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Pudendal Neuralgia

The pudendal nerve is a nerve that travels through the pelvis to provide sensation to the anus, genitals and perineum (the space between your genitals and anus). This nerve also controls some of the muscles to your anus and bladder. Pudendal neuralgia results in injury to this nerve from a variety of causes. 

Symptoms

Patients with pudendal neuralgia may experience numbness and/or pain in the lower portion of the buttock, the genital region and the perineum. This pain is usually associated with prolonged sitting and usually worsens throughout the day. The pain may be described as burning, sharp, stabbing or aching.

There may be associated sexual dysfunction in both men and women. In men, this may include difficulty maintaining an erection or pain with an erection and in females, pain with intercourse or failure to achieve an orgasm.

There may also be disturbances in bladder and bowel function, including incontinence (the involuntary loss of urine or feces). Sometimes things that are not normally painful such as your clothing touching that area may cause pain (allodynia).   

Causes

Pudendal neuralgia is caused by irritation or injury to the pudendal nerve anywhere along its course. The pudendal nerve can become trapped with repetitive activities such as cycling or squats, and is commonly associated with professional cyclers. This condition is called pudendal nerve entrapment syndrome or Alcock canal syndrome and is rare.

The nerve can be injured by excessive or acute stretching during a difficult or prolonged childbirth or chronic straining from constipation. The nerve may also be damaged by chronic conditions affecting nerves such as diabetes or multiple sclerosis. Gynecologic surgery, tumors in the pelvis or surgery to remove the tumor may also directly injure the nerve. 

Treatments

Treatment for pudendal neuralgia may include a referral to a pain management specialist. At the JLR Center for Pain Medicine, your physician will work with you to design a customized treatment plan. At your initial examination, a thorough history and physical exam will be performed. 

Early treatment focuses on confirmation of the diagnosis and the initiation of a treatment to alleviate pain. Your treatment plan may involve some lifestyle modifications. If pain is not improved with some of these, you and your pain management doctor may discuss the addition of medications designed to treat nerve pain. This may include a combination of anti-convulsants (nerve-stabilizing medications), anti-depressants which also work to stabilize the nerve, and topical creams.

Your doctor may also suggest administration of a nerve block to help alleviate some of the pain. If the pain persists, despite the initial treatment options, your provider may suggest a spinal cord stimulator trial. Rarely is surgery required to alleviate symptoms.