What is Pudendal Neuralgia?

The main symptom of pudendal neuralgia is pain. Pudendal neuralgia occurs when the pudendal nerve becomes compressed or irritated as it runs it's course through the pelvis.

The pudendal nerve travels from your low back, along your pelvic floor muscles and out to your perineum (the skin between your pubic bone and tailbone). This condition can be a result of an acute traumatic event or repetitive small traumas over time.

Symptoms of Pudendal neuralgia:

• Pain with sitting

• UTI symptoms with negative test results

• Dyspareunia (pain during or after intercourse)

• Sharp pain, burning, itching, electric shock, aching, throbbing or a raw feeling into the perineum (between your "sit bones"), vagina, clitoris, labia, urethra, anus or rectum

• Deep pelvic pain

• A sensation of fullness or feeling like a foreign object is in the rectum or vagina

• Pain radiating into your legs, buttock and feet

• Inability to wear tampons or undergo pelvic medical exams due to pain

• Dysfunction in bowel and bladder habits (such as pain, stinging, hesitancy, increased frequency, urgency, incomplete evacuation)

What causes pudendal neuralgia?

• Birth trauma (use of forceps, long or difficult labor, tearing etc.)

• Falls onto a hard surface

• Surgery

• Cycling (nerve irritation from compression by bike seat)

• Past pelvic trauma

• Pelvic floor over-activity

• Chronic constipation/straining

• Stress

• Repetitive/excessive physical exercise

If your experiencing any of the above symptoms, please seek help from an expert as there is generally always something you can do to improve your symptoms

Treatment of Pudendal Neuralgia:

Pudendal neuralgia is often chronic. Chronic pain is complex and there are often many contributing factors but manual therapy and education can be a very effective way to help ease pain and symptoms associated with Pudendal neuralgia.

Management of pain usually includes adjustments to your lifestyle, work and exercise routines. Finding yourself a good osteopath and/or physiotherapist who specializes in women's health is really important. Your doctor may also recommend medical intervention if required.

Treatment may include:

• Modifying aggravating activities like prolonged sitting, cycling, weight lifting, excessive core or pelvic floor exercises (avoiding Kegels), jumping and horse-riding

• A cushion with a cut out to relieve pressure from the perineum when sitting

• Pelvic floor osteo or physio to assess/treat the pelvic floor, advise on good bladder and bowel habits, tips to avoid pain during sex, and prescribe home exercises for the pelvic floor

• Osteopathic treatment to calm the nervous system and decrease tension around the muscles/joints/ligaments of the pelvis & low back

• Breathing exercises to relax the pelvic floor

• Minimize constipation and straining by increasing foods containing high fiber, drink plenty of water and place your feet on a stool when sitting on the toilet

• Meditation/mindfulness practices to help you cope with chronic pain

• Acupuncture for pain management and stress relief

• Medication may be indicated to desensitized your nervous system and give you some pain relief

• Get adequate sleep, typically the pain lessens during the night or when your lying down
  

With the right education and healthcare team, you can significantly reduce your pain and it's affect on your quality of life

FYI Pudendal neuralgia can also affect men, it's not just limited to women

Written by Dr Emma Berry (Osteopath)