Do you also have constant pain in your lower abdomen? Could it be pudendal neuralgia?

Do you sometimes feel unbearable pain, burning, or numbness in your lower abdomen , that is, in the genital area and rectum? Does this pain seem to get worse, especially when you sit down? If so, it is very important for you to be aware of this condition called Pudendal Neuralgia, which we are going to talk about today. Although this is a rare condition, it can be very distressing for some people.

What is Pudendal Neuralgia?

Simply put, pudendal neuralgia is a long-term pelvic pain caused by damage, compression, or a problem with your pudendal nerve . Specifically, when this nerve is injured or compressed, it causes a stabbing, burning, or electric shock-like pain. This pain can be felt in your buttocks, perineum , and genitals. It is most severe when you are sitting.

Where is the pudendal nerve located?

Think about it, the pudendal nerve starts at the back of our pelvis and connects to the entire area between our legs, including the muscles and skin. To put it another way, think of every spot where you press against the seat when you ride a bike. That entire area can be affected by damage to the pudendal nerve. This nerve controls the movements and sensations of your genitals and anus. It also controls the sphincter muscles that help you urinate and defecate.

What is the function of the pudendal nerve?

This nerve carries some of the most important sensations from our body to the brain. That is:

• Contact
• Pleasure (sexual)
• Pain
• Temperature

These sensations come from the following areas:

• Male names: penis and scrotum
• Female names: vagina , labia , and vulva
• For both: the area between the anus and the vagina/penis (perineum)
• Anal canal and anus
• Urethra (the tube through which urine exits the body)

In terms of how common this condition is, Pudendal Neuralgia is actually a relatively rare condition . But it can affect anyone. It is most commonly seen in adults over the age of 19.

What are the symptoms of pudendal nerve damage?

The main and most severe symptom of this condition is pain . This pain can affect any organ or muscle controlled by the pudendal nerve. You may feel this pain in the clitoris, labia, vagina, penis, scrotum, anus, or rectum .

Some people describe this pain like this:

• It feels like a piercing, a sting, a burning sensation, or like being stabbed with a knife .
• Numbness, tingling, or a feeling of loss of sensation .
• The pain seems to increase in the evening and at night and then subside a little in the morning .
• The intensity of the pain varies from time to time (some days it's more, some days it's less).
• The pain is most felt when sitting . It subsides a little when standing or lying down.

Imagine, Nilanthi had been experiencing a strange pain in her lower abdomen for months. She had seen several doctors, but they couldn't pinpoint the exact cause. She found it most difficult to sit in her office chair and work. Sometimes the pain was so severe that she cried. Finally, a specialist diagnosed it as Pudendal Neuralgia.

In addition to this main pain, other symptoms may occur:

• The sensitivity increases to the point where you feel pain even when wearing underwear.
• The area around the anus feels swollen, as if something is stuck inside the anus .
• A sudden feeling of needing to urinate .
• I feel pain when I defecate .
• I feel pain during sex .
• It's difficult to reach orgasm.
• Men may experience erectile dysfunction .
• There may be general numbness, coldness, or loss of sensation in the legs, feet, and buttocks.

Our pudendal nerve has three main branches: the rectal branch, the perineal branch, and the clitoral/penile branch. The symptoms you experience depend on which of these branches is damaged.

What are the causes of the increase in Pudendal Neuralgia?

The pudendal nerve can be damaged (by compression or other means) or become compressed by surrounding tissues or muscles. Some of the things that can cause this are:

• Activities that put constant pressure on the pelvic area. For example, things like cycling , squatting during weightlifting, horseback riding, or chronic constipation can damage the pelvis.
• Sitting for a long time.
• Nerve compression due to surrounding muscles and ligaments.
• Complications of some surgeries, for example, prostatectomy .
• Fracture of a pelvic bone.
• Trauma during childbirth.
• Some infections or diseases.
• A non-cancerous (benign) growth or lesion.
• Neuropathy caused by diabetes mellitus or other medical conditions.

How is Pudendal Neuralgia diagnosed?

Doctors diagnose this condition through a physical exam and other tests. They first ask you about your symptoms and the location of the pain. Often, doctors also try to rule out other conditions that can cause similar pain.

Some of the tests used for this are:

• Vaginal or rectal exam: The doctor inserts a gloved finger into your rectum or vagina and applies pressure directly on the pudendal nerve.
• Magnetic Resonance Imaging (MRI): This is a powerful imaging test that can examine the pudendal nerve and surrounding structures to identify problems.
• Electromyography (EMG): In this test, doctors use a small device to send electrical impulses to your pudendal nerve to see how well it is functioning and responding to stimulation.
• Nerve blockers: Doctors will inject a pain-relieving drug into your pelvic area to numb the pudendal nerve. They will then see if your pain goes away. If the pain goes away, it means that the pain is likely coming from the pudendal nerve.

Other conditions that can be confused with Pudendal Neuralgia

Pudendal neuralgia and a number of other conditions have similar symptoms. For example, pain and incontinence. So your doctor may do tests or ask questions to rule out other problems. Some of these other conditions include:

• Vulvodynia: Pain in the external vaginal area .
• Coccygodynia: Pain in the tailbone.
• Prostatitis: Diseases related to the prostate gland.
• Sciatica: Pain in the back and legs caused by damage to the sciatic nerve.
• Pelvic floor dysfunction: Damage to the pelvic floor muscles causes difficulty in defecating or holding urine.

How is Pudendal Neuralgia treated?

Treatments may include physical therapy, medications, lifestyle changes, or even surgery. Doctors may use one or more of these treatments together to quickly relieve symptoms.

Physical Therapy

A physical therapist can teach you stretches and exercises to relax the muscles that are causing your pudendal nerve pain. They may also recommend using a TENS (Transcutaneous Electrical Nerve Stimulation) machine to reduce nerve pain.

Lifestyle changes

Some things can make pudendal nerve pain worse, so it may be helpful to avoid or modify those activities. Here are some examples:

• Sitting for a long time at a time.
• Cycling.
• Squat exercise done while lifting weights.
• Horse riding.
• Straining during bowel movements if you have constipation.

It's a good idea to use a donut pillow or a U-shaped pillow when you sit. These pillows have a hole in the middle, which reduces pressure on the pelvic floor muscles and the perineum. If you're frequently constipated, eat more fiber-rich foods or take a stool softener. This will help you pass stools more easily.

Medication

Some people can use painkillers or steroids to reduce pain. There are several medications specifically prescribed for pudendal neuralgia:

• Painkillers.
• Neuroleptic or antiepileptic drugs, for example , Gabapentin .
• Injection of local anesthetics (block nerve pain) or corticosteroids (reduce inflammation).
• Tricyclic antidepressants, such as amitriptyline .
• Botox injections to relax the muscles around the pudendal nerve.

Surgery

Surgery is usually a last resort. Pudendal nerve decompression is a procedure that removes muscle or tissue from your pudendal nerve. Surgeons make an incision in your gluteal muscles or perineal muscles to reach the pudendal nerve. This surgery can take months, or even years, to relieve pain. It is not an immediate cure.

Can the pudendal nerve be massaged?

Massage therapy is not an approved treatment for pudendal neuralgia. However, some doctors recommend massaging the muscle tissue around the pudendal nerve to relieve tightness and pressure. This may provide temporary relief from the pinched pudendal nerve.

How can I reduce the risk of developing pudendal neuralgia?

This can be difficult to reduce if the cause is childbirth, an accident, or surgery. However, some activities can affect your pudendal nerve.

There are several things you can do to reduce your risk of pudendal nerve pain:

• Avoid horseback riding or cycling.
• Don't sit all the time, stand up every now and then.
• Use a donut-shaped pillow when sitting to reduce pressure on your pelvis.
• Avoid straining while urinating or defecating.

Can Pudendal Neuralgia be completely cured?

No, there is no cure for this. The goal of treatment is to reduce symptoms as much as possible. However, symptoms may not go away completely.

How do you live daily life with pudendal nerve pain?

When you have chronic nerve pain, it can affect your daily life. It can affect your relationships, activities, and general well-being. If you have pelvic pain, sexual dysfunction, bladder/bowel control issues, or depressive thoughts, it's important to seek medical advice . They can help you find relief for your pain and determine if the pudendal nerve is the cause.

When should I see a doctor?

If you have pain in your pelvic area or genitals , see a doctor immediately . If left untreated, your pain can worsen and make it difficult for you to perform your daily activities. Here are some symptoms to watch out for:

• A “pins and needles” sensation in the pelvis, buttocks, or genitals.
• A feeling as if something is stuck inside the anus.
• Pain when urinating or the need to urinate frequently.
• Sexual function problems.

If you have chronic pelvic pain and suspect you may have pudendal neuralgia, you are not alone. Although it is rare, pudendal neuralgia can be a debilitating condition that can affect your lifestyle, relationships, and daily activities. Talk to your doctor about your symptoms. He or she can then determine the best treatment option based on the severity and location of your pain. Remember, seeking medical advice can help you get relief from your pain.

The most important thing (Take-Home Message)

• Pudendal neuralgia is a severe, long-lasting pain in the pelvic area caused by damage to the pudendal nerve.
• A key symptom is that the pain worsens when sitting .
• This can be caused by several factors; things like constant stress, surgery, childbirth , etc.
• It is very important to seek medical advice without delay if you have symptoms.
• Symptoms can be managed with physical therapy, medications, lifestyle changes, and sometimes surgery.
• Even if there is no complete cure, you can get help to reduce the pain and live a normal life.