents

    The pudendal nerve is a major somatic nerve of the sacral plexus.

    Overview:Nerve roots – S2-S4Sensory – innervates the external genitalia of both sexes and the skin around the anus, anal canal and perineumMotor – innervates various pelvic muscles, the external urethral sphincter and the external anal sphincter.

    In this article, we shall look at the anatomy of the pudendal nerve – its course, motor and sensory functions, and any clinical correlations.

    Anatomical Course

    The pudendal nerve is formed from the sacral plexus – a network of nerve fibres located on the posterior pelvic wall. It arises from the ventral rami (anterior divisions) of the spinal nerves S2, S3 and S4.

    After its formation, the pudendal nerve descends and passes between the piriformis and ischiococcygeus muscles. It leaves the pelvis through the lower part of the greater sciatic foramen. It then crosses the sacrospinous ligament (close to its insertion to the ischial spine), and then re-enters the pelvis through the lesser sciatic foramen.

    After re-entering the pelvis, it accompanies the internal pudendal artery and vein, coursing anterosuperiorly through the pudendal canal (also known as Alcock’s canal – a structure formed by the fascia of the obturator internus muscle). Inside the pudendal canal, the nerve divides into branches, first giving off the inferior rectal nerve, then the perineal nerve, before continuing as the dorsal nerve of the penis or clitoris.

    Note: there is variation with the anatomical course between individuals, however, its close association to the ischial spine is generally consistent.

    By TeachMeSeries Ltd (2022)

    Fig 1 – Derivation of the pudendal nerve from the sacral plexus.

    By TeachMeSeries Ltd (2022)

    Fig 2 – The anatomical course and branches of the pudendal nerve.

    Motor Function

    The perineal nerve innervates muscles of the perineum and pelvic floor:

    BulbospongiosusIschiocavernosusLevator ani muscles (including the iliococcygeus, pubococcygeus and puborectalis).

    The levator ani muscles also recieve innervation directly from the anterior ramus of the S4 nerve root

    The nerve also innervates the external urethral sphincter. A branch of the pudendal nerve, the inferior rectal nerve, provides motor supply to the external anal sphincter. Therefore, the pudendal nerve provides the voluntary/somatic control of faecal and urinary continence.

    (Tip: a way to remember the continence function of the pudendal nerve is; S2, S3, S4 keeps the poo off the floor!)

    Adapted from work by OpenStax [CC BY 4.0], via Wikimedia Commons

    Fig 3 – Superior (bird’s eye) view of the pelvic floor. The levator ani muscles (puborectalis, pubococcygeus and iliococcygeus) are innervated by the pudendal nerve

    Sensory Function

    The pudendal nerve supplies sensation to external genitalia of both sexes and the skin around the anus, anal canal and perineum through its branches:

    Inferior rectal nerve – innervates the perianal skin and lower third of the anal canal.Perineal nerve – innervates the skin of the perineum, labia minora and majora or posterior scrotum.Dorsal nerve of the penis or clitoris – innervates the skin of the penis or clitoris. Thus, responsible for the afferent component of penile and clitoral erection.

    Clinical Relevance: Pudendal Nerve Block

    A pudendal nerve block is a form of analgesia occasionally given before vaginal childbirth, episiotomy and other minor vaginal procedures.

    To administer a pudendal nerve block, the patient is placed in the lithotomy position, and the ischial spine is palpated transvaginally. Local anaesthetic is then injected into the tissues around the ischial spine. The procedure is then completed on the opposite side.

    As the pudendal nerve is accompanied by the internal pudendal artery, it is essential to aspirate before injecting local anaesthetic – this ensures that local anaesthetic is not administered into the systemic circulation.

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    Source : teachmeanatomy.info

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