Pudendal Neuralgia

Pudendal Neuralgia is pain or numbness in the pelvis and surrounding area which is caused by the pudendal nerve. Both men and women can suffer from pudendal neuralgia. Fortunately, treatment is available and there are things you can do to manage your pain and ease your symptoms. 

The Causes of Pudendal Neuralgia 

Pudendal Neuralgia often occurs as a result of trauma. This could be a large trauma or small trauma, such as straining to use the toilet, riding a bike, or hard physical exercise for long periods of time over many months or years.  For women, trauma leading to pudendal neuralgia could be a fall, labour and childbirth, gynaecological surgery, correction of a prolapse, excessive physical exercise such as weightlifting, or straining with chronic constipation. 

Although you may suffer from pudendal neuralgia after surgery, it is not necessarily the result of incorrectly performed surgery. 

The Location of the Pudendal Nerve

The pudendal nerve is one of the main nerves in the pelvis. It runs from the lower back, along the pelvic floor muscles and out to the perineum, which is the skin between the pubic bone and the tailbone. It is the nerve responsible for carrying the sensation of touch and pain in the perineal area. It also controls the muscles responsible for the opening and closing of the bladder and bowel, called the sphincters.

Nerves are usually supple and stretchy but when they suffer a large trauma or lots of repetitive small trauma, they can become irritated. If the pudendal nerve becomes damaged, compressed or irritated, you can be affected by pain, discomfort and other issues. 

Symptoms of pudendal neuralgia can include: 

  • Pain or numbness in your clitoris, labia, vagina, urethra, perineum or rectum.
  • Pain in between your ‘sit’ bones or deep pelvic pain. 
  • The pain can be pins and needles, stabbing, aching, burning, or hypersensitivity. 
  • Difficulty in sitting down because of pain.
  • A full sensation in the vagina or rectum. 
  • Pain in the buttocks, legs and feet.
  • Frequent need to urinate or the feeling of a bladder infection.
  • Bowel problems or the sensation of an urgent need to open the bowels.
  • Sexual problems or pain with intercourse.

Most women with pudendal neuralgia report pain on sitting that gets worse as the day goes on. It usually resolves itself when they lie down or during the night. 

Pudendal Neuralgia after Childbirth 

During a vaginal delivery, the pudendal nerve is stretched. Usually, after delivery, this resolves itself within a couple of weeks. However, for some women, particularly those who have had a difficult labour, the pudendal nerve is damaged or becomes inflamed. In some cases, the pain comes back months or years after the baby is delivered. 

Diagnosing Pudendal Neuralgia 

The doctor will need to carry out a vaginal examination to examine the pudendal nerve. An ultrasound or MRI scan of your pelvic joints, ligaments, and muscles may also be carried out. It is important that you tell your doctor about all of your symptoms because he or she will want to rule out other possible conditions. 

Pudendal Nerve Block 

A pudendal nerve block will determine if you have pudendal neuralgia. This procedure involves injecting local anaesthetic into the canal through which the nerve travels, called the Alcock’s canal. If you have pudendal neuralgia, the pain will usually diminish or disappear for a while.  

Managing Pudendal Neuralgia 

Although your healthcare professional will advise you on how to manage your pain, a lot of it is down to you to take control. You might need to make some lifestyle changes to your diet and leisure time to help control your symptoms. Some activities are best avoided if you have pudendal neuralgia; these include trampolining, long bicycle rides, horse riding, weight lifting and bench pressing. 

Diet and Lifestyle 

Take steps to avoid becoming constipated or straining to use the toilet, as this could further stretch the nerve. Eat foods high in fibre, such as fresh fruit and vegetables, wholemeal bread and bran, and drink plenty of water. 

TENS and Other Methods of Pain Management 

Drugs and Topical Treatments: Your doctor may prescribe pain-relieving medication, muscle relaxants cream or ointment. 

TENS Machine: Some people find TENS (Trans-epithelial Nerve Stimulation) to be helpful. A TENS machine is a small, battery-operated device that delivers small electrical impulses to your body by way of sticky pads (electrodes). This is something you can safely administer yourself at home. The electrical impulses from the TENS machine can stimulate your body’s natural painkillers (endorphins) and reduce the pain signals to your spine and brain. 

Alternative medicine: Acupuncture is an alternative to traditional medicine and may be suitable if you are worried about the side effects of conventional drugs. Consider other alternative methods of pain management if this is something you are interested in. 

Physiotherapy: Physiotherapy can help the pelvic floor muscles to relax which will decrease the pressure on the nerve. Physiotherapy can also help you to control your bladder or bowels if this is becoming an issue for you. 

How to Sit Comfortably if you Have Pudendal Neuralgia

  • When you sit down, make sure all of your weight is on your bottom or your ‘sit’ bones. Do not put any pressure on your perineum. 
  • Use a coccyx cut-out memory foam cushion. These are special cushions that you can modify so that when you sit down, no weight is placed on your perineum. 
  • If sitting down at work for long periods is uncomfortable, find out if you can use a standing desk instead. 
  • When you sit on the toilet, put your feet on a stool to make bowel movements easier and less painful.