Pudendal Neuralgia (PN) is a condition where there is pain or irritation along the distribution of the pudendal nerve. The pudendal nerve provides sensation and motor control to the muscles around the perineum. There can be many reasons someone can experience pudendal neuralgia. It can be caused by prolonged sitting activities (bike riding, horseback riding), prolonged constipation, childbirth, squatting exercises, post surgical procedures (hysterectomy, pelvic reconstruction), and chronic infections (yeast infections, bacterial prostatitis, bladder infections).
Symptoms can include:
Pudendal Nerve Entrapment (PNE) differs from PN because the pudendal nerve is constricted or distorted within a fibrous band or tunnel. The most common areas of entrapment occur in structures around the pelvis or sacroiliac joint, a certain tunnel in the pelvis (Alcock’s canal) or around the base of the penis.
With both PN and PNE, there is often a correlation with an overactive pelvic floor. The pudendal neuralgia or entrapment and pelvic floor dysfunction may co-exist. In other words, one may lead to the other; there may be an overlap of the characteristic pain. One type of pain may be more intense than the other. All of this adds to a complication with diagnosis and treatment.
PN and PNE are diagnosed by a combination of tests by physicians including a thorough internal physical examination with direct pressure to regions where the pudendal nerve runs,
Doppler ultrasound (pelvic and perineal vessels)
Electrophysiological testing (for distal motor latency and sensory pathway assessment)
EMG of muscles innervated by the pudendal nerve, and pudendal nerve blocks.
Treatment of PN and PNE can be complicated because of the slow healing nature of nerves. Treatments often include medications aimed at neuropathic pain and physical therapy to address pelvic floor dysfunction which can be a cause of PN and PNE. Physical therapy treatment will be aimed at releasing tightened tissues in and around the pelvic region to improve the nerves ability to glide and heal. Other treatment options can be
steroid injections around the nerve
trigger point injections to the pelvic floor muscles
spinal cord stimulators and in certain cases