Pudendal neuralgia is a rare and long-term pelvic floor condition that affects and causes pain, discomfort or numbness in your pelvis or genitals (1). It can also be very distressing and take a toll on your mental health. It originates from damage or irritation of the pudendal nerve – a main nerve in the pelvis that supplies the areas between the lower buttocks and genitals (perineum), the area around the anus and rectum (2). Pudendal neuralgia can make it hard to sit down, use the bathroom or have sex. The pain is constant and at times can be particularly heightened for those suffering with this type of pain. It is not known how people develop this condition, but the signs and symptoms are clear, and they can develop gradually or be brought on suddenly. The pain is felt in the pelvic area and it feels like a burning, crushing or prickling sensation which can be made worse when sitting down. Some see an improvement when standing or lying down (2). If you are experiencing any of the pudendal neuralgia symptoms described it is advisable to seek medical advice. From there you will be diagnosed, and a pudendal neuralgia treatment plan will be developed to suit you. There are also plenty of resources available for those who would like to explore self help for pudendal neuralgia. We hope this has helped answer the question of what is pudendal neuralgia?
Causes / Origin / Why pudendal neuralgia?
Pudendal neuralgia causes are far reaching, and can happen if the pudendal nerve is damaged, irritated, or trapped (2). When the pudendal nerve is affected it causes mechanical types of injury to the area such as compression, transaction, or stretching. These can show up as but are not limited to:
- Compression of the pudendal nerve
- An existing injury or broken bone in the pelvis
- Direct trauma to the buttocks or back
- Pelvic surgery – as well as after mid-urethral surgery, hysterectomy and anterior colporrhaphy
- Chronic constipation
- Childbirth – vaginal delivery causes a significant stretch of the pelvic floor muscles by the fetal head, which can result in pudendal nerve damage
- Prolonged sitting
- Types of exercise such as riding a bicycle or horse riding for extended periods.1,2,3
Non-mechanical pudendal neuralgia causes can include:
- Viral infections (herpes and HIV)
- Multiple sclerosis,
- Diabetes mellitus 3
In some cases, a specific cause may not be found.
The origin of pudendal neuralgia was first understood because of a reported case where cycling resulted in the continuous pressure on the Alcock canal (3).
Symptoms of pudendal neuralgia
Pudendal neuralgia symptoms show up first and foremost as pain and although this can be highly variable pain in your pelvic area, it is typically a good indicator that you are suffering with pudendal neuralgia. The sensations you experience may be feelings of:
- Burning pains
- Electric shock pains
- Shooting pains
- Aching pains
- Genital pains
Suffering from any of these symptoms may make it difficult to sit down in any setting. Other indicators are bladder and bowel irritation as well as pain in your legs and buttocks. This is because the skin in this area is supplied by the same level of your spinal cord and your brain perceives the pain in your skin as your buttocks, legs, and feet (4).
If you suffer with persistent pelvic pain and experience any of the above symptoms, it is advisable to reach out to your healthcare provider for a consultation to ensure you get the correct diagnosis and most importantly the right treatment for you.
Treating pudendal neuralgia
Before any treatment can be devised, an initial physical exam will be performed. This helps your healthcare provider to make a full assessment of you, your condition and the correct diagnosis. Once this has been established, a personalized approach can be curated just for you. The prescribed pudendal neuralgia treatment will be multifaceted as well as call on a range of healthcare providers such as physiotherapists and osteopaths. Self help for pudendal neuralgia is prudent for recovery as without ownership and commitment to your treatment, it will just be words on a page or screen!
Pudendal neuralgia treatment
- Pudendal neuralgia physical therapy – can help to relax and / or stretch your pelvic floor muscles to decrease the irritation
- Osteopathy – can encourage a reduction in your pudendal nerve by relaxing the joints, muscle, and soft tissue
- Psychotherapy – promotes better mental health and how you cope with chronic pain
- Yoga – in some circumstances movement and techniques such as Kegel exercises may be helpful in recovery.4
Perifit: strengthen your pelvic floor with games and biofeedback
A key component of your self-help for pudendal neuralgia is to take complete ownership of the plan for your road to recovery. Pudendal neuralgia physical therapy is integral to your treatment plan and you may want to consider Perifit. Perifit is a device and platform that uses the biofeedback approach to provide you with instant feedback on your pelvic floor strength and the quality of your contractions (Kegels) by using its internal sensor and mobile app (5). This device, which can be accessed through your smart phone, uses a program to provide pelvic floor biofeedback training to all users regardless of age or pelvic floor condition. Perifit offers a fun and engaging way to increase your pelvic floor strength.
- Diastasis Recti
- The Pelvic Floor: What you need to know
- 5 Ways to Train your Pelvic Floor
- All you ever wanted to know about overactive pelvic floors
- WebMD, ‘What Is Pudendal Neuralgia?’ date accessed on 08/26/2021: https://www.webmd.com/pain-management/pudendal-neuralgia
- NHS, ‘Pudendal neuralgia’ accessed on 08/26/2021: https://www.nhs.uk/conditions/pudendal-neuralgia/
- NCBI, ‘Pudendal Nerve Entrapment Syndrome’ date accessed on 09/02/2021: https://www.ncbi.nlm.nih.gov/books/NBK544272/
- WHRIA, ‘Pudendal Neuralgia’ accessed on 09/02/2021: https://www.whria.com.au/for-patients/pelvic-pain/pudendal-neuralgia/
- Perifit, ‘Strengthen your pelvic floor with games’ Perifit, date accessed on 08/26/2021: https://perifit.co/