A no-surgery fix for cyclist’s syndrome

What is pudendal nerve entrapment, and how do you get rid of it without surgery?

JIM

Los Angeles

Pudendal nerve entrapment is the constriction of a key nerve that runs through the lower central pelvic area. It can be extremely painful and can affect urinary, anal and sexual function.

Though a genetic predisposition may contribute to the condition, it is thought to be triggered by some type of pressure or trauma to the nerve, such as damage from childbirth, squatting exercises, chronic constipation or cycling. It is sometimes called cyclist’s syndrome.

To diagnose the condition, doctors need to rule out other conditions that may be causing the pain, such as prostatitis or interstitial cystitis.

Pudendal nerve entrapment can be treated nonsurgically by trying to avoid the offending trigger. For example, a cyclist should stop biking. Patients are told to avoid sitting as much as possible or to use a special cushion when sitting.

Physical therapy can also help, and some patients receive periodic injections of a local anesthetic and corticosteroids to block pain. Surgery and post-surgical physical therapy is sometimes recommended.

-- Shari Roan

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Why does drooling occur during sleep, and is there a way to stop drooling at night?

RANDY

Thousand Oaks

Minor drooling in one’s sleep is often a simple matter of sleeping with your mouth open, says Dr. Christina McAlpin, an otolaryngologist at California Hospital Medical Center and Cedars-Sinai Medical Center. Two possible causes of slack-jawed sleeping are nasal congestion or a sleep disorder, she says.

“One of the reasons you drool is because you’re having trouble breathing,” she says. “A lot of people with nasal congestion or sleep apnea have that problem.”

The mechanics of drooling are relatively simple: “Either you’re producing more saliva than normal or the muscles that keep your mouth closed or that keep the saliva moving to the back of your mouth aren’t functioning properly,” she says.

If your drooling is caused by simple congestion, it could be remedied by a humidifier or an over-the-counter medication.

If congestion isn’t the cause, McAlpin recommends consulting a neurologist or otolaryngologist. The specialists may want to rule out a serious neurological condition, such as multiple sclerosis, cerebral palsy or Parkinson’s disease. The physician may also recommend evaluation by a sleep clinic to rule out a sleep disorder.

Fortunately, there are lots of remedies for drooling, including biofeedback and, for serious cases, anticholinergic medications that block the secretions. Be warned, however, that anticholinergic agents are associated with significant side effects, including loss of muscle control, double vision and disorientation.

To treat extreme, uncontrolled daytime drooling, McAlpin has resorted to Botox injections and even to excising saliva glands or rerouting ducts toward the back of the mouth.

Presumably, your drooling isn’t that severe, in which case your simplest course of action would be to invest in a nice, absorbent pillow.

Janet Cromley

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To see more reader questions and answers, go to www.latimes.com/health.