• Nicole Cozean

What is Pudendal Neuralgia?

Definition


Pudendal neuralgia describes chronic pain along the path of the pudendal nerve ("neuralgia" simply means nerve pain). that worsens with sitting. The presentation and severity of symptoms vary considerably from patient to patient.


Pudendal pain can be put into three categories, which is important because it affects how they are treated.


  • Pudendal nerve irritation - When tight muscles within the pelvic floor irritate the pudendal nerve, which can cause pain to radiate anywhere the nerve runs. Eventually, if the nerve is irritated long enough, it actually begins generating pain itself and becomes neuralgia. This is also just referred to as 'pelvic floor dysfunction' in many cases.

  • Pudendal neuralgia - When the nerve is irritated long enough the nerve itself begins to generate pain and can take longer to calm down, even after the original irritation has been removed.

  • Pudendal nerve entrapment - Extremely rare, the pudendal nerve is only truly entrapped after a surgery or another major trauma to the region.


If you're dealing with pudendal neuralgia, nerve irritation or another cause of pelvic pain, there's absolutely hope. For practical, positive information and a supportive community, we established the Finding Pelvic Sanity online Facebook group - feel free to join!


Symptoms


Pudendal nerve pain can manifest anywhere the nerve runs. Pain, burning or pressure in the perineum, genitals, rectum, or deep in the pelvic floor are all symptoms of pudendal neuralgia.


The pain can be a dull ache, a burning, or a sharp, stabbing sensation. It can also feel like pressure or that you're sitting on a golf ball, and is often associated with painful intercourse, incontinence or sexual dysfunction.


Diagnosis


Primarily diagnosed by symptoms, pudendal neuralgia is technically diagnosed according to the Nantes criteria:


  1. Pain in the area of the pudendal nerve

  2. Pain that is made worse by sitting

  3. Pain does not cause you wake at night

  4. No sensory loss

  5. Pain is relieved with a pudendal nerve block


Physical Therapy for Pudendal Neuralgia


The pelvic floor is generally the driving cause of pudendal pain (either irritation or neuralgia). Tight muscles within the pelvic floor irritate the nerve, causing pain along the path of the nerve. Physical therapy works to restore normal function the muscles and remove the pressure on the nerve to reduce symptoms.



Depending on how long the nerve irritation has been present, it may take a significant amount of time to reduce symptoms. Your pelvic PT should be familiar with medical management of the condition and guide your overall care.


Clinical trials have shown pelvic physical therapy can benefit 9 of 10 patients diagnosed with pudendal neuralgia. If caught early, pelvic PT can also eliminate irritation of the pudendal nerve before it develops into true pudendal neuralgia.


Wondering if you may have pelvic floor dysfunction? Take the free Cozean Pelvic Health Screening Protocol!


At PelvicSanity, we support patients beyond the walls of our own clinic in Southern California. We offer an Out-of-Town program, remote consultations, and a Facebook support group for patients called Finding Pelvic Sanity.

Dr. Nicole Cozean is the founder of PelvicSanity Physical Therapy in Orange County, CA. PelvicSanity treats patients from all over the world with remote consultations and the Immersive Out of Town Program. She also runs Pelvic PT Rising, training other pelvic PTs to better serve patients.


Named Physical Therapist of the Year, Dr. Nicole is author of the award-winning book The Interstitial Cystitis Solution and the first PT to serve on the ICA Board of Directors, Her passion is helping those with pelvic health issues - regardless of where they live - find lasting relief.


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