Long term pain in the pelvis?: You may have Pudendal neuralgia

What is a pudendal nerve?

It’s a nerve that runs from your pelvis to the genitalia where it forms branches of other nerves. It sends sensory information to the brain from the lower buttocks and the area between the buttocks and genitalia, area around the anus and rectum, vulva, labia majora and clitoris in women, and scrotum and penis in men. This nerve is also responsible for the control of anal sphincter and urethral sphincter muscles, which opens and closes during the bowel movement and urination respectively.

What is pudendal neuralgia?

Pudendal neuralgia is a painful and long lasting condition.  The compression or damage of the pudendal nerve causes it.

What causes pudendal neuralgia?

Some causes of Pudendal neuralgia are:

  • Giving birth.
  • Pudendal nerve compression which can be caused by muscle or cancerous or non-cancerous tissue growth next to the nerve.
  • Prolonged sitting including cycling and horse-riding.
  • Broken bone of the pelvis.
  • Surgery to the pelvis area.

There are some cases where the cause of pudendal neuralgia can not be determined.

What are the symptoms of pudendal neuralgia?

There are several symptoms that you may experience if you have pudendal neuralgia. However, symptoms and the intensity may vary depending on the cause of the condition. Most common symptoms are:

  • Pain which might feel like burning, prickling, shooting or crushing situated around the lower buttocks, anus and genitalia.
  •  Pain can be intermittent or constant, however, the intensity may vary throughout the day with pain being at its worst while sitting and ease off while lying down or standing up.
  • Symptoms can build up gradually or suddenly.

There are a number of other symptoms that can be associated with pudendal neuralgia.

  • A sensation of a foreign object around the area between the anus and genitalia. Usually, people describe it as having a tennis sized ball.
  • Pins and needles or numbness in the pelvic area.
  • Sudden or frequent urges to go to the loo.
  • Heightened sensitivity to touch to the point where wearing clothes can irritate the area and exacerbate the pain.
  • Painful sexual intercourse, erectile dysfunction in men and difficulty achieving orgasm.

What is the treatment for pudendal neuralgia?

Conservative treatment is usually the primary approach to treat the pudendal neuralgia if the nerve compression or damage is not severe. In addition, you should seek medical help as soon as possible if you have constant pelvic pain. As a result of an early stage treatment you may have more effective results.

Treatment can include avoiding anything that makes it worse, for example: wearing loose clothing, managing your time sitting down, avoiding cycling or other activities which places stress on the pelvic area. 

Besides, physiotherapy, behavioral therapy,  osteopathy and sports therapy are an option, too because a specialist can teach you on how to loosen the pelvic floor muscles and apply some articulation techniques which can ease off the symptoms. 

These approaches can be combined with pain medication or you should see a pain management specialist if you have been suffering from pudendal neuralgia for a long time and if pain has a negative impact on your mental health and the quality of life.

Is treatment of pudendal neuralgia invasive?

As mentioned in the previous section, most of the time treatment of pudendal neuralgia is conservative. However, when conservative treatment fails then health practitioners consider invasive procedures. 

They will offer you a nerve stimulation where a small device is surgically placed under your skin. The device sends electrical impulses to the nerve which help to block the pain signals from reaching the brain.

They may suggest steroid injections and local anesthetic. They can help alleviate the pain for a few months at a time. 

Pudendal nerve decompression operation can also be performed if there is some form of tissue that is compressing the nerve.

How long can this condition last?

This is a very personal experience for everyone suffering from pudendal neuralgia. If it has been caught and addressed early, it might take several weeks for the symptoms to improve significantly. If conservative treatment did not work and you had to have an operation, it might take anywhere between 6 months to a few years for full recovery.

Can I exercise with pudendal neuralgia?

In short, yes you can. However, ensure to consult a healthcare professional regarding the type of exercises and the exercise intensity. Generally, avoid cycling, horse-riding and other sports that involve sitting or placing excessive strain on the pelvic area. Some specific pelvic floor, Pilates or yoga exercises may also help to alleviate the symptoms.

We hope this information is useful for you. If you need advice or have any questions about our treatments, please contact us. You can find us in Mill Hill Broadway and Islington. We are always happy to help. If you like this blog, please share!




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