Pudendal Neuralgia

About
  • Long-term pelvic pain that originates from damage/irritation of the pudendal nerve – a main nerve in the pelvis
  • Supplies areas including the
    • Lower buttocks
    • Area between the buttocks and genitals (perineum)
    • Area around the anus and rectum
    • Vulva, labia and clitoris in women
    • Scrotum and penis in men

Potential Causes
  • Compression of the pudendal nerve by nearby muscles/tissue – sometimes called pudendal nerve entrapment or Alcock canal syndrome
  • Prolonged sitting, cycling, horseback riding or constipation (usually for months or years) – can cause repeated minor damage to the pelvic area
  • Pelvic surgery
  • Broken pelvis
  • Damage to the pudendal nerve during childbirth
  • A growth pressing on the pudendal nerve

Symptoms
  • Pelvic pain (any of the areas supplied by the pudendal nerve can be affected), which can feel like a burning, crushing, shooting or prickling sensation
    • Can develop gradually, suddenly or be constant
  • Numbness and pins and needles in the pelvic area
  • Increased sensitivity to pain
  • Feeling as though there’s swelling or an object in your perineum
  • Needing to go the toilet frequently or suddenly
  • Pain during sex
  • Difficulty reaching orgasm
  • Erectile dysfunction in men

Diagnosis
  • Vaginal/Rectal exam: To see if the pain occurs when pressure is applied to the pudendal nerve
  • MRI scan: To check for problems such as a trapped pudendal nerve and to rule out other possible causes
  • Nerve studies: A small device inserted into the rectum is used to stimulate nearby nerves with mild electrical impulses to check how well the nerves are working
  • Nerve block injections: Painkilling medication is injected around the pudendal nerve to lessen/eradicate pain

Treatment
  • Nerve pain medication
  • Pelvic physiotherapy: Learn exercises to relax your pelvic floor muscles and other muscles that can irritate the pudendal nerve
  • Painkilling injections: Local anaesthetic and steroid medication for temporary relief
  • Decompression surgery: Tissue removal (if there is any) to keep it from pressing on the pudendal nerve
  • Nerve stimulation: A small device is surgically implanted under the skin to deliver mild electrical impulses to the nerve and interrupt pain signals sent to the brain
  • Avoid things that make the pain worse ie: cycling, prolonged sitting
  • Stay regular