• Lila Abbate, PT, DPT, MS, OCS, WCS

Pudendal Neuralgia - Diagnosis and Treatment by a Pelvic Health PT

Pudendal neuralgia is a pelvic pain disorder often occurring in women over the age of 50+, however, neither men nor younger patients are excluded from this diagnosis. (2) This pain disorder is characterized by compression or entrapment of the pudendal nerve, which is located deep in the body’s pelvic floor. (1)


Trauma ranging from childbirth to surgery to prolonged sitting to extensive stretching exercises to the pelvis are all capable of compressing or entrapping the nerve. And common causes of pudendal neuralgia. Tumors, endometriosis and activities that include repeated hip flexion, like cycling, have also been shown to contribute to the development of this rare type of pelvic pain (2,5).


Physicians and physical therapists can diagnose pudendal neuralgia based on a collection of symptoms called “Nantes Criteria (4).” First, it’s important to note exactly where you are sensing pain. The pudendal nerve has branches that reach from the anus, perineum, vagina and clitoris in women and scrotum and penis in men; and pain can be present in any of these areas. (2) Pudendal nerve pain is often worsened by sitting and in some studies is accompanied by numbness or loss of sensation. An additional side effect of pudendal neuralgia is pelvic floor muscle spasms, particularly when the pain is brought on by exercises like cycling and squats. (2) If these are all traits of your pelvic pain, a diagnostic nerve block can solidify your diagnosis and help get you on track for properly targeted treatment. (4)


See a doctor or speak to a pelvic health professional right away if you think you have pelvic nerve pain of any kind. The sooner we can diagnose the issue, the sooner we can start to treat it, as many patients with pudendal neuralgia are able to manage and clear their pain through physical therapy, lifestyle shifts, and appropriate medications. (1) Let us at New Dimensions Physical Therapy get you back to your regularly scheduled activities in good health and spirits.


Sources:

  1. Hibner, M., & Coyne, C. (2016). Groin Pain Etiology: Pudendal Neuralgia. The SAGES Manual of Groin Pain, 137–151. doi: 10.1007/978-3-319-21587-7_11

  2. Martin, H. D., & Carlos Gómez Hoyos Juan. (2019). Posterior hip disorders: clinical evaluation and management. Cham, Switzerland: Springer.

  3. Luther, R. D., & Castellanos, M. E. (2019, September 24). Successful Treatment of Penile Numbness and Erectile Dysfunction Resulting From Pudendal Nerve Entrapment. Retrieved from https://www.sciencedirect.com/science/article/pii/S0090429519308234

  4. Chow, J., Lewis, M., Hart, R., Goulding, E., Sykes, P., Connan, K., … Fraser, I. S. (2019, June 6). Interventional management options. Retrieved from https://www.ogmagazine.org.au/21/2-21/intervention-management-options/

  5. Ünlü, Z., Yentur, A., & Çakil, N. (2015, October 23). Pudendal Nerve Neuropathy: An Unknown-Rare Cause of Pelvic Pain. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5827876/

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