Pudendal Neuralgia

Pudendal neuralgia is a pelvic pain condition caused by irritation, compression or damage of the pudendal nerve, which is responsible for movement and sensation within the genital area, bladder and rectal regions. It can happen in men and women, and the pain can be very distressing. The good news is that help is available.

What is Pudendal Neuralgia?

To understand pudendal neuralgia, let’s first get to know the pudendal nerve. The pudendal nerve is the primary nerve in the pelvis. It allows for movement and sensation in the genitalia, bladder and rectal muscles. The pudendal nerve is complex, and is divided into 3 main branches: the rectal, the perineal, and the dorsal (clitoral or penile).

1. The rectal branch supplies sensation to the anus and allows for control of the external sphincter (which allows us to control bowel function).

2. The perineal branch connects to the labia and vulva, as well as the outer third of the vagina in women. In men, it runs from the skin from the anus down to the scrotum and the underside of the penis. It also connects to the pelvic floor muscles.

3. The dorsal branch gives sensation to the clitoris and its hood in women, and the back of the penis and glans in men. It is also vital for bladder control and ejaculation/orgasm.

Sometimes, the pudendal nerve can become compressed or irritated, causing pelvic pain – the hallmark symptom of pudendal neuralgia. The pain may feel like a burning or shooting sensation, and can develop either slowly or suddenly. It tends to get worse when sitting down, which irritates the pudendal nerve. Other symptoms may include:

• Numbness or tingling in your pelvic region

• Increased sensitivity to pain

• Feeling like there’s something in your perineum, like a golf ball

• Pain during sex

• Difficulty controlling your bladder

Pudendal neuralgia can be challenging to diagnose since the pain can occur anywhere in the pelvic region (i.e., buttocks, perineum, genital area) and can be confused with other conditions causing pelvic pain.

If you are experiencing chronic pelvic pain, be sure to talk to your doctor so that a proper diagnosis can be made. Effective treatments are available, including pelvic health physiotherapy.

What Causes Pudendal Neuralgia?

Pudendal neuralgia is sometimes referred to as “cyclist’s syndrome” because it often occurs in cyclists. This is because cycling compresses the pudendal nerve, so when done repeatedly, can lead to prolonged irritation. However, there are other causes of pudendal neuralgia, including:

• Prolonged sitting, which puts pressure on the pudendal nerve

• Difficult childbirth (e.g., if forceps or a vacuum is needed)

• Other forms of exercise, such as squats or weightlifting

• Pelvic surgery, which in rare cases, can damage pelvic nerves

What Is The Role of The Pelvic Floor in Pudendal Neuralgia?

The pelvic floor is a group of dome-shaped muscles, ligaments, and tissue that are located at the bottom of the pelvic bones. A strong pelvic floor is vital for our health, and is needed for many daily functions, including:

• Supporting the pelvic organs

• Stabilizing the low back and hip joints

• Maintaining bladder and bowel continence

• Optimizing sexual sensation and arousal

Repeated compression of the pudendal nerve, such as through sports or extended sitting, can cause the nerve to thicken. This thickening can be made worse if the pelvic floor has overly high muscle tone (i.e., is too tense and unable to relax). A thickened pudendal nerve leaves less room for nerve signals to pass through, which can lead to numbness and pain within any tissues it connects to in the pelvic area.

How Can Pelvic Health Physiotherapy Help Me?

 Pelvic Health Physiotherapy can be very effective in reducing muscle tension in the pelvis, which in turn, increases the mobility of the pudendal nerve and allows for better blood supply. Basically, it can help your pelvic muscles relax and your pudendal nerve work properly!

A Pelvic Health Physiotherapist will teach you specific relaxation techniques for the pelvic floor muscles. This is usually coupled with internal techniques (vaginally or rectally) to help target  muscle tension and sore points. Other holistic techniques include:

·      Teaching you postural improvements to help encourage blood flow in the pelvic area. Learn more

• Suggesting ergonomic adjustments to ease pressure on the pudendal nerve

• Guidance on how to modify sports equipment (e.g., bicycle seats) to reduce nerve compression and improve blood flow

• Addressing other psychosocial factors that may contribute to the pain experience

Keep in mind: slow and steady wins the race. It often takes time to see improvements in your symptoms, so try to be patient. With dedication and hard work, you can ease the tension within your pelvic floor to help ease your symptoms and get back to the activities you love. Your Pelvic Health Physiotherapist is there to support and guide you, and arm you with techniques to help manage acute episodes of pain.

How Do We Approach Treatment For Pudendal Neuralgia?

At Proactive Pelvic Health Centre, we are passionate about pelvic health and are here to guide you, support you, and empower you along your path towards optimal pelvic health. Our first step in treatment is to identify your pain; where is it, how does it feel, and when does it flare up. By understanding your pain experience, we can build a personalized treatment plan to help you achieve your goal: less pain, more function!

Our approach is compassionate, holistic and evidence-based using a combination of education and clinical care to put you on a positive course to achieving your pelvic health and wellness goals. As healthcare professionals passionate about pelvic health, we are committed to providing a safe and comfortable place where clients can access multi-disciplinary pelvic care to help improve their quality of life.