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A Guide to Pudendal Neuralgia: Symptoms, Causes and Treatment Options

By May 28, 2021Blog, Pelvic Pain
pudendal neuralgia patient

It goes without saying that chronic pelvic pain can take the vibrancy right out of life. If you’re suffering from pudendal neuralgia, you know firsthand how it can interfere with everyday living — from sitting to walking to having sex. But because it’s rare, those suffering from it might not know what they have, or hesitate to seek out help from their doctor or a pelvic pain specialist.

Thankfully, we at Pelvic Pain Doc are here to have the hard conversations, find out what’s at the root of your pelvic pain, and, more importantly, alleviate your symptoms. If you have pudendal neuralgia, Dr. Sonia Bahlani wants to help you find your way to a pain-free life. 

In this post, Dr. Bahlani explains:

  • What is the pudendal nerve?
  • What pudendal neuralgia is
  • Pudendal neuralgia symptoms
  • What causes pudendal neuralgia
  • Getting a diagnosis
  • Pudendal neuralgia treatment

What is the Pudendal Nerve?

Let’s start with what the pudendal nerve is. For both women and men, the pudendal nerve is the main pelvic nerve that supplies sensation to the lower buttocks, the perineum, and the area around the anus and rectum. For women it innervates the labia, vulva and clitoris, and in men,  the scrotum and penis. It carries autonomic and motor signals from the genitals and anus, and controls the sphincter muscles that you use when having bowel movements.  

The pudendal nerve starts at the bottom of the pelvis then runs to the base of the vagina (or penis — in pudental nerve damage in males) before branching out into three separate nerves that go to the anal-rectal region, the perineum, and the clitoris (or penis). 

What Pudendal Neuralgia Is

So the big question is: What is pudendal neuralgia? This is a term used to describe a damaged, irritated, or trapped pudendal nerve that results in pain. From its location alone, you can see why pain from pudendal nerve damage or irritation would be so disruptive to every day activities, not to mention your sex life. Any of the areas it serves can be affected — from the genitals to the buttocks.  

Pudendal Neuralgia Symptoms

As you might have gathered, pain is the most common of the pudendal neuralgia symptoms. But the severity of pain can vary from person to person. So can the type of pain: pudendal neuralgia can feel like mild discomfort, all the way to a prickling, stabbing, or burning sensation. Some people might even experience numbness. We’ve had patients describe that their clitoris hurts, or tell us, “It feels like something is in my vagina!” 

The onset of pain can be gradual or sudden; it might last for a long time but feel worse sometimes and better at other times.

Specific pudendal neuralgia symptoms include:

  • Pain in the clitoris, vulva, perineal area pain and/or pain in the rectum, especially when sitting
  • An increased sensitivity to pain: even a light touch or clothing might trigger discomfort
  • The feeling of swelling or a foreign object in the perineum or vagina — and only on one side
  • Frequent trips to the toilet or the need to urinate suddenly
  • Pain during sex
  • Difficulty reaching orgasm

Causes of Pudendal Neuralgia

Of those who have experienced pudendal neuralgia, two-thirds are women. If you’ve given birth or had a c-section, it’s possible that your pelvic pain stems from a damaged pudendal nerve, although it may heal after a few months. 

Other causes include:

  • A pelvic injury
  • A broken bone in your pelvis
  • Pelvic surgery
  • Nearby tissue or muscle compressing the nerve
  • A tumour  — either cancerous or benign — pressing on the nerve
  • An infection 

Activities like prolonged bike riding or horseback riding are known to cause pudendal nerve damage. Or if you’ve been suffering from years of constipation, this can also affect the pudendal nerve and result in the presence of symptoms .

Diagnosis

It’s important to share any of the above history and symptoms with your pelvic pain specialist as soon as possible. You’ll be happy to know that the sooner Dr Bahlani can identify if you have pudendal neuralgia, the more effective your treatment can be. 

We should also mention that because symptoms of pudendal neuralgia can present similarly to other conditions, and because it’s rare, pudendal neuralgia can be misdiagnosed. Fortunately, a pelvic pain specialist like Dr. Bahlani has the expertise to determine if pudendal neuralgia is what you’re suffering from. 

In an appointment at Pelvic Pain Doc, Dr. Bahlani might:

  • Press on the nerve in a vaginal or rectal exam
  • Order an MRI scan that allows us to see your organs and reveal if a trapped pudendal nerve is the issue
  • Give you a pudendal nerve block — this is an injection given around the nerve to see if your pain decreases or your symptoms improve
  • Screen you for possible infections or immune diseases
  • Suggest a pelvic floor exam to determine the health of your pelvic floor muscles and see if skeletal alignment abnormalities exist

pelvic pain doctor with patient

 

Pudendal Neuralgia Treatment

The good news is that pudendal neuralgia symptoms can be alleviated, allowing you to live a life with more comfort and less pain. Lifestyle changes, medication, and physical therapy can go a long way in treating pudendal neuralgia symptoms. 

So who treats pudendal neuralgia? Dr. Bahlani is your New York pelvic pain specialist who can expertly diagnose and treat your pelvic pain with treatment that’s right for you. 

Lifestyle Changes:

A good start is avoiding things that make the pain worse — like cycling, sitting for too long, or squats. If you’ve suffered from chronic constipation, a diet rich in whole grains, veggies, and fruit should help bring your bowels back in balance.

Medication: 

Dr. Bahlani can suggest oral and topical medications that can help specifically with nerve pain. We might also recommend injections of a local anesthetic and steroid medication that can alleviate pain for a few months at a time. Botox is another treatment — when injected into your pelvic floor muscles, Botox has been shown to relax muscles that may be irritating the pudendal nerve.

Physical therapy:

A physical therapist will take you through pudendal neuralgia exercises that help you relax and stretch your pelvic floor muscles, as well as the surrounding muscles that might be irritating the pudendal nerve. They work towards myofascial release, and sometimes use trigger point therapy internally through the vagina or rectum. Physical therapy can also help with incontinence if pudendal neuralgia has affected how well you can hold your bladder and bowels.

If pudendal neuralgia exercises in physio don’t help with the pain after 6-12 sessions, your Manhattan pelvic floor specialist can prescribe more serious treatment like the following.

Decompression Surgery:

When an MRI shows that something is pressing on your pudendal nerve, like a piece of tissue, surgery can move it away from the nerve and improve your pain. However, surgery is the most invasive treatment for pudendal neuralgia and doesn’t always end in success. It also has a lengthy recovery time: from six months to a few years since nerves heal very slowly. 

Nerve Stimulation:

This is when a small device is surgically implanted under your skin to deliver mild electric impulses to the pudendal nerve. These electrical impulses interrupt pain signals to your brain.

Time to Alleviate Your Pain With Pelvic Pain Doc

Are you wondering if your pelvic pain is a symptom of pudendal neuralgia? Now that you’ve got the basics, set up a virtual appointment to see Dr. Bahlani for an exam. Let’s work together to make your days less about pain and more about living the vibrant life you deserve.

Dr. Bahlani

Author Dr. Bahlani

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