Pudendal Neuralgia or pudendal nerve pain is a chronic condition in which the pudendal nerve becomes injured, irritated or compressed. It can cause pain or numbness in your pelvis or gential area. The pain often comes in waves and can become very intense suddenly and then end suddenly. Pudendal neuralgia can be extremely debilitating as it can make normal day-to-day life activities difficult including going to the bath, having sex, or even sitting down.
At Bellevue Pain and Wellness PLLC, located in Bellevue, Washington serving Seattle, WA, Robert Bowers, MD, a double board-certified and fellowship-trained anesthesiologist and pain medicine physician, diagnoses pudendal neuralgia and offers a variety of customizable treatment options. Don’t let pudendal neuralgia interfere with your quality of life. Call Bellevue Pain and Wellness to schedule a consultation today.
The pudendal nerves are a major peripheral nerve that runs from the back of the pelvis to near the base of the penis or vagina. It is the main nerve of the perineum( area between the genitals and the buttocks). The pudendal nerve is responsible for motor, sensation, and autonomic functions. The nerve communicates sensation information of your genitals, anus, and other pelvic regions. It also controls the opening and closing of the sphincter muscles both the urthral sphincter used during urination and the external anal sphincter used during defecation. There is one pudendal nerve on each side of your body. It branches out of the sacral plexus and contains nerve roots of the S2, S3, and S4. The sacral plexus is the bundle of nerves located at the lowest area of the spine at the back of the pelvis. The sacral plexus communicates sensation and movement messages to your upper and lower legs, feet and part of the pelvis.
The pudendal nerve traverses anteriorly between the sacrotuberous and sacrospinous ligaments and then travels through the pudendal canal or Alcock canal and branches into the perineal nerve, the dorsal nerve and the inferior rectal nerve.
Many things can damage the Pudendal Nerve. These may include:
The discomfort of pudendal neuralgia is usually felt unilaterally(on one side) in the lower body, specifically in the pelvis, buttocks, genitals or perineum. Symptoms may worsen in a sitting position and be alleviated when standing or lying down. The symptoms are less in the mornings and tend to increase as the day progresses.
Symptoms of pudendal neuralgia include:
As with any condition, correct diagnosis of the condition via thorough history and examination is critical. Imaging such as an MRI may be needed to correctly rule out other conditions. Management of pudendal neuralgia comprises of nerve protection, medication, and interventional modalities.
If the condition is a result of a repetitive aggregating motion, patients must be educated on self-care. A cushion can be purchased or made so that the perineum area is cut out to reduce pressure. Stopping hip flexion exercising such as cycling, squats, horseback riding are essential to preventing further pudendal nerve damage or injury.
Medications can also be used to control nerve pain as well as reduce the hypersensitization of the nerve. Medications may need to be titrated to maximize benefit over side effects.
Pudendal nerve blocks or injections are often used as a first line treatment. Injections are done with an anesthetic and optionally a steroid under x-ray guidance or fluoroscopy. The blocks can be repeated after 3-4 weeks as needed to control pain. Often pain is immediately achieved. Other intervention injections may be needed depending on the nerve impairment location such as epidural injections, ganglion impar blocks, superior hypogastric nerve blocks, and sacral nerve root block to s2, s3, s4.
For more information about pudendal neuralgia or other pelvic pain, call the Bellevue Pain and Wellness or request an appointment. We are happy to serve Bellevue, Seattle, Tacoma and the surrounding PNW area.