Pudendal Neuralgia: Unmasking the Pelvic Pain 

Pudendal neuralgia might not be a term you hear every day, but for those who suffer from it, it’s a condition that significantly impacts their daily lives. This blog aims to shed light on this often misunderstood and underdiagnosed condition, its causes, symptoms, treatment options, and more. If you’ve been struggling with unexplained pelvic pain, numbness, or other related symptoms, read on – this information could be crucial for you.

What is Pudendal Neuralgia?

Pudendal neuralgia is a chronic pain condition that affects the pudendal nerve, which runs through the pelvis. This nerve is responsible for sensation and muscle control in the pelvic region, including the genitals, anus, and urethra.

Anatomy of the Pudendal Nerve

To understand pudendal neuralgia, knowing a bit about the pudendal nerve is essential. It’s a major pelvis nerve originating from the sacral spinal nerves S2-S4. It controls the muscles used for urination and defecation.

What’s Going On Down There?

Imagine your pudendal nerve as a busy highway. When something goes wrong, like a traffic jam or road construction, it can cause a major disruption. That’s essentially what happens with Pudendal Neuralgia. The nerve gets irritated or damaged, leading to pain and discomfort.

Pudendal Neuralgia Symptoms

The symptoms of pudendal neuralgia can vary widely but often include:

• Chronic Pelvic Pain: Persistent pain in the genital area, perineum, or rectum.
• Genital Numbness: Loss of sensation in the genital region.
• Urinary Problems: Difficulty urinating or a frequent need to urinate.
• Pain During Intercourse: Painful sensations during or after sexual activity.

Impact of Pudendal Neuralgia on Daily Life

It can severely limit physical activities. Even simple actions like sitting, walking, or having sex can become excruciatingly painful. Living with chronic pain can take a toll on mental health. Many individuals with pudendal neuralgia experience stress, anxiety, and depression. It’s essential to address these issues alongside physical symptoms.

Causes and Risk Factors of Pudendal Neuralgia

While the exact cause of Pudendal Neuralgia is often unknown, several factors may contribute to its development:

Primary Causes

• Childbirth: The pudendal nerve can be stretched or compressed during delivery.
• Injury: Bike accidents or pelvic surgery can sometimes damage the nerve.
• Prolonged Sitting: Extended periods of sitting, especially on hard surfaces, can compress the nerve.

Secondary Causes

• Tumors: Pelvic tumors can press on the pudendal nerve.
• Infections: Certain infections can lead to inflammation around the nerve.
• Nerve Entrapments: can occur due to scar tissue or other anatomical abnormalities.
• Neurological Conditions: Certain neurological disorders can affect the pudendal nerve

Risk Factors

Several risk factors increase the likelihood of developing pudendal neuralgia, such as:

• It’s more common in middle-aged and older adults.
• Women are more frequently affected than men.
• Activities that involve prolonged sitting or cycling.
• A history of pelvic trauma or surgery
• Diabetes and Autoimmune diseases

Diagnosis and Assessment

Getting an accurate diagnosis can be a challenging journey due to its overlapping symptoms with other conditions. The diagnostic process typically includes:

• Physical Examinations: A thorough examination to check for tenderness and other signs.
• Imaging Tests: MRI or CT scans to look for anatomical issues.
• Nerve Blocks: An injection to numb the pudendal nerve and confirm the diagnosis.

How I Cure My Pudendal Neuralgia – Treatment Options

There’s no one-size-fits-all approach to treating Pudendal Neuralgia. What works for one woman may not work for another. A combination of treatments is often necessary.

Initial Treatment – Conservative Approaches

• Physical Therapy: Specialized pelvic floor therapy can help alleviate symptoms.
• Lifestyle Changes: Modifying activities that exacerbate pain, such as reducing sitting time.
• Medications: Pain relievers, anti-inflammatory drugs, and nerve pain medications.

Interventional Treatment

If conservative treatments aren’t effective, interventional options may be considered:

• Nerve Blocks: Injections to block pain signals from the pudendal nerve.
• Botox Injections: Botox can help relax muscles and reduce pain.
• Radiofrequency Ablation: A procedure to disrupt nerve function and reduce pain.

Surgical Options

For severe cases, surgery may be considered as a last resort. Surgical options include decompression surgery to relieve pressure on the pudendal nerve. Success rates vary, and it’s crucial to discuss the risks and benefits with a specialist.

Complementary and Alternative Therapies

Some individuals adopt the following alternative therapies for their pain management, improving flexibility, and reducing tension in the pelvic area.

• Acupuncture
• Chiropractic care
• Yoga Poses
• Meditation

Self-Care Strategies

There are several self-care strategies to help manage symptoms:

Dietary Changes: Anti-inflammatory diets can help reduce pain.

Ergonomic Adjustments: Using cushions and altering seating positions to reduce nerve compression.

Exercises to Relax Tensed Pudendal Nerve

Managing pudendal neuralgia often involves exercises aimed at relaxing the muscles around the pudendal nerve. These exercises can help reduce tension, improve blood flow, and alleviate pain. Don’t forget to consult a physical therapist specializing in pelvic floor disorders for personalized guidance and adjustments before trying them.

1. Pelvic Floor Relaxation

Purpose: To release tension in the pelvic floor muscles.

How to Perform:

1. Find a Comfortable Position
2. Lie on your back with your knees bent and feet flat on the floor. You can also do this sitting on a comfortable chair with your feet flat on the ground.
3. Take deep, slow breaths. Focus on expanding your abdomen as you inhale and contracting it as you exhale.
4. As you breathe in, imagine your pelvic floor muscles relaxing and dropping down. Visualize these muscles letting go of any tension.
5. Hold the relaxed state for 5-10 seconds, then release. 
6. Repeat for 5-10 minutes daily.

2. Child’s Pose (Balasana)

Purpose: This yoga pose gently stretches the pelvic muscles and can help release tension around the pudendal nerve.

How to Perform:

1. Begin on your hands and knees, with your knees spread wide apart and your big toes touching.
2. Sit back onto your heels, extending your arms forward and lowering your forehead to the ground.
3. Focus on your breathing, allowing your pelvic area to relax with each exhale.
4. Stay in this position for 1-3 minutes, or as long as it is comfortable.

3. Hip Flexor Stretch

Purpose: Stretching the hip flexors can reduce pressure on the pelvic region, including the pudendal nerve.

How to Perform:

1. Kneel on the floor with one knee bent in front of you at a 90-degree angle and the other knee on the ground behind you.
2. Gently push your hips forward, keeping your back straight and your pelvis neutral. You should feel a stretch in the hip flexor of the leg that is behind.
3. Hold for 20-30 seconds, then switch legs. 
4. Repeat 2-3 times per leg.

4. Happy Baby Pose (Ananda Balasana)

Purpose: This pose helps to open up the hips and release tension in the pelvic floor.

How to Perform:

1. Lie on your back and bring your knees toward your chest.
2. Grab the outer edges of your feet with your hands, with your arms inside your knees.
3. Gently pull your feet towards the ground, creating a gentle stretch in the pelvic area.
4. Hold the position for 1-2 minutes, focusing on deep, relaxing breaths.

5. Deep Squats

Purpose: To stretch and strengthen the pelvic muscles, which can help alleviate pressure on the pudendal nerve.

How to Perform:

1. Stand with your feet shoulder-width apart.
2. Lower yourself into a deep squat position, keeping your heels on the ground and your back straight.
3. Hold the squat for 20-30 seconds, then slowly rise back to a standing position. Repeat 5-10 times.
4. If a full squat is too challenging, use a chair or wall for support.

6. Pelvic Tilts

Purpose: To mobilize the lower back and pelvic muscles, reducing tension around the pudendal nerve.

How to Perform:

1. Lie on your back with your knees bent and feet flat on the floor.
2. Gently arch your lower back, lifting your pelvis slightly off the floor. Then, press your lower back into the floor, tilting your pelvis up.
3. Repeat this tilting motion 10-15 times, focusing on slow and controlled movements.

7. Cat-Cow Stretch

Purpose: To improve flexibility and reduce tension in the spine and pelvic region.

How to Perform:

1. Begin on your hands and knees in a tabletop position.
2. Round your back, tucking your chin to your chest and drawing your belly button towards your spine.
3. Arch your back, lifting your head and tailbone towards the ceiling.
4. Alternate between Cat and Cow stretches, holding each position for 5-10 seconds. 
5. Repeat 10-15 times.

Expert Interviews

Insights from medical professionals specializing in pudendal neuralgia can provide valuable information on managing this condition. These experts share their knowledge on the latest treatments, research developments, and advice for managing the condition.

1: Michael Hibner, MD, PhD | Pelvic Surgeon

2: Dr. Aaron Filler | Neurologist

Support and Solutions Await!

Living with pudendal neuralgia is challenging, but with the right information and support, it’s possible to manage the condition and lead a fulfilling life. If you or someone you know is struggling with pelvic pain, seek professional help and explore the treatment options available. Remember, you’re not alone, and help is available.

FAQ :

1. What are the symptoms of pudendal neuralgia?
Pudendal neuralgia symptoms include pelvic pain, burning, or numbness, often worsening when sitting and causing discomfort during activities like biking or sex.

2. What is the best way to relax the pudendal nerve?
To relax the pudendal nerve, try pelvic floor exercises, gentle stretching, heat therapy, and avoid prolonged sitting. Physical therapy and relaxation techniques also help.

3. How do you detect pudendal nerve?
Pudendal nerve issues are detected through physical exams, nerve blocks, MRI scans, and specialized tests like EMG to assess nerve function and pinpoint pain sources.

4. Can stress cause pudendal neuralgia?
Yes, stress can worsen pudendal neuralgia by increasing muscle tension and inflammation, which may aggravate the nerve and intensify symptoms.