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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

What Our Patients Have to Say

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Testimonial by T.H.

I started seeing Heather in October 2014. For more than two years, I had been suffering from painful urinary tract infection type symptoms after my bartholins gland surgery which included constant burning and urinary frequency sensation that led to more and more painful intercourse. I had made multiple visits to internist, obgyn and urologist's offices, went through a range of treatment with UTI and bladder frequency medication that included antibiotics, vesicare, estrogen cream, but nothing worked.

Read more: Testimonial by T.H.

Testimonial by P.M.

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!

Read more: Testimonial by P.M.

Testimonial by M.M.

A personal journey and testimonial from one of my patients:

My husband and I were married for 5 years before we were able to have intercourse due to my vaginismus. There was nothing traumatic in my past but for some reason, even though I wanted sex, I mentally avoided "that area" of my body and didn't even admit to myself that there was a problem for a long time, even though I was never able to put tampons in. Once I finally opened my eyes up to the fact that I had a problem, I had a surgery that was supposed to fix the issue.

Read more: Testimonial by M.M.

Testimonial by R.D., age 38

"I had a severe tear during childbirth that was not stitched together correctly and therefore healed poorly. Even after having a surgery a year later to remove the scar tissue, I was still having pain, and no one could explain why -- there was no overt 'reason' to explain the pain. I had tried other 'specialists' and even saw another physical therapist who had me do hip / leg stretches -- what a joke! I was about to give up and just 'live with it' until thankfully I kept searching online and found Heather.

Read more: Testimonial by R.D., age 38

Testimonial by Fritzette H.

I went to Heather after the birth of my third child. It was lucky, really, that I was referred to her, because my doctor had referred me to a surgeon for a possible hysterectomy or pelvic wall rebuild. Thankfully, I went to Heather before undergoing either surgery, she was able to fix the problem. She has studied extensively in women's health--even written a book about it--and was able to diagnose my problem, suggest a course of treatment (6 weeks), and then follow through with said treatment. By the end, as she said, I was as good as gold. Boy, was it worth it! Though uncomfortable to talk about, much less write about, it is worth getting the word out there. If you have painful intercourse, especially after birth or other trauma, the treatment may be as simple as Physical Therapy (with Heather, of course). I highly recommend her.

-- Fritzette H., 3/24/16 via Yelp!

Testimonial by R.S.

I wanted to thank you so much for helping me get through something I thought I may never be able to. We have achieved pain-free intercourse and this has really solidified our marriage. We are so grateful to you for all the work you do! Thank you!!

-- R.S.

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