16May 2017

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Pudendal Neuralgia

Imagine experiencing pain, severe sensitivity, numbing or a mixture of these symptoms in your most intimate and private areas but feeling too embarrassed to seek help.  Or, worse, taking the brave step to seek medical help only to find that they may not be knowledgeable or comfortable in evaluating and treating your genital/pelvic pain and discomfort.  

Either situation is far from ideal, which unfortunately, is the case for many suffering from a condition with these symptoms called Pudendal Neuralgia, a type of pelvic pain.

Do you have these symptoms?

  • Pain while sitting, which may be relieved on standing/walking
  • Progressive pain during the day
  • Burning pain in the pelvic area
  • Numbness in genital area
  • Increased sensitivity to touch or pressure (hyperesthesia or allodynia)
  • Knife-like or deep aching pelvic pain
  • Feeling of a lump/swelling present internally
  • Twisting/pinching pains in the pelvis on certain movements
  • Painful intercourse and/or sexual dysfunction
  • Urinary retention (bladder does not empty fully) or increased urgency/frequency of urination
  • Straining or burning with bladder and bowel movements

A person with Pudendal Neuralgia may experience some but not all of the above.1,2  

Symptoms for this condition, as illustrated, can be wide-ranging.

What is it and how is it caused?

PNThe genitals, anal area and urethra1 send and receive sensory, autonomic and motor signals (“messages”) via a network of nerves. The pudendal nerve is a prominent part of this network, located in the pelvis. Should this nerve become inflamed — as a result of an autoimmune disease, a virus, or through mechanical damage/trauma to the nerve — Pudendal Neuralgia may result1,2,3.

 

 

 

 

 

 

With regard to mechanical damage1,2 to the pudendal nerve, it can occur from

  • nerve entrapment (by a ligament or muscle pressing on the nerve as it passes),
  • childbirth,
  • a fall landing onto the buttocks, or
  • after sacral surgery such as a sacroiliac fusion.

Pudendal neuralgia may also be accompanied by musculoskeletal pain in other parts of the pelvis such as the lower back, coccyx (tailbone), piriformis or sacroiliac joint2,4.

So, who can get it?

bikesUnfortunately, anyone can present with Pudendal Neuralgia. It can be experienced by both men and women, although it has a higher prevalence in women5. For women, areas affected may include the clitoris, mons pubis, vulva, lower aspect of the vagina and labia. In men, the penis and scrotum may be involved1.

However, there is some research to suggest that certain individuals may be more prone to developing the condition.

 

 

 

 

These can include those who:

  • Sit or who drive for prolonged periods of time2,3
  • Participate in sports/activities involving repetitive hip flexion such as heavy weight lifting, cycling2
  • Have anatomical differences in pelvic structure, ligament or muscle alignment2

How is it diagnosed?

  • Detailed history surrounding medical history, the pain and activities relating to the pain2,3
  • Physical Examination2
  • A pudendal nerve block under fluoroscopy or CT guidance can act as a diagnostic tool2 in addition to a treatment

What treatments are available for this debilitating condition?

There are various treatment options available such as neuropathic pain medications and pelvic floor physical therapy4, which may be tried before any injections like the pudendal nerve block. This pudendal nerve block may also be completed to assist in the diagnosis of Pudendal Neuralgia. Pudendal nerve blocks are a minimally invasive, non-surgical treatment for chronic pain with a growing body of evidence for their beneficial effects on reducing the sensitivity of the nerve and improving function and quality of life2,5. If the symptoms are quite severe, a nerve block may be more appropriate before any physical therapy is attempted.

If conservative management is unsuccessful, more invasive treatment options include neuromodulation4 and decompression surgery2.  It is important to remember that no two patients will present exactly the same which is why our team of physicians, nurse practitioners and physician assistants here at The Spine & Pain Institute of New York will complete a comprehensive evaluation and create an individualized treatment approach for each  patient presenting with these symptoms.

I have these symptoms but I feel embarrassed… Will it resolve itself? What if I do not get treatment for Pudendal Neuralgia?

Unfortunately, Pudendal Neuralgia tends not to resolve without seeking medical help. If left untreated, Pudendal Neuralgia may cause both worsening bladder and bowel incontinence, chronic constipation and sexual dysfunction2,3. It can lead to debilitating, constant pain, even when you are in a standing or lying position (not just seated)2,3.

Our team here in the Spine & Pain Institute of New York are highly trained and experienced in diagnosing and treating this condition and, as with any patient, you will be assessed and treated with the utmost sensitivity, confidentiality and care.

For further information on Pudendal Neuralgia or to schedule an appointment to discuss your symptoms with one of our Physicians, please click here.

Sources:

1 – Labat et al 2007. Diagnostic Criteria for Pudendal Neuralgia (Nantes Criteria)

2 – Hibner et al 2007. Pudendal Neuralgia, A review Article. www.pudendalhope.org

3 – Gupta et al 2015. A multidisciplinary approach to the evaluation and management of interstitial cystitis/bladder pain syndrome: an ideal model of care.

4 – Mamlouk et al 2013. CT guided for Pudendal Neuralgia: Diagnostic and Therapeutic Implications

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Marie Geraghty, Medical Assistant        Casey Grillo, Nurse Practitioner         Kallback, Marketing Manager

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