Pudendal Neuralgia

Pudendal Neuralgia is a painful neuropathic condition that is caused by inflammation of the pudendal nerve.

Causes

Triggers for the sensitivity include trauma secondary to childbirth, surgery, cycling, squatting exercises, bio-mechanical abnormalities (e.g., sacro-iliac joint dysfunction, pelvic floor dysfunction), chronic constipation, repetitive vaginal infections and direct falls on the tailbone.  Pudendal neuralgia is known in some circles as ‘cyclist’s syndrome’,  ‘pudendal canal syndrome’ or ‘Alcock’s syndrome.’

Symptoms

Pelvic pain with sitting that may be less intense in the morning and increase throughout the day.  Symptoms may decrease when standing or lying down.  The pain can be perineal, rectal or in the clitoral / penile area; it can be unilateral or bilateral.

Sexual dysfunction

In women, dysfunction manifests as pain or decreased sensation in the genitals, perineum or rectum.  Pain may occur with or without touch.  It may be difficult or impossible for the woman to achieve orgasm.  In men, dysfunction presents as pain during erection, difficulty sustaining an erection or painful ejaculation.

Difficulty with urination / defecation.

Patients may experience urinary hesitancy, urgency and/or frequency. Post-void discomfort is not uncommon.  Patients may feel that they have to ‘strain’ to have a bowel movement and the movement may be painful and/or result in pelvic pain after.  Constipation is also common among patients with pudendal neuralgia.  In severe cases, complete or partial urinary and/or fecal incontinence may result.

Sensation of a foreign object being within the body.

Some patients will feel as though there is a foreign object sitting inside the vagina or the rectum.

Treatment

The pudendal nerve can be blocked with numbing medication to help diagnose this condition.  Sometimes cortisone will be injected around the nerve as well to decrease irritation.

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