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Pudendal neuralgia causes chronic pain in the pelvic floor, genitals, perineum, and anus. It can be caused by nerve damage from cycling, childbirth, surgery, or structural problems. Treatment includes injections, surgery, and medication. Diagnosis involves ruling out other conditions with similar symptoms.
Pudendal neuralgia is a chronic pain condition that affects the pelvic floor. Pain can occur in the genitals, perineum and anus. The pain is usually worse during the day, especially when sitting. Pudendal neuralgia usually occurs with compression, rubbing, or stretching of the pudendal nerve. A number of conditions can cause symptoms similar to those of pudendal neuralgia, so this condition is normally diagnosed by process of elimination. Treatment may involve steroid or other injections, surgery, and prescription drugs.
The chronic pain disorder known as pudendal neuralgia often occurs due to nerve damage caused by frequent cycling or squatting exercises, childbirth, surgery in the pelvic area, or structural problems in the pelvic floor or sacroiliac joint. Other causes of this condition include chronic constipation, recurring vaginal infections, and direct impacts on the tailbone. Symptoms may include tingling, burning, or throbbing sensations, numbness, coldness, or a twisting sensation in the genitals, anus, and perineum. Men and women may feel like a foreign object is trapped inside the anus or vagina, and pain and discomfort may occur on one or both sides of the pelvic floor.
Patients suffering from pudendal neuralgia may not experience any discomfort upon waking, however, discomfort typically increases throughout the day, especially when patients sit upright. Sitting on a donut-shaped pillow or lying down can relieve pain and discomfort.
Pudendal neuralgia can cause sexual dysfunction in both sexes. Both men and women may experience pain or numbness in the genital area. Women may have trouble reaching orgasm. Men can experience painful erections and painful ejaculation. Problems with urination and defecation can also occur, ranging from feelings of constipation and urinary hesitancy to partial or complete fecal and urinary incontinence. Emptying the bowels and bladder can become difficult and painful.
Diagnosing pudendal neuralgia is often a matter of ruling out other possible causes of these symptoms. Conditions such as vestibulitis, pelvic congestion, interstitial cystitis, or coccygodynia can produce symptoms similar to those of pudendal nerve damage. Once the diagnosis is made, treatment may vary depending on the cause of the nerve damage or entrapment.
Steroid injections given to the pudendal nerve are often used to treat pudendal neuralgia. Steroids can help relieve inflammation, allowing the nerve to heal. In many cases, a series of two or three of these injections can solve the problem of chronic pain.
Antidepressant or antiepileptic drugs may also be given during treatment. For some patients, surgical decompression of the pudendal nerve may be a more effective treatment. Surgery is believed to be successful in about 60% of cases.
