Pudendal Neuralgia (PN) is a condition that can cause chronic pain or numbness along the course of the pudendal nerve, which is the nerve that innervates the pelvic floor.
Pudendal nerve entrapment and neuralgia are complex medical conditions that can significantly impact an individual's quality of life. In this comprehensive blog, we will delve into the causes, symptoms, and various treatment options available, with a special focus on the role of pelvic physical therapy in managing these conditions.
Pudendal Nerve Entrapment and Neuralgia: An Overview
The pudendal nerve, like other peripheral nerves in your body, is how your brain “connects” with the muscles and tissues of the body- sending and receiving messages between the brain and body like movement and sensation. When nerves get compressed, irritated, or constricted, problems can occur in this “message chain” and you might feel things like pain, numbness, tingling.
Pudendal Nerve Entrapment (PNE): The pudendal nerve is a crucial nerve responsible for transmitting signals between the brain and the pelvic region, including the genitals, anus, and perineum. Pudendal nerve entrapment occurs when the nerve becomes compressed or irritated, leading to pain and dysfunction.
Pudendal Neuralgia: Pudendal neuralgia is characterized by chronic pain along the distribution of the pudendal nerve. It can be caused by various factors, including trauma, inflammation, or compression of the nerve.
Causes of Pudendal Nerve Entrapment and Neuralgia:
Trauma: Traumatic events, such as childbirth, pelvic surgery, or accidents, can result in damage to the pudendal nerve, leading to entrapment and neuralgia.
Compression: Pudendal nerve compression can occur due to prolonged sitting, cycling, or other activities that put pressure on the pelvic area.
Inflammation: Inflammatory conditions, such as infections or chronic inflammation, can contribute to pudendal nerve issues.
Symptoms of Pudendal Nerve Entrapment and Neuralgia:
Chronic Pelvic Pain: Patients often experience persistent, severe pain in the pelvic region that may worsen with sitting or activities that increase pressure on the nerve.
Altered Sensations: Individuals may report tingling, numbness, or a burning sensation in the genital, anal, or perineal areas.
Sexual Dysfunction: Pudendal neuralgia can lead to sexual dysfunction, including pain during intercourse or difficulty achieving orgasm.
Other Symptoms include:
Vulvar pain
Clitoral pain
Fecal incontinence
Numbness of the genitalia
Treatment Options for Pudendal Nerve Entrapment and Neuralgia:
Conservative Measures:
Physical Therapy: Pelvic floor physical therapy is a cornerstone in the conservative management of pudendal nerve issues. Therapists employ various techniques to release muscle tension, improve blood flow, and alleviate symptoms.
Medications: Pain medications, muscle relaxants, and nerve-stabilizing drugs may be prescribed to manage symptoms.
Interventional Procedures:
Nerve Blocks: Injecting anesthetic agents around the pudendal nerve can provide temporary relief from pain.
Decompression Surgery: In severe cases, surgical procedures may be considered to release pressure on the pudendal nerve.
Pelvic Physical Therapy: A Vital Component of Treatment
Pelvic floor PT can help Pudendal Neuralgia or Entrapment by guiding your body in restoring the structures that are contributing to the dysfunction of your pudendal nerve. For example, if certain muscles in the pelvic floor are affecting your pudendal nerve, we will help you release them and then give you exercises and a home program to keep those structures released and healthy.
Some of the modalities used at COPE PT can include (but are not limited to):
Manual therapy including soft tissue massage, connective tissue manipulation, muscle energy techniques, and myofascial release to treat connective tissue dysfunction and myofascial trigger points
Internal pelvic floor manual therapy to treat sensitive tissues, muscle spasms, trigger points, and muscle guarding that can cause issues like pain with sex, frequency and urgency of urination, and pain with bowel movements
Therapeutic exercises to release entrapped nerves or strengthen the pelvic floor
Visceral mobilization (gentle massage techniques that loosen internal adhesions and restore movement to the organs including the intestine, bladder, uterus, and ovaries) to improve motility and GI organ function
Training in self treatment techniques so you can start to manage your symptoms at home. These techniques can include self pelvic floor massage using medical dilators
Neuromuscular re-education and autogenic relaxation to reduce chronic muscle over-activity and improve parasympathetic nervous system function, including pain management and digestion
Patient Education and Empowerment
Lifestyle modifications like sexual positioning, stress reduction, bladder and bowel habits, hygiene, and optimal fluid intake and dietary fiber intake to control other factors that may be contributing to pelvic floor dysfunction.Evaluation and Assessment: Pelvic physical therapists conduct a thorough assessment to identify specific issues contributing to pudendal nerve dysfunction.
Targeted Exercises: Therapists design personalized exercise programs to address muscle imbalances, improve flexibility, and promote overall pelvic health.
Pudendal nerve entrapment and neuralgia are challenging conditions, but a multimodal approach to treatment, including pelvic physical therapy, can significantly improve outcomes. If you or someone you know is experiencing symptoms, consult with a healthcare professional to explore the most suitable treatment plan for individual needs. Remember, with proper care and management, individuals with pudendal nerve issues can regain control of their lives and find relief from chronic pain.
To learn more about our total body approach approach to chronic pelvic pain, contact us here.