What is Pudendal Neuralgia?
As stated in my previous blog, “Neuralgia refers to a damaged or irritated nerve and can occur in any nerve. It is typically associated with a burning or shooting pain, and when involving the Pudendal nerve the pain is felt in the pelvic region”. It is seen in all genders and while seen in cyclists, and equestrians, it can happen to anyone. Pudendal Neuralgia pain typically is initiated with sitting and goes away with standing or laying down but prolonged standing can still accentuate the pain.
Where is the Pain with Pudendal Neuralgia?
As explained in my blog: “How to Diagnose and Treat Pudendal Neuralgia”,
courtesy of teachmeanatomy.info
“The Pudendal nerve is the lower section of a series of nerves that come from the lower back and sacrum called the Sacral Plexus. The Pudendal nerve comes out of the S2-5 area, goes under the Piriformis muscle, leaves the pelvis through the greater sciatic foramen, back to the lessor sciatic foramen, over the sacrospinous ligament, and under the sacrotuberous ligament.
Pudendal Nerve route (Wikepedia)
Anywhere along the path, from the lower back and sacral area to the ending of the pudendal nerve (vagina/pelvis, anus, and perineum), this nerve can be pressured on, compressed, irritated, and entrapped causing symptoms that lead to the diagnosis of Pudendal Neuralgia.”
Is Pudendal Neuralgia Curable?
Just like all nerve conditions, time is of the essence. In the case of Pudendal Neuralgia, it is important to detect the possibility of the diagnosis and treat the condition as if it is confirmed as soon as possible instead of going through the routine of blocking the nerve. The protocol for diagnosis is improvement by the block however, in my opinion, the inflammation of the nerve does not stay within the nerve and impacts the surrounding tissues as well so it only makes sense to work on the surrounding tissue while the game of “wait and see” takes place.
Typically in a successful nerve block, it takes about 2 weeks for the symptoms to improve and the decrease in pain lasts 2-3 months or even sometimes more. There is nothing lost if, during this time, the patient performs exercises such as Developmental Kinesiology (DNS) to bring stability into the pelvis which is crucial in the health of all soft tissue within the area including the nerves.
Are Pudendal Nerve Blocks Safe?
Every medical procedure has an inherent danger that may complicate matters and a Pudendal nerve block is not an exception. The procedure is performed using ultrasound to see the landmarks that allow the nerve to be identified. Of course, the expertise of the medical provider performing the procedure is the number one criterion to be concerned about.
Is Pudendal Neuralgia a Disability?
As stated before, treatment timeliness is of the essence and the degree of irritation to the pudendal nerve determines the prognosis of treatment. As time goes by, an unresolved pudendal nerve irritation ends up with symptoms that may be permanent. Whether or not this qualifies as a disability depends on the Sedentary Residual Functional Capacity (RFC) score which looks at how much capacity you have and how much is lost with sitting and your job description. Social Security Administration reviews the job description and the medical services reports and procedures to determine if you qualify for disability or not.
If you have pudendal neuralgia and are concerned about getting the right treatment in a timely manner, contact me with your questions.
Dr. Shakib
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