(courtesy of https://orthoinfo.aaos.org/)
What is Pudendal Neuralgia?
The pudendal nerve originates from the lowest part of the lower back and sacrum. From there it branches off into the pelvis to supply the lower buttocks, the area between the buttocks and genitals (perineum), and around the anus and rectum. The nerve has 3 branches that go to the clitoris or penis, anus, and the area in between. Knowing this information helps in locating the portion of the Pudendal nerve that may be irritated for treatment purposes.
Now, Pudendal Neuralgia has become more common in recent years and in people with poor posture! This is yet another issue related to our sedentary lifestyle that is impacting people of all ages and genders. It can be scary if you read about it on the internet without understanding the challenges in treating it. These challenges have to do with the fact that multiple providers are involved in treating different aspects of one condition. Other challenges commonly faced in treating Pudendal Neuralgia include:
- Difficulties ‘seeing’ the nerve location
- The patients and providers expectation for faster results and
- Most often patients doubt their ability to overcome the problem.
How Does the Pudendal Nerve Get Damaged?
While the exact cause of Pudendal neuralgia varies, the irritation seems to start at a mild level. This irritation repeated over a long time makes the condition become more moderate to severe. This can be from chronically sitting with poor posture, cycling with a narrow and hard seat, to trotting on a horse irritating the nerve branches that supply the perineal area.
Irritation of the sacral nerves in the pelvis can be due to:
- Disc disease
- Chronic constipation
- Trauma to the nerve through childbirth
- Trauma to the pelvis
These are all some of the common causes of Pudendal Neuralgia. Other potential causes include:
- Bony (structural) imbalances
- Chronic muscle guarding due to pain elsewhere
- Fear and anxiety
- Direct nerve compression due to cyst or tumor
- Bone spurs
- Swelling
- Scars
- Mesh from surgery
- Spinal neuralgias
- Nerve dysfunction
Pudendal nerve (courtesy of Chicago Urogynecology)
The nerve can get irritated or compressed anywhere along the path from the exit line at the sacrum to the area of the anus, perineal, and clitoris/penis. This may result in a sharp and burning sensation in the pelvis, which is a common characteristic of Pudendal Neuralgia.
When it comes to nerve and other soft tissue pain, there seems to be a correlation between the brain adapting to the chronic pain in the body and the resulted inflammation increasing the level of pain. Inflammation and swelling go hand-in-hand which then cause tension in the surrounding tissues and on the nerve. This not only applies to the pudendal nerve but to all types of soft tissue, which is why nerve related pain over time seem to get more intense.
How is Pudendal Neuralgia Diagnosed?
History and physical examination are important, but oftentimes subtle symptoms are missed, considered as separate or unrelated issues. In general, pain along the path of the pudendal nerve, burning and shooting pain when sitting (which goes away at night when sleeping), and pain present when going from sitting to standing up all point to Pudendal Neuralgia.
With the preventative measures in mind and avoiding Pudendal Neuralgia, in today’s society, I wished I was seeing everyone for a check up to include a full body balance and movement assessment! This would include functional mobility assessment, pelvis positioning and stability assessment, and bowel movement behavior. In my opinion, the annual yearly check ups we are receiving and typically paid by health insurance only cover severe and drastic conditions and neuromusculoskeletal health is fully ignored.
Unfortunately, the healthcare system is pain driven and considers managing pain, to be good enough treatment. What is managing pain? Pain that is not killing us? With that dogma, most people are conditioned to ignore the issue when pain is mild or subtle and when it comes to Pudendal Neuralgia, the success rate is highly dependent on the length of time the problem has existed.
Look for more blogs on pelvic floor dysfunction on my website and contact me for a Pudendal Neuralgia assessment.
Dr. Shakib
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