Pudendal Neuralgia can affect both women and men. It is not a common condition, though patients often present with the diagnosis. The pudendal nerve is a major nerve (like the sciatic nerve) arising from the sacral plexus. It is an important nerve for differential diagnosis in cases of CPP (Chronic pelvic pain). The difference between pain arising from somatic structures (muscle, bladder, bowel etc) are that they are often achey or deep. Nerve pain is different and will behave in a manner where manifestations of lancinating, sharp, throbbing or stabbing sensations are experienced. This is what we call neuropathic pain. Pain is often felt along the pathway of the nerve. However, it is not a common diagnosis and is often over diagnosed.
Pain arising from the pudendal nerve is felt in the perinium, testicles and penis (for men), vagina (for women) and anus. The pudendal nerve supplies the skin of the genitals and also the pelvic floor muscles. Common symptoms include:
- a golf ball in the perinium
- unable to sit for long
- burning sensation in the genitals.
- stabbling pain in the perinium
- achey constant pain
Pain can develop because or tension or stretching in the saddle region. More common for women through child birth. Sometimes heavy exercise can bring on symptoms. The more robust structures in the pelvis makes this less of an issue in men. There is emerging evidence that prolonged sitting or cycling could be a contributing factor due to the compression element. Therefore, awareness of sitting times is a key component in the management of pain. Less common for men is the direct trauma due to surgery unless local to the rectum. General increase in tension through the pelvis due to recurrent infection could cause muscle tightness impacting on fascia and therefore tensioning across the nerve.
Hands on manual therapy treatment to your low back and pelvis, getting the joints moving correctly
Trigger point therapy: Getting the muscles working properly and rid of the overactive parts in both the low back muscles, hip muscles and pelvic floor muscles. You will also be taught how to do this yourself also.
Pelvic floor exercises to release your pelvic floor
Specific hip, spine and pelvis exercises to get you and your pelvic floor moving better, think yoga poses and squatting
Specialised Breathing and relaxation work
Re-education of the pelvic floor, hip and abdominal musculature
Other management strategies can include the use of local Injection to anaesthetise the nerve. This should always be used in conjunction with conservative therapies.