Pudendal neuralgia is a condition that causes pain, discomfort, or numbness in your pelvis or genitals. It happens when a major nerve in the lower body is damaged or irritated, and it can make it hard to use the bathroom, have sex, or sit down.
There is no one cause of pudendal neuralgia. It may be related to:
- Childbirth trauma
- Gynaecological or colo-rectal surgery
- Cycling
- Excessive physical exercise
- Past pelvic or perineal trauma
- Injury
- Straining
- Musculoskeletal issues
- Posture
Symptoms
- Bladder and bowel irritation
- Occasionally there is a full sensation in vagina or rectum.
- Sometimes pain can be felt into the buttocks, legs and feet.
- Sometimes you can feel this irritation without feeling much pain
- The main symptom of this problem is pain. This can be highly variable. You might feel burning, electric shock, shooting, aching, itch or a raw feeling in your clitoris, labia, vagina (penis in men), urethra, perineum, anus or rectum. You might find it difficult to sit because of your pain
- This is because the skin there is supplied by the same level of your spinal cord and your brain ‘perceives’ the pain in the skin of your buttocks, legs and feet
- Activated platelet extract injections (PRP platelet-rich plasma): to activate healing
- Acupuncture
- Adapting your sex life: Some people find sex can flare their pain. There are many options to keep your sex life going while avoiding pain. Your clinician can help you with this.
- Avoiding physical activities that irritate the nerve: The biggest ones are spending hours on a pushbike and horse-riding. Other activities to minimize are trampoline jumping, bench pressing and excessive ‘core muscle’ exercises. Osteopathy and physiotherapy can help you identify movements specific to you that may need to be minimized for a period of time.
- Botox / Botulinum toxin Type A injections: for overly tight muscles
- Bowel and bladder management strategies: Try not to strain when emptying your bowels or passing urine, as this stretches the nerve. Avoid stimulant laxatives. Physiotherapy can help you develop a plan for good bladder and bowel habits that suit you.
- Cortisone injections: near a nerve, into a joint, tendon or tender point
- External exercises and stretches and you may need to address your posture and activities that may flare your pain.
- Hyaluronic acid injections near the nerve to help with healing (often added to the diagnostic pudendal nerve block injection)
- Medication
- Nerve block. Under X-ray or ultrasound, your doctor will inject a local anesthetic into the canal the nerve travels through.
- Neuro-modulation with implantable electrodes
- Osteopathy
- Physical examination – Initial physical examination with one of our doctors and an allied health professional.
- Physiotherapy
- Psychotherapy
- Pudendal nerve block
- Pudendal nerve MRI – The MRI will give providers information about the anatomic structures surrounding the nerve.
- Pudendal nerve release surgery
- Pulsed radio-frequency treatment of the pudendal nerve, sacral nerve roots or sacroiliac joints: for pain modulation
- Sitting modification: Avoiding pressure on the perineum (the area inside your ‘sit bones’) helps to prevent the nerve compressing.
- Sonography of the pelvic floor muscles
- Sonography of the sacroiliac joint and ligaments
- Support & Yoga for Pelvic Pain
- TENS (trans-cutaneous electrical nerve stimulation) for effective self-management – but ask the physiotherapist to help you place the electrodes correctly.
- Testing on neurological and musculoskeletal functions of your legs, pelvis and perineum by checking your muscles, joints, posture and reflexes.
