Pudendal Neuralgia

Pudendal neuralgia is a chronic neuropathic pelvic pain, which is often misdiagnosed, and therefore often inappropriately treated, leading some patients to wait long periods of time to receive effective treatment. Causes are wide ranging and include childbirth trauma, excessive cycling, gynecological or colorectal surgery, or pelvic or perineal trauma.  The primary symptom is pain in the genitals or the anorectal area and the symptoms are usually worse when sitting. The pain can move around in the pelvic area and can occur on one or both sides of the body. The pain is often described  as burning, knife-like or aching, stabbing, pinching, twisting or even numbness. Sexual dysfunction and difficulties with urination and/or bowel movements are also common.

There are multiple routes of treatment including medical management comprised of medications, invasive interventions such an surgery, injections, and neuro-modulation, as well as non-invasive or conservative therapy consisting of pelvic health physical therapy. A skilled pelvic health physical therapist will perform an assessment to determine what musculoskeletal impairment may be driving your symptoms. This often includes a postural evaluation, external pelvic muscle and fascia assessment, and a gentle internal pelvic floor muscle evaluation. There are multiple areas within the pelvis that the pudendal nerve can become compromised, and an internal assessment can provide insight into where this might be occurring. Treatment also consists of extensive patient education and a development of a home self care and exercise program.