Pudendal Nerve Pain and Pudendal Neuralgia
Condition Overview
The pudendal nerve, aka pudendal neuralgia, gives sensory and motor supply to the pelvic floor. The nerve originates from the sacrum and runs through our gluteal and pelvic muscles eventually branching off near the SIT bones into three nerve roots to supply the clitoris, the penis, the perineum (including the labia and scrotum), and anal opening. Therefore, this nerve is important for sensation, sexual functioning (erection, ejaculation, orgasm), pelvic floor muscle coordination/strength/endurance, and anal sphincter closure.
Symptoms of Pudendal Nerve Pain
Typically if you have this issue, you will feel pain and/or numbness in the pelvic region, anus, or genitalia. The pain can feel like sharp/burning pain, swollen sensation in genitalia, or a fullness in your rectum.
Symptoms can also include
Urinary, bowel, and sexual dysfunction or pain
The sudden urge to urinate
Pain during intercourse (externally or internally)
Difficulty getting an erection.
Pain typically worsens with sitting and improves with lying flat or standing
What Causes Pudendal Nerve Pain?
Direct trauma to the area
Childbirth - especially with a prolonged labor and delivery
Prolonged pressure on the nerve (cycling, driving/traveling, chronic constipation)
Repetitive/intense loads with squatting
Complications following pelvic surgery (prostatectomy, prolapse repair)
What Does Treatment for Pudendal Nerve Pain Look Like?
There are a few medications including steroids, painkillers, botox injections, and nerve blocks that may give some people pain relief. As a last option, a pudendal nerve decompression surgery may also be warranted.
How Can PT Help?
Since the pudendal nerve supplies the pelvic floor muscles with motor and sensation, these muscles are typically affected and will need to be treated.
In physical therapy, we will discuss your symptoms and go over each of the systems of the pelvic floor (bladder, bowel, sexual health, and gynecological health) in order to diagnose your symptoms appropriately.
We will perform a low back and hip screen and assess muscles where the pudendal nerve travels through to see if there are signs of decreased range of motion, impaired joint mobility, muscle atrophy, tension, or inflammation.
With your consent we will perform an external and internal pelvic floor muscle assessment and palpate the pudendal nerve to see if this triggers your symptoms. We will also assess your abdominal wall, low back/hips, adductors, and superficial and deeper pelvic floor muscles. We will determine your muscle function, strength, endurance, and coordination.
From our findings we will set-up a treatment plan depending on your pelvic floor characteristics!
There may be lifestyle modifications that we need to address (reduce sitting times, improved posture, constipation).
We may perform manual treatment that can include but is not limited to dry needling, myofascial release, cupping, and connective tissue mobilization around your glutes and external pelvic floor musculature.
With each session we will progress as able and learn new activities to include in your daily routine to manage and prevent worsening symptoms!