Pudendal neuralgia a patient guide
Pudendal neuralgia is a type of long-term (chronic) pelvic pain that originates from irritation or damage 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 and inside the back passage (anal pain) .
- vulva, labia, and clitoris in women .
- scrotum and penis in men .
Pudendal neuralgia can be very uncomfortable and distressing, but help is available and there are several treatments that can be tried.
Symptoms of pudendal neuralgia
The main symptom of pudendal neuralgia is pelvic pain. Any of the areas supplied by the pudendal nerve can be affected.
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:
- 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 .
- in some patients pudendal neuralgia can cause anal pain and anal spasm .
Causes of pudendal neuralgia
Pudendal neuralgia can occur due to a wide variety of causes if the pudendal nerve is irritated, stretched or squashed (compressed).
Possible causes include:
- compression of the pudendal nerve by nearby muscles or tissue – sometimes called pudendal nerve entrapment or Alcock’s 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 .
- previous pelvic trauma.
- a fracture in one of the bones in the pelvis .
- excessive straining due to chronic constipation secondary to difficult rectal emptying.
- damage to the pudendal nerve during childbirth, in multiparous women or following prolonged labour.
- a non-cancerous or more rarely a cancerous growth (tumour) pressing on the pudendal nerve .
In some cases, a specific cause is not identified.
When to get medical advice
Please come and see one member of our Pelvic Centre team if you have persistent pelvic pain.
Don't delay seeking advice if the pain is causing problems.
Pudendal neuralgia can continue to get worse and worse if left untreated, and early treatment may be more effective.
The stress of living with the condition can also have a significant impact on your physical and mental health if it's not treated, having an impact on your loved ones too. Moreover, other causes of pelvic pain have to be ruled out.
Tests for pudendal neuralgia
Your Consultants will ask about your symptoms and may carry out an examination of the area to check for any obvious causes of your pain.
If they think you could have pudendal neuralgia, or they're not sure what's causing your pain, they may refer you for further tests. These tests may include:
- a vaginal or rectal exam – to see if the pain occurs when your doctor applies pressure to the pudendal nerve with their finger .
- a magnetic resonance imaging (MRI) scan – to check for problems such as entrapment (compression) of the pudendal nerve and rule out other possible causes of your pain.
- neurophysiology studies such as the bulbocavernous muscle reflex latency test, pudendal nerve evoked potentials and needle EMG of the pelvic floor muscles: a neurologist can perform some test to stimulate the pudendal nerve for identifying specific abnormalities within the nerves and muscles of the pelvic floor.
- pudendal nerve block injections – painkilling medication is injected around the pudendal nerve to see if your pain improves; this procedure is performed under neurophysiological guidance rather than radiological guidance, in order to avoid radiation exposure to the patient and obtaining a better localization of the nerve; a significant relief of your symptoms is supportive for the diagnosis of pudendal neuralgia.
- High resolution anorectal manometry to identify the presence of abnormal pattern of muscle resting and voluntary or involuntary activity of the anal sphincter.
- Urodynamic study can identify abnormal patterns of your bladder function.
Treatments for pudendal neuralgia
Treatments for pudendal neuralgia include:
- pudendal nerve block can be diagnostic and therapeutic for your pelvic pain. If effective, a long term block of the sensory component of the pudendal nerve can be achieved with radiofrequency ablation, providing a sustained relief from pudendal neuralgia symptoms, up to 9 months.
- avoiding things that make the pain worse, such as cycling, constipation or prolonged sitting – it may help to use a special cushion with a gap down the middle when sitting and tryconstipation treatments.
- medications to alter the pain – these will normally be special medications for nerve pain, rather than ordinary painkillers; some of these mediations in UAE are controlled drugs, and hence a special prescription might be needed .
- 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 .
- sacral nerve modulation – a special device is surgically implanted under the skin to deliver mild electrical impulses to the nerves of the sacral plexus and interrupt pain signals sent to the brain .
This leaflet has been realized to provide information to patients suffering from pelvic pain and/or pudendal neuralgia. The quality of the content and the accuracy of the information provided has been checked at the date of the production. However, this leaflet is not meant to be used for self-diagnosis or self-medication of migraine or any other medical condition without a medical supervision. We will not take any responsibility for any unfortunate event deriving from the misuse of this leaflet.
Harley Street Medical Centre
Villas A18, 19, 20, 21, 22
P.O. Box: 41475
Abu Dhabi – UAE
Tel. 02 613 3999