If you suffer from intense, disruptive pelvic pain, you may have a condition called pudendal neuralgia.. You desperately want relief after months or years of discomfort impacting all facets of life. You’ll uncover what these sensitive nerves to become irritated and inflamed, leading to symptoms like rectal pain, painful urination, and discomfort during sex. More importantly, how to calm irritation for good through physical therapy, medication, or surgery if conservative options fail.
By the end, you’ll grasp treatment choices to discuss with your doctor so they take your pain seriously. Equipped with knowledge, you can reclaim comfort and resume cherished relationships and activities pain-free! First understand what provokes symptoms then explore your best treatment options, from lifestyle changes and physical therapy to medications and surgery, so you can reclaim your life.
What is pudendal neuralgia?
In less technical terms, pudendal neuralgia refers to chronic pelvic pain caused by an inflamed or damaged pudendal nerve. This key nerve runs from your lower spine down to your pelvic area. Essentially, an aggrieved nerve equals an aggrieved you.
When the pudendal nerve gets pinched, compressed, stretched, or injured, it alerts your brain that something’s amiss down under. The result? Aching, burning, stabbing discomfort centralized in your genitals, rectum, anus, or perineum (the area between your genitals and anus). Sitting tends to aggravate pudendal nerve pain, while standing brings relief.
Pudendal neuralgia can negatively impact your bladder and bowel function too. You may face painful peeing, constipation, fecal incontinence, or feel like your bladder’s got a mind of its own. Trouble climaxing, erectile dysfunction, uncomfortable intimacy, and general genital numbness are other common pudendal neuralgia symptoms.
Navigating where your pudendal nerve resides
Your pudendal nerve branches out to stimulate and supply sensation to your entire pelvic floor region – think all the areas that touch a bike seat. Its job is facilitating urination, defecation, arousal, and orgasm by coordinating communication between your bowel, bladder, genitals and sensory nerves.
More specifically the pudendal nerve interacts with:
- Your penis, scrotum, testicles – male anatomy
- Your clitoris, vagina, labia, vulva – female anatomy
- Your perineum
- Your anal canal and external anal sphincter
- Your urethra and urinary sphincter
If pudendal neuralgia is causing you misery, pinpointing which branch is implicated can help guide tailored treatment and recovery.
How widespread is pudendal nerve pain?
Although pudendal neuralgia isn’t common, anyone can develop it – estimates indicate between 30,000 to 200,000 cases in America. Most diagnoses occur in adults over age 30.
Women endure the majority of pudendal nerve issues due to potential complications during vaginal childbirth. Damage may also arise from Caesarian sections.
Men face risks following prostate cancer operations or prostatectomy procedures. Trauma from bike riding, horseback riding, squatting exercises, and falls can also irritate the pudendal nerve. Sometimes there’s no known cause for the burning pain in the genitals.
Given the sensitive nature of symptoms, pudendal neuralgia frequently gets overlooked, wrongly labeled as something else, or never gets brought up with doctors. Getting properly diagnosed is essential to stopping the pain permanently.
Symptoms of pudendal neuralgia explained
Pudendal nerve pain varies depending on which branches are affected. Damage to the rectal branch typically causes rectal, anal, or perineum discomfort. Issues with the clitoral/penile division lead to genital and urinary symptoms. Every patient’s experience differs slightly.
On the whole, the hallmark pudendal neuralgia symptoms include:
- Sharp, aching, burning genital pain, rectal pain or pain in the perineum
- Increase in symptoms while sitting
- Temporary relief standing up or lying down
- Tingling genitals
- Genital numbness
- Painful urination or increased urinary frequency/urgency
- Repeated bladder infections
- Pain during intercourse, trouble climaxing, erectile dysfunction
- Bowel problems – constipation, diarrhea, pain when pooping
Less common signs involve:
- Swelling feeling in the perineum
- Cold or unusual sensations in the legs, feet or buttocks
- Muscle spasms in the pelvis or pain radiating into the hips/upper legs
Typically pudendal discomfort comes and goes but intensifies over time without treatment. Pain levels commonly worsen as the day goes on, with milder symptoms upon waking, a typical symptom pattern for those experiencing pudendal nerve pain syndrome. Activities like exercising, having a bowel movement, or wearing tight pants may spur flare ups.
How doctors diagnose pudendal neuralgia
Since pudendal nerve irritation sparks generic pelvic pain and bladder problems, physicians first eliminate other diagnoses like coccydynia (tailbone pain), vulvodynia (vulva pain) or overactive bladder.
Your medical team will carry out a physical examination of your pelvic floor, followed by specialized tests like:
- Pelvic/vaginal/rectal exams assessing nerve pain response to applied pressure
- MRIs visualizing the pudendal nerve’s shape and trajectory
- Pudendal nerve blocks numbing the nerve to evaluate changes in pain levels
- Electromyography using electric signals to monitor nerve communication with your pelvic floor muscles
Through diagnostic testing, doctors can determine whether pudendal neuralgia explains your symptoms, rule out mimicking disorders, pinpoint areas of entrapment, and design a customized treatment plan.
Causes of pudendal neuralgia
A variety of issues can compress, trap, strain or damage the intricate pudendal nerve network, provoking inflammation and chronic neuropathic pain. Common culprits consist of:
- Repeated strain on the pelvic floor – long periods sitting, cycling, squatting
- Taut muscles, ligaments or scar tissue squeezing nerves
- Childbirth trauma – vaginal delivery risks nerve damage
- Pelvic fractures from injury or accidents
- Spinal issues like slipped discs
- Complications following pelvic surgeries such as hysterectomies
- Diabetes (a risk factor for nerve damage)
- Neurological disorders – multiple sclerosis
- Infections – shingles, HIV
Sometimes the source of nerve irritation remains unclear after testing. Pinpointing causes directs custom therapy for resolving compression and calming neural inflammation.
Treatment for pudendal neuralgia
Given potential side effects with long-term medication usage, starting pudendal neuralgia treatment conservatively is recommended. Physical therapy represents a top initial option, especially for mild to moderate nerve aggravation. PT utilizes exercises, modalities and manual techniques to calm nerve irritation and release muscle tension placing pressure on pelvic nerves.
Tailored physical therapy protocols involve:
- Myofascial release – Hands-on soft tissue massage gently stretching rigid ligaments and muscles surrounding compromised nerves.
- Joint mobilization – Gentle movements opening up stiff pelvic joints with limited mobility that contribute to nerve compression.
- Manual trigger point therapy – Isolated pressure applied to knotted muscle fibers contributing to pudendal nerve entrapment, a common issue in the diagnosis of pudendal neuralgia.
- Neuromuscular reeducation – Strategies promoting positional nerve sliding and glide to allow smoother mobility within compressed zones.
- Modalities – Applications of moist heat packs or ice providing pain relief. Electrical stimulation via TENS machines can also calm pudendal nerve activity.
- Posture correction and ergonomic training – Reducing strain on the pelvic floor in daily positions. This encompasses alternating sitting with movement, promoting core engagement, and using supportive cushions.
Making certain lifestyle tweaks in conjunction with structured PT maximizes healing. This denotes limiting prolonged sitting, avoiding pressure-inducing activities like cycling, and preventing constipation through proper hydration and fiber intake.
The medication route for pudendal neuropathy
If physical therapy and lifestyle adjustments fail to adequately control pudendal discomfort after a few months, your doctor may try medicinal alternatives while therapy continues.
Potential pudendal neuralgia medications include:
- Pain relievers – Over-the-counter NSAIDs like ibuprofen. For acute flare ups, stronger narcotic painkillers may be prescribed judiciously.
- Steroid injections – Cortisone shots injected around irritated nerve zones decrease localized inflammation. However, long term steroid use risks side effects.
- Antidepressants – Tricyclic varieties like amitriptyline applied in low doses calm nerve pain signals.
- Anti-seizure drugs – Medications containing gabapentin reduce neuropathic pain sensitivity. Lyrica is another option.
- Muscle relaxants – These temporarily release spastic pelvic floor muscles straining nerves.
- Nerve blocks – Numbing injured areas with local anesthetic demonstrates pudendal involvement and offers short-term relief by desensitizing pain signaling.
- Botox injections – When pelvic floor muscles remain persistently taut, strategically relaxing the muscles compressing nerves brings relief.
Ongoing physical therapy and activity modification should complement oral or injectable medication therapies targeting stubborn pudendal nerve irritation.
Pudendal nerve decompression surgery
When all else fails and pain continues severely reducing quality of life, undergoing pudendal nerve decompression surgery may be appropriate. This outpatient procedure entails a small incision in the lower buttocks providing access to compressed pudendal nerves. Surgeons then remove any constricting ligaments, bands of muscle or scar tissue choking nerves. This liberates trapped nerves to slide and glide smoothly.
Patients report 50-80% pain improvement following decompression surgery based on studies. However, pain relief often requires several months up to a year post-operation as nerve regeneration continues progressively. Surgery risks include infection, bleeding, damage to surrounding anatomy, or lack of symptom improvement.
Conservative therapy concurrent with surgery facilitates optimal nerve recovery. Activity modifications plus pelvic floor physical therapy assist the healing process for several months following decompression procedures aimed to treat pudendal neuralgia.
Can pudendal neuralgia be prevented?
Preventing initial pudendal nerve compression or injury isn’t guaranteed since triggers like childbirth trauma or some medical procedures remain unpredictable, often leading to pelvic floor dysfunction. However, you can reduce aggravating repetitive strain. This denotes:
- Avoiding prolonged sitting – Get up and move!
- Selecting ergonomic chairs and cushioning
- Limiting pressure-increasing activities like cycling
- Stretching hip flexors and core muscles
- Keeping your bowels moving to prevent straining
- Managing chronic health conditions increasing neuropathy risk like diabetes
Seeking prompt care for symptoms suggestive of pudendal nerve involvement allows quicker access to treatments preventing permanent damage. Be vocal about pelvic and genital pain or changes in urinary/bowel habits with your physician. Catching nerve problems early heightens the chances of stopping their spread in its tracks.
The pudendal neuralgia outlook – Can it be cured?
Unfortunately pudendal neuralgia related to entrapment or compression-induced nerve irritation can’t be cured outright. Since nerves heal slowly, treatment aims to control and minimize symptoms so they don’t rule your life. As nerves regenerate over months to years, discomfort should abate. But some degree of pain may persist long term, with flare risk.
Lifestyle strategies keeping symptoms in check must continue indefinitely. On the bright side, most patients find an individualized treatment plan offering substantial pain relief and restored quality of life. Starting with conservative therapies, then progressing to more advanced options maximizes outcomes.
Working closely with professionals like physical therapists, pelvic pain doctors and surgeons well-versed in pudendal neuralgia stacks the odds in your favor. Be patient with the process, communicate challenges, and support healing with self-care. In most cases solutions are readily available once correctly diagnosed.
Where to turn for life-changing pudendal neuralgia help
If you relate to debilitating pelvic pain or sexual dysfunction, seek help from a pelvic health specialist. Getting properly diagnosed and beginning appropriate therapy ASAP prevents worsening pain and damage. Catching pudendal neuralgia early allows for pain-free living once again.
You deserve support. Now equipped with everything you need to know regarding potential pudendal nerve damage, take the next step. Find an expert near you, get evaluated, and have hope. This miserable condition is treatable when intervened upon early!
