Pudendal Neuralgia

Pudendal Neuralgia is a painful condition resulting from an injury to the pudendal nerve. The pudendal nerve originates in the sacrum and is comprised of three branches (rectal, perineal, and clitoral/penile) that innervate the rectum, anus, urethra, perineum, and genitals of both sexes.

Common Symptoms & Known Causes

Clients with Pudendal Neuralgia often present with the following symptoms:

  • Stabbing, burning, and/or tingling pain in the regions innervated by the pudendal nerve (rectum, anus, urethra, perineum, labia/clitoris and/or vagina in women; testicles and/or penis in men). Pain can be on one or both sides. Some clients describe a sensation of a foreign object in the vagina or the rectum.
  • Pain increases with sitting and often worsens throughout the day.
  • Urination and defecation difficulties – Clients may experience urinary hesitancy (needing to urinate but a delay in starting to urinate or a slow, dribbling stream; urinary frequency (defined as voiding more than 8 times in 24 hours); and in more severe cases, urinaryand fecal incontinence (the leaking of urine, feces or gas).
  • Clients often describe having to strain in order to empty their bowels or bladder and often describe pain during and/or after a bowel movement. In addition, constipation is often a problem for clients dealing with pudendal neuralgia.
  • Sexual dysfunction - Female sexual dysfunction may include genital, perineal, and/or rectal pain; difficulty achieving orgasm; pain during intercourse; and/or pain during or after orgasm. Male sexual dysfunction may include pain during erection, pain during ejaculation, and difficulty sustaining an erection.

Some known causes of Pudendal Neuralgia include:

  • Trauma to the pelvic region
  • Gynecologic surgery
  • Varicose veins inside the pelvis
  • Repetitive activities, such as cycling and squatting exercises

Pudendal Neuralgia can be caused by entrapment of the pudendal nerve or other compression/ tension issues. If the nerve is entrapped, the likely treatment includes physical therapy, analgesic medication, pudendal nerve blocks, and pudendal nerve decompression surgery. If the Pudendal Neuralgia is a result of compression/tension (often the result of muscular problems due to biomechanical abnormalities), treatment may include physical therapy, analgesic medication, and pudendal nerve blocks. In order to ensure a successful treatment outcome, it’s important to acknowledge both dysfunctions (entrapment and compression/tension) and treat accordingly. Patients are encouraged to exhaust conservative treatment measures, such as physical therapy, lifestyle modification, analgesic medications, and nerve blocks, before entertaining surgical intervention.

Pudendal Neuralgia can be a very painful and debilitating condition. In order to prevent further injury and better manage symptoms, it’s important for patients to avoid activities that exacerbate the condition, such as cycling, sitting, bending, squatting. For further information or consultation, please contact CorePhysio at 360-752-2673.

Fig. 1. Schematic anatomy of deep dissection of gluteal region.(Used with permission of the Mayo Foundation) Most of gluteus maximus and medius muscles have been removed. Segment of sacrotuberous ligament also has been removed, revealing pudendal nerve. Pudendal nerve emerges from pelvis inferior relative to piriformis muscle and enters gluteal region medial relative to sciatic nerve, superficial relative to sacrospinous ligament, and deep relative to sacrotuberous
 
 





Fig. 2A.  Schematic anatomy of the pudendal nerve. (Used with permission of the Mayo Foundation) Drawing illustrates pudendal nerve arising from sacral nerve roots S2– S4, exiting pelvis to enter gluteal region through lower part of greater sciatic foramen and reentering pelvis through lesser sciatic foramen. Pudendal nerve gives rise to inferior rectal nerve, perineal nerve, anddorsal nerve of penis or clitoris.



Fig. 2B. Schematic anatomy of the pudendal nerve. (Used with permission of the MayoFoundation) Drawing shows pudendal nerve inpudendal (Alcock's) canal. Inferior rectal nerve arises from pudendal nerve before entering canal. Note location of falciform process of sacrotuberous ligament, which is possible site for pudendal nerve entrapment.









References:

http://www.spuninfo.org - a website dedicated to educating clinicians and patients about Pudendal Neuralgia.

http://www.mayoclinic.com/ - a website providing medical information and news on health topics.