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Pudendal Neuralgia (PN) is a condition that can cause chronic pain or numbness along the course of the pudendal nerve, which is the nerve that innervates the pelvic floor.

What is the pudendal nerve and what does it do?

The pudendal nerve, like other peripheral nerves in your body, is how your brain “connects” with the muscles and tissues of the body- sending and receiving messages between the brain and body like movement and sensation. When nerves get compressed, irritated, or constricted, problems can occur in this “message chain” and you might feel things like pain, numbness, tingling.

If you’ve ever had carpal tunnel syndrome or if your leg has ever fallen asleep while sitting criss cross apple sauce- you’ve experienced what nerve compression can feel like. Pudendal neuralgia is similar, just involving your pudendal nerve.

Symptoms of Pudendal Neuralgia

  • Pelvic pain which include burning, shooting pain, stabbing pain, dull pain, and/or tingling, pins and needles sensation in the following structures:
    • Pelvic floor muslces
    • Perineal area
    • Distal part of the urethra
    • Anal canal
    • Penis
    • Scrotum
    • Clitoris
    • Parts of the labia and vulva
  • Pain with sitting
  • Vulvar pain
  • Penile Pain
  • Clitoral pain
  • Pain with bowel movements
  • Pain with urination
  • Pain with orgasm

Other issues which can occur alongside Pudendal Neuralgia:

  • Fecal incontinence
  • Urinary incontinence
  • Numbness of the genitalia

What Causes Pudendal Neuralgia?

Two of the most common causes of Pudendal Neuralgia are:

  • Nerve entrapment or compression along the course of the nerve, which causes nerve dysfunction, pain, and pelvic floor muscle dysfunction.
  • Connective tissue abnormalities, which causes sensitization of the nerve resulting in pain and other symptoms.

Risk Factors for Pudendal Neuralgia

  • Anatomy--some people are pre-disposed to having pudendal nerve issues due to the unique pathway of the nerve in their body and how it interfaces with various bony structures, muscles, etc.
  • Physical trauma of the pelvic region (falls or accidents)
  • Tailbone injuries
  • Surgery in the area
  • Exercises which can cause pressure to the area, including cycling
  • Chronic constipation

How is Pudendal Neuralgia treated?

Treatment should involve a multidisciplinary team including doctors, pain management experts, mental health, and pelvic floor physical therapy.

Some sample treatment options (you and your treatment team will identify what is appropriate):

  • Medical Treatment with your doctor or pain specialist that may include medication
  • Physical Therapy specializing in the pelvic floor and chronic pelvic pain
  • Nerve Blocks
  • Subcutaneous Infiltrations
  • Trigger Point Treatment
  • Lifestyle Modifications
  • Surgical Nerve Decompression using the approach Trans-gluteal

How Pelvic Floor Physical therapy Can Help Pudendal Neuralgia

Pelvic floor Physical therapy can help Pudendal Neuralgia by guiding your body in restoring the structures that are contributing to the dysfunction of your pudendal nerve. For example, if certain muscles in the pelvic floor are affecting your pudendal nerve, we will help you release them and then give you exercises and a home program to keep those structures released and healthy.

Some of the modalities used at Femina Physical Therapy can include (but are not limited to):

  • Manual therapy including soft tissue massage, connective tissue manipulation, muscle energy techniques, and myofascial release to treat connective tissue dysfunction and myofascial trigger points
  • Internal pelvic floor manual therapy to treat sensitive tissues, muscle spasms, trigger points, and muscle guarding that can cause issues like pain with sex, frequency and urgency of urination, and pain with bowel movements
  • Therapeutic exercises to release entrapped nerves or strengthen the pelvic floor
  • Biofeedback technology to help you focus on relaxing the pelvic floor
  • Photobiomodulation Therapy for pain relief and encouraging cellular healing and desensitization of scar tissue adhesions, tender trigger points, and muscle spasm pain.
  • Visceral mobilization (gentle massage techniques that loosen internal adhesions and restore movement to the organs including the intestine, bladder, uterus, and ovaries) to improve motility and GI organ function
  • Training in self treatment techniques so you can start to manage your symptoms at home. These techniques can include self pelvic floor massage using medical dilators
  • Neuromuscular re-education and autogenic relaxation to reduce chronic muscle over-activity and improve parasympathetic nervous system function, including pain management and digestion
  • Patient Education and Empowerment
  • Lifestyle modifications like sexual positioning, stress reduction, bladder and bowel habits, hygiene, and optimal fluid intake and dietary fiber intake to control other factors that may be contributing to pelvic floor dysfunction.

To learn more about our total body approach approach to chronic pelvic pain, contact us here.

References

Bartley, J., Han, E., Gupta, P., Gaines, N., Killinger, K. A., Boura, J. A., … Peters, K. M. (2018). Transvaginal Trigger Point Injections Improve Pain Scores in Women with Pelvic Floor Hypertonicity and Pelvic Pain Conditions. Female Pelvic Medicine & Reconstructive Surgery, 1. doi:10.1097/spv.0000000000000581

St. Johns Hospital. Pudendal Neuralgia/Chronic Pelvic Pain. https://www.stjosephhospital.com/services/surgical-services/pudendal-neuralgiachronic-pelvic-pain

Kaur J, Singh P. Pudendal Nerve Entrapment Syndrome. [Updated 2020 Mar 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544272/

*Additional Edits by Heather Jeffcoat, DPT

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I was hopeful but frankly skeptical when the doctor treating me for Interstitial Cystitis recommended that I go to Heather for physical therapy. Medication and diet helped control my IC symptoms, but I had never heard of physical therapy being used to treat IC. The education and treatment I received from Heather was a revelation. She explained that the pain I experienced with IC had helped create a cycle of muscle guarding which affected the entire pelvic area. I had no idea of the amount of tension being held there. No wonder my husband and I had not been able to have sexual intercourse for years!

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Testimonial by Lauren B.

Femina PT (née Fusion Wellness & Physical Therapy) has been such an answer to prayer, i'm so glad I found them! I've been struggling with vaginismus my whole life, but didn't have a name for it until about 6 or 7 months ago. Even once I did have a name for it though, I didn't know where to begin in getting help. My OB/GYN had me get a set of dilators, but I couldn't even insert the smallest one by myself. Most times I tried I just ended up frustrated and in tears. I felt really alone, like I was broken and didn't have the energy to keep trying. When I got engaged a few months ago though, I realized I needed to get answers so i wasn't dreading my honeymoon.

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I was in multiple car accidents a decade ago, and I have been to many physical therapists through the years without success. They found the root of my lower back pain problems and after nearly a decade of barely being able to walk I finally can again without pain. They are also the best pelvic floor pts and the only ones who found the connection between my pelvic floor and lower back problems. If you need help with physical pain, they are your answer.

-- Jackie W., 1/19/17 via Yelp!

Testimonial by Mary L.

I started seeing Heather to treat my Interstitial Cystitis in November 2016. At this time, I was extremely miserable, in constant pain, and felt as though no one was listening or understood what was going on with my body. I have just finished my last appointment and I can honestly say that my life has completely changed for the better because of Heather and her team of PTs! I live almost completely pain free, and when I do have flare ups, I am able to treat them at home on my own. I am so grateful that this office was recommended to me a honestly cannot recommend them enough!

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Heather is without exaggerating AMAZING! After years of trouble with a certain part of my body, in no time, she made everything change back to equilibrium and to what would be considered normal. She explains everything in detail and therefore gives you a better understanding of why things are the way they are, and how you can work towards turning things around. I would highly recommend Heather for any type of Physical Therapy. She has created her own "Method/Therapy" through years of studying (with some of the greatest practitioners), practice and breaking down the issues of her past patients, enabling her to fine tune her own system. I'm so thankful to have found her, and I'm especially grateful for the quick recovery I've achieved, after years of distress. If you cannot afford her, I recommend you purchase her book. Although it may not be Heather in person, it can still help you to get on the right path to recovery!

-- Alexandra B., 5/20/2015 via Yelp!

Testimonial by Carolina J.

I had tried Pelvic Floor Physical Therapy before (with another PT) and I had a really bad (painful) experience. A friend of mine and fellow patient, told me about Heather, Laureen and Femina PT (née Fusion Wellness & Physical Therapy) and I decided to try again. I am so happy I did! Femina PT have, literally, changed my life. I was able to do again things I couldn't do for over 10 years!! Their bedside manners are impeccable, their knowledge and understanding make me feel comfortable to recommend this place to anyone in pain. Specially if you have Endometriosis. 100% recommended!!

-- Carolina J., 12/28/16 via Yelp!

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