Pudendal Neuralgia is a condition that causes long term pain that radiates throughout nerve endings of regions of the body supplied by a nerve called the pudendal nerve. This nerve runs from the lower back along the pelvic floor muscle and eventually supplies the vulva, vagina, clitoris, perineum (area between the anus and genitals) and rectum in women. In men, pudendal neuralgia affects the glans penis, scrotum, perineum and rectum.
When nerves go through sudden large trauma or repetitive small trauma, they can become irritated and cause pain. The cause of pudendal neuralgia is often trauma to the nerve during childbirth or surgical procedures. The pudendal nerve could also become entrapped by surrounding muscles and tissue resulting in similar pain. Endometriosis can produce severe scarring or inflammation that might affect the pudendal nerves.
Causes
- Childbirth trauma
- Endometriosis
- Mesh placed for urinary incontinence
- Gynecological or colorectal surgery
- Cycling
- Excessive physical exercise
- Past pelvis or perineal trauma
- Straining
- Musculoskeletal problems
Neural pain is often very variable. It could feel like burning, electric shock, shooting, aching or itching.
Symptoms
- Unilateral pelvic pain usually but may present bilaterally
- Pain is worse upon extended periods of sitting
- Pain is better standing, lying flat
- Increase in urinary frequency/urgency
- Bladder and bowel irritation
- Bladder, bowel or sexual dysfunction
Diagnosis
If you are experiencing any of the above symptoms, your gynecologist will ask you a list of questions and perform a physical exam to help with the diagnosis.
There are some diagnostic tests that you may undergo, including:
- Pudendal nerve block: the nerve is anesthetized through a vaginal injection. A relief of pain is diagnostic of pudendal neuralgia.
- Imaging such as ultrasonography or MRI to visualize the nerve entrapment site
Treatment
There are several treatment options for pudendal neuralgia ranging from conservative therapy to surgery. You and your doctor will agree on the best option for you.
- Conservative treatment:
Consists of lifestyle modifications that help with avoidance of painful triggers. These include bowel and bladder management, sitting modifications, avoiding physical activities that irritate the nerve such as cycling, and adapting your sex life with the help of a professional.
- Physical therapy:
A physiotherapist can teach you how to relax and stretch your pelvic floor muscles to ease the tension around the nerve. They can also teach you to plan your bladder and bowel management strategies.
- Medications:
Pain killers, muscle relaxants and certain types of anticonvulsants that relief neuropathic pain may be used to control symptoms but might not always help.
- Pudendal nerve block:
Similar to the diagnostic nerve block, this treatment provides temporary anesthesia to the painful nerve, leading to symptom relief.
- Surgical decompression:
If your doctor determines that you are a surgical candidate, you may opt for surgical decompression which is the most effective treatment for pudendal neuralgia as it releases nerve entrapment and destroys the nerve fibers, eliminating its painful sensation. Surgery can be done via minimally invasive techniques.
At CEAPS, we always opt for minimally invasive approaches to provide the best experience for our patients with the least amount of side effects and complications. Pudendal decompression surgery is technically challenging and requires a high level of surgical expertise.
Choose your surgeon with the training and the experience to manage these technically challenging conditions in a minimally invasive fashion.
Dr. Moawad is a highly reputable leading expert in this domain.
