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Pudendal neuropathy is a painful condition caused by trauma or overexertion in the lower pelvis. Symptoms include sharp pains in the genitals and rectum, painful urination and bowel movements, and sexual dysfunction. Treatment options include rest, pain relievers, physical therapy, and surgery.
Pudendal neuropathy is a painful disease that affects the pudendal nerve in the lower pelvis. If the main nerve or one of its branches becomes compressed, damaged, or inflamed, it can cause sharp pains and other symptoms in the genitals and rectum. Pudendal neuropathy is usually caused by severe trauma to the site, although problems can also develop if a person puts constant pressure on the area, as can happen with riding a bicycle every day. Treatment depends on the severity of symptoms, and a patient may need to take medications, engage in physical therapy, or undergo surgery to find relief.
Many cases of pudendal neuropathy are caused by traumatic events in which great pressure is placed on the groin and anus region. A bicycle accident, a fall over a fence, or a particularly difficult birth are possible causes. In some cases, nerve compressions occur gradually over time due to overexertion. Avid cyclists have a particularly high risk of developing slow-onset pudendal neuropathy. Pelvic surgical procedures can also lead to neuropathy if the procedure causes extensive swelling or if the pudendal nerve is accidentally damaged.
Sharp, stabbing pains in the external genitalia, anus, or area between are the most common symptom of pudendal neuropathy. The pain is typically made worse when sitting or touching the area. A person may also have very difficult, painful, or burning urination or bowel movements. Some men and women also experience sexual dysfunction, such as an inability to become aroused or a marked decrease in sensation in their genitals.
A doctor might suspect pudendal neuropathy after reviewing a patient’s symptoms and performing a quick physical exam. X-rays and computed tomography scans are usually done to look for damaged tissue and nerves in the pelvis. If it’s not clear where the problem lies, a shot of local anesthetic might be given along a suspicious site in the nerve to see if the pain eases. Doctors base treatment decisions on the location, nature, and intensity of the pudendal neuropathy.
People with minor symptoms are usually able to recover with rest and taking over-the-counter pain relievers. Pelvic floor exercises may be recommended after a few weeks to gradually build strength and resilience in the pelvic muscles. If the pain is severe, a patient may need to receive a steroid injection to temporarily relieve the inflammation and pain. Surgery to decompress the pudendal nerve is needed only if symptoms return frequently or don’t improve with medical care and exercise.
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