What is Pudendal Neuralgia (PN)?
Pudendal neuralgia is a big umbrella term for pain radiating at any point along the distribution of the pudendal nerve. The pudendal nerve is arguably the most important nerve that innervates our pelvic floor and genitals with sensory, motor and autonomic fibers (the only nerve that has all 3!). The pudendal nerve comes from our very low spine at sacral nerve roots 2-4 and has a tortuous path as it travels in and out of our pelvis to get to its targeted locations. This is one of the reasons why it can be difficult to assess and treat. Various resources estimate that approximately 1/100,000 people experience pudendal neuralgia, although we believe the number is higher. (Hibner, et al., 2011).
Symptoms of pudendal neuralgia vary widely in terms of pain intensity and involvement including sexual, bladder and bowel dysfunction. Pain may be experienced all the time, or only during certain activities, and may be described as sharp, shooting, stabbing, tingling, burning, numb, or a sensation of that something is inside the vagina/rectum.
What are the most common signs and symptoms?
-pain with sitting, often (but not always) relieved by standing, lying down, or sitting on toilet
-pain anywhere between the clitoris or penis to the rectum
-bladder/bowel dysfunction (urgency, hesitation, feeling incomplete)
-sexual dysfunction
The Health Organization for Pudendal Education (HOPE) lists in more detail the varying levels of symptoms.
What causes PN?
There are many different factors contributing to irritation of the pudendal nerve such as inflammation, mechanical injury, and/or musculoskeletal. Musculoskeletal causes can stem from pelvic floor muscle tightness and/or spasms coming from trauma, surgeries, falls, or childbirth injuries. Additionally, there may be anatomical differences causing more compression on the pudendal nerve. Connective tissue, muscular, and fascial restrictions can all aggravate the pudendal nerve causing an array of unwanted symptoms.
To learn more about pudendal nerve and pelvic anatomy, visit the HOPE website’s anatomy section.
How can we treat PN?
Any type of injury or compression to any nerve takes time to heal. The first thing you want to do is to minimize any activities that are worsening your symptoms. Then, seek a pelvic floor physical therapist near you. Pelvic floor physical therapists would perform a thorough examination, including an internal assessment of the nerve(s), muscles, connective tissue and the surrounding structures to rule in/out possible pudendal neuralgia, and more importantly help reach a diagnosis of the “why” of the pain. Physical therapy sessions would be individualized based on assessment and symptoms, and involve extensive education, gentle exercises/stretches, and manual techniques to help decrease inflammation, restore muscle tone, optimize muscle function, and thus allow for nerve healing. This may include suggestions on how to sit, lifestyle modifications, and pain management tools. As physical therapists, our ultimate goals are to decrease patients’ pain, restore bladder, bladder and sexual function and help patients return to activities they love.
References:
Hibner, M, Castellanos, M, et al, Glob. libr. women’s med., (ISSN: 1756-2228) 2011; DOI 10.3843/GLOWM.10468
