What is Pudendal Neuralgia?

Pudendal neuralgia is a little known type of chronic pelvic pain that originates from damage or irritation of the pudendal nerve. The pudendal nerve is one of the main nerves in the pelvis, supplying areas such as the:

  • Lower buttocks
  • Area between the buttocks and genitals (perineum)
  • Area around the back passage (rectum)
  • Vulva, labia, and clitoris in women
  • Scrotum and penis in men

Pudendal neuralgia occurs in both men and women, although studies reveal that about two-thirds of those with the disease are women. The condition can make it hard to use the bathroom, have sex, or sit down, and the pain tends to come and go. Although pudendal neuralgia can be very uncomfortable and distressing, relief is available and there are several treatments that can be implemented.

What are the Causes?

Pudendal neuralgia can occur if the pudendal nerve is damaged, irritated or squashed (compressed).

Possible causes include:

  • Compression of the pudendal nerve by nearby muscles or tissue. This is sometimes called pudendal nerve entrapment or Alcock canal syndrome
  • Prolonged sitting, cycling, horse riding or constipation (usually for months or years). This can cause repeated minor damage to the pelvic area
  • Previous surgery to the pelvic area
  • A break in one of the bones in the pelvis
  • Damage to the pudendal nerve during childbirth – this may improve after a few months
  • A non-cancerous or cancerous growth (tumor) pressing on the pudendal nerve

In some cases, a specific cause isn’t identified.

What are the Symptoms?

The main symptom of pudendal neuralgia is pelvic pain, and any of the areas supplied by the pudendal nerve can be affected. You usually feel pudendal neuralgia symptoms in your lower body, genitals, or perineum (the area between your genitals and anus).

The pain may:

  • Feel like a burning, crushing, shooting or prickling sensation
  • Develop gradually or suddenly
  • Be constant – but worse at some times and better at others
  • Be worse when sitting down and improve when standing or lying down

Other symptoms can include:

  • Numbness and pins and needles in the pelvic area
  • Increased sensitivity to pain – you may find just a light touch or wearing clothes uncomfortable
  • Feeling as though there’s swelling or an object in your perineum – often described as feeling like a golf or tennis ball
  • Needing to go the toilet frequently or suddenly
  • Pain during sex, difficulty reaching orgasm, and erectile dysfunction in men
  • Severe depression and suicidal thoughts

What are the Treatments?

Most people with pudendal neuralgia get treatment with a combination of physical therapy, lifestyle changes, and medicines.

Treatments for pudendal neuralgia often include:

  • Sitting up straight or standing more often to help with nerve pain. This can take pressure off the pudendal nerve.
  • Avoiding things that make the pain worse, such as cycling, squats, constipation or prolonged sitting. It may help to use a special cushion with a gap down the middle when sitting and try constipation treatments
  • Medications to alter the pain. These will normally be special medications for nerve pain, rather than ordinary painkillers like paracetamol
  • Physiotherapy. A physiotherapist can teach you exercises to relax your pelvic floor muscles (muscles used to control urination) and other muscles that can irritate the pudendal nerve
  • Painkilling injections. Injections of local anaesthetic and steroid medication may relieve the pain for a few months at a time
  • Decompression surgery. If something is pressing on the pudendal nerve, such as a piece of tissue, surgery to reposition it away from the nerve may help improve your pain
  • Nerve stimulation. A special device is surgically implanted under the skin to deliver mild electrical impulses to the nerve and interrupt pain signals sent to the brain

The pain management specialists at CSPP will work with you to develop a customized pain management program for support and advice about treatment. Call us today at 818-325-2088 for an appointment.