Do you ever feel a sharp pain, burning feeling, or numbness in your lower belly, pelvic region, or private parts? Does this discomfort get much worse when you sit down for a long time?
If this sounds familiar, you may want to learn about a condition called pudendal neuralgia. While it is not talked about very often, it can cause severe discomfort for those who experience it.
This guide explains what pudendal neuralgia is, why it happens, and what you can do to find relief with the help of your doctor.
Key Takeaways About Pudendal Neuralgia
- It is caused by irritation or pressure on your pudendal nerve.
- Sitting down often makes the burning or stabbing pain much worse.
- Common treatments include physical therapy, lifestyle changes, and special cushions.
- Talking to a doctor helps rule out other pelvic issues and starts you on the right path.
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What Is Pudendal Neuralgia?
Simply put, pudendal neuralgia is a type of long-term pelvic pain. It happens when your pudendal nerve gets damaged, squeezed, or irritated.
When this nerve is hurt or pinched, it can feel like a knife stabbing you, a hot burning sensation, or electric shocks. You might feel this pain in your buttocks, your perineum (the area between your genitals and anus), and your sexual organs. Sitting down is usually the hardest part.
Where Is the Pudendal Nerve Located?
Think of the pudendal nerve as running from the back of your pelvic cavity down to the area between your legs, supplying muscles and skin. To picture it, remember every spot that touches a bicycle seat when you ride.
Any injury to this entire region can be linked to pudendal nerve trouble. This nerve controls movement and feeling in your sexual organs and back passage.
It also helps control the sphincter muscles that help you hold or release urine and stool.
What Does the Pudendal Nerve Do?
This nerve carries several very important physical feelings up to your brain. These feelings include:
- Touch.
- Sexual pleasure.
- Pain.
- Temperature.
You feel these sensations in specific parts of your body:
- In males: The penis and scrotum.
- In females: The vagina, labia (vaginal lips), and vulva (external female genital area).
- For everyone: The perineum, anal canal, and anus.
- Urethra: The tube where urine leaves your body.
How common is this condition? Pudendal neuralgia is considered a rare medical condition, but it can affect anyone. It is most commonly seen in adults over the age of 19.
What Are the Symptoms When the Pudendal Nerve Is Damaged?
The main and most severe symptom of this condition is pain. Any organ or muscle controlled by the pudendal nerve can feel this discomfort.
You might feel this pain in your clitoris, labia, vagina, penis, scrotum, anus, or rectum .
Some people describe the pain in these ways:
- Stabbing, aching, burning, or feeling like you are poked with a knife.
- Numbness, tingling, or a deadened feeling in the area.
- Worse pain by evening and feeling a bit better in the morning.
- Pain levels that change from day to day.
- Pain that gets much worse when you sit down and feels better when you stand or lie down.
Imagine Nilanthi, who had a strange pain in her lower belly for months. Several doctors could not figure out what was wrong. Her pain was worst when she sat at her office desk to work. Some days, the pain was so bad she wanted to cry. Finally, a medical specialist discovered this could be pudendal neuralgia.
Along with this main pain, other symptoms can show up:
- Increased sensitivity, making it painful just to wear underwear.
- Swelling or feeling like something is stuck inside your back passage.
- A sudden, urgent need to urinate.
- Pain when having a bowel movement.
- Pain during sexual intercourse.
- Trouble reaching orgasm.
- Erectile dysfunction in men.
- General numbness, coldness, or loss of feeling in the legs, feet, and buttocks.
Our pudendal nerve has three main branches: a rectal branch, a perineal branch, and a clitoral or penile branch. Your symptoms depend on which part of the nerve is injured.
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Check Availability →What Causes Pudendal Neuralgia to Get Worse?
The pudendal nerve gets damaged or squeezed because of surrounding tissues or muscles pressing on it. Some common causes include:
- Activities that put constant pressure on your pelvic area. Examples include riding a bicycle, doing squats with heavy weights, horseback riding, or long-term chronic constipation.
- Sitting down for very long periods of time.
- Stretching of the nerve caused by tight nearby muscles and ligaments.
- Complications from certain surgeries, such as prostate removal surgery (prostatectomy).
- A broken pelvic bone.
- Trauma or injury during childbirth.
- Certain infections or medical conditions.
- Non-cancerous (benign) growths or lesions.
- Nerve damage (neuropathy) linked to diabetes (diabetes mellitus) or other health conditions.
How Do Doctors Diagnose Pudendal Neuralgia?
Doctors diagnose this condition using a physical exam and a few tests. First, they will ask you about your symptoms and exactly where you feel the pain.
Doctors also try to rule out other medical conditions that cause similar pain.
Some common tests used for this include:
- Vaginal or rectal exam: The doctor puts a gloved finger into your back passage or vagina to press directly on the pudendal nerve.
- Magnetic Resonance Imaging (MRI): This is a powerful imaging scan that checks the pudendal nerve and nearby structures for problems.
- Electromyography (EMG): Doctors use a small tool to send electrical impulses to your pudendal nerve to check how well it works and responds.
- Nerve blocks: Doctors inject a pain medicine into your pelvic area to numb the pudendal nerve and see if your pain goes away. If the pain stops, it suggests the pudendal nerve is the source.
Other Conditions That Can Feel Like Pudendal Neuralgia.
Pudendal neuralgia shares symptoms with several other conditions, such as pain and trouble controlling urine or stool. Because of this, your doctor may ask questions to rule out other issues, including:
- Vulvodynia: Pain in the external female genital area.
- Coccygodynia: Pain in your tailbone.
- Prostatitis: Inflammation or issues with the prostate gland.
- Sciatica: Pain in the lower back and leg caused by injury to the sciatic nerve.
- Pelvic floor dysfunction: Trouble controlling bowel movements or urine due to weak or tight pelvic floor muscles.
How Is Pudendal Neuralgia Treated?
Treatments can include physical therapy, medicines, lifestyle changes, or even surgery. Doctors may combine one or more treatments to help reduce symptoms quickly.
Physical Therapy.
A physical therapist can teach you stretches and exercises to relax the muscles causing your pudendal nerve pain. They may also suggest using a TENS (Transcutaneous Electrical Nerve Stimulation) unit to help lower nerve pain.
Lifestyle Changes.
Certain activities can make pudendal nerve pain much worse, so stopping or changing them helps. Examples include:
- Sitting down for long stretches of time.
- Riding bicycles.
- Doing squat exercises with heavy weights.
- Horseback riding.
- Straining during bowel movements if you have constipation.
When you sit down, using a donut pillow or a U-shaped cushion is helpful. These cushions have a hole in the middle to take pressure off your pelvic floor muscles and your perineum. If you deal with frequent constipation, eat more high-fiber foods or take a stool softener so you can pass stool without straining.
medicine.
Some people use painkillers or steroids to lower their pain. There are specific medicine types given for pudendal neuralgia:
- Pain relief medicines.
- Nerve-calming or anti-seizure medicines, such as gabapentin.
- Local anesthetics to numb nerve pain, or corticosteroids to reduce swelling.
- Tricyclic antidepressants like amitriptyline.
- Botox injections to relax muscles around the pudendal nerve.
Surgery.
Surgery is usually considered a last resort. Pudendal nerve decompression is a surgery where doctors remove muscle or tissue pressing on your pudendal nerve. Surgeons make a cut in your buttock muscles (gluteal muscles) or perineal muscles to reach the nerve.
Healing and pain relief after this surgery can take many months or even years. It is not an instant fix.
Can You Massage the Pudendal Nerve?
Massage therapy is not a standard treatment for pudendal neuralgia. However, some doctors suggest massaging the muscle tissues around the pudendal nerve to lower tightness and pressure.
This may give temporary relief to a squeezed pudendal nerve.
How Can I Lower My Risk of Getting Pudendal Neuralgia?
If the cause is childbirth, an injury, or surgery, lowering your risk can be difficult. However, certain habits can protect your pudendal nerve.
Things you can do to lower your risk of pudendal nerve pain include:
- Avoid horseback riding or bicycle riding.
- Take breaks to stand up instead of sitting continuously.
- Use a donut cushion when sitting to lower pressure on your pelvis.
- Avoid straining when you urinate or have a bowel movement.
Can Pudendal Neuralgia Be Cured Completely?
No, there is no complete cure for this condition. The goal of treatment is to reduce symptoms as much as possible, though symptoms may never go completely away.
| Helpful Habits (Do's). | Risky Habits (Don'ts). |
|---|---|
| Use ergonomic or donut cushions when sitting. | Sit for many hours without taking standing breaks. |
| Eat fiber-rich foods to prevent constipation. | Ride bicycles or horses often if symptomatic. |
| Work with a pelvic floor physical therapist. | Strain heavily during bowel movements. |
Living Your Daily Life With Pudendal Nerve Pain.
Long-term nerve pain can affect your daily life, relationships, activities, and overall well-being. If you have pelvic pain, sexual health issues, bladder or bowel control problems, or depressive thoughts, be sure to seek medical advice.
Doctors can help you find pain relief and figure out if the pudendal nerve is causing your symptoms.
When Should I See a Doctor?
If you have pain in your pelvic region or sexual organs, see a doctor right away. Left untreated, your pain can get worse and make daily tasks difficult.
Signs and symptoms you should watch out for include:
- A "pins and needles" feeling in your pelvis, buttocks, or sexual organs.
- A feeling like something is stuck inside your back passage.
- Pain when urinating or needing to urinate often.
- Trouble with sexual function.
Emergency Red Flags
Seek immediate medical attention at your nearest Emergency Department (ER / A&E) or call 911 (US/Canada) or 999 (UK) if you experience sudden loss of bowel or bladder control, severe progressive numbness in your groin (saddle anesthesia), or sudden severe weakness in your legs.
If you have long-term pelvic pain and think you might have pudendal neuralgia, you are not alone. While it is rare, pudendal nerve pain is a real condition that affects daily life, relationships, and routines.
Talk to your doctor about your symptoms so they can find the best treatment plan for your pain level and location. Remember that asking for medical advice can help you find relief from pain.
💡 Take-Home Message.
- Pudendal neuralgia is severe, long-term pelvic pain caused by injury to the pudendal nerve.
- Pain that gets worse when sitting is a key sign.
- Causes include frequent pressure, surgeries, and childbirth.
- Getting medical advice early is very important if you have symptoms.
- Physical therapy, medicines, lifestyle changes, and sometimes surgery can help manage your symptoms.
- While there is no complete cure, you can get help to lower your pain and live a normal life.
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