Pudendal nerve pain – it’s a mouthful but certainly a serious condition if you or anyone you know have ever experienced it. This condition can be extremely debilitating, since the pudendal nerve is such a key player of the nerves in your pelvic region. The pudendal nerve runs from your lower back all the way down through your pelvis and into your genitals, anus, and perineum. When this nerve is irritated, inflamed or compressed, chronic pain and bladder and bowel issues can appear.
What causes pudendal nerve pain?
Pudendal neuralgia (aka nerve pain) can be caused by pressure on the nerve or irritation to the nerve by the other tissues around it. Here are some of the most common causes:
- Prolonged sitting: Compression of the nerve can happen in cyclists, office workers, or those who drive for extended periods.
- Childbirth: There can be damage to the pudendal nerve during delivery, such as compression or stretching of the nerve.
- Surgery: Pudendal nerves can be damaged during surgeries like hysterectomies, prostate surgery, hernia repairs or any other surgery within the abdomen and pelvis. Scar tissue from illnesses and surgeries in the pelvis can also lead to nerve pain.
- Constipation: People with chronic constipation can experience pudendal nerve pain from the constant pressure on the nerve.
- Trauma or injury: Things like falls, pelvic fractures, accidents, or trauma to the pelvis can irritate or compress the nerve.
- Pelvic floor issues: Some people have overly tight pelvic floor muscles, and many don’t even know it, which can lead to chronic nerve irritation.
Symptoms of pudendal nerve pain
While the severity of pudendal nerve pain can vary from mild to severe, and can feel like a stabbing, burning, or aching pain. The most common symptoms are:
- Pain: Usually the pain worsens with sitting and gets better when standing or lying down
- Numbness: Many people have numbness or tingling in the genitals, anus or pelvic area
- Increased or decreased sensation: You can have either less feeling or be overly sensitive in the pelvic area
- Pain during sex: Pudendal nerve pain can cause pain during or after sex
- Bladder or bowel issues: This can be any change to bladder and bowel habits, such as the feeling of needing to urinate frequently or difficulty passing bowel movements
Treatment options
There are multiple ways that pudendal neuralgia can be treated. The best treatment option will depend on your symptoms and the cause of the issue. Treatment can include:
- Pelvic floor physical therapy: A pelvic floor physical therapist can help to release tight pelvic tissues and lessen the pressure on your nerves.
- Lifestyle: Spending less time sitting, using a special cushion, or incorporating movement into your day can help.
- Medications: Nerve pain medications may be prescribed for temporary relief.
- Nerve block: A pudendal nerve block (an injection of steroids mixed with anesthetics) can temporarily relieve nerve pain.
- Surgery: In cases that nothing else works, surgery might need to be done to decompress the nerve.
If you are living with pelvic pain that is caused by, or potentially due to pudendal neuralgia, we know how hard it can be to get it correctly diagnosed and get the help you need to feel better. It can be helpful to be evaluated and treated by an experienced pelvic physical therapist. Your pelvic PT will assess and treat potential underlying causes, such as mechanical, fascial, muscular dysfunctions, which can make a world of difference.