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Pudendal Neuralgia

Written by Emma McGeorge

What is Pudendal Neuralgia?

Pudendal neuralgia is a chronic pain condition caused by damage or irritation of the pudendal nerve, which is responsible for providing sensation to the genital area, anus, and perineum. The pudendal nerve originates from the sacral nerve roots and runs through the pelvis to innervate the external genitalia and perineal muscles.

Let’s Talk Pudendal Nerve Neuralgia (Pain and Numbness in Your Pelvis)

If you have pudendal neuralgia we don’t need to tell you how painful it is. If you’re reading this and wondering if this is what you’re experiencing, simply put it’s shooting or stabbing pain anywhere along the nerve that goes from the bottom of your spine out into your pelvic floor. It can come and go, or be a constant (ouch) pain.

What is the Pudendal Nerve?

The pudendal nerve is a complex one, so there’s no easy definition. But we’ll try. It’s a really big nerve running behind your pelvis to the base of your vagina to the pelvic floor and acts like the messenger between your brain and genitals (and controls your sphincter muscles).

It wraps and weaves itself in and out of the muscles and structures of your pelvis, so there’s plenty of opportunities for it to get janky.

Here’s the complexity. It has three threads known as fibers which do three different things. Not only does it have motor fibers, which make your muscles do the things, and sensory fibers, which collect information to keep an eye on the body's internal and external conditions, it also has autonomic fibers which act pretty much outside of your awareness.

It’s thanks to the autonomic fibers of this nerve that our pelvic floor muscles keep a degree of tone. These are what keep us from running to the toilet immediately following a lunch date.

Causes of Nerve Pain in the Vagina

Our pudendal nerve is meant to flow through our pelvic region – the muscles, tissue and spaces between our joints – like a key fitting into a well oiled lock. This means that pudendal neuralgia, and the pelvic pain that arises from it, is due to issues with the nerve’s disposition. It doesn’t stretch like our muscles. So when the pelvic floor muscles around it are tight, there’s joint dysfunction, or connective tissue issues, the pudendal nerve doesn’t like it. It gets irritated and stuck in the lock, rather than gliding through with ease. This is often called pudendal nerve entrapment.

Here are some of the most common reasons why irritation can occur:

  • Childbirth - it can be irritated from over stretching in delivery 
  • Pelvic surgery 
  • Hip surgery
  • Bone breakage in the pelvic area
  • A growth (cancerous or non-cancerous) putting pressure on the pudendal nerve
  • Neural sensitivity and ischemia
  • Aggravating factors such as repetitive yeast or bacterial infections can sensitize the nerve
  • Endometriosis
  • Vulvodynia and IC
  • Nearby muscle or tissue compressing the pudendal nerve
  • Over time, activities such as sitting, horse-riding or cycling, as well as constipation, can irritate the pudendal nerve

Symptoms of Pudendal Neuralgia

Pudendal neuralgia can have some pretty annoying symptoms that can be localized, as well as emotional side-effects.

Symptoms can include:

  • General pelvic pain
  • Pain in the genitals or perineum (sharp, stabbing, prickling or shooting sensations)
  • Burning pain in pelvic area and lower back
  • Pain in the buttocks, legs and feet
  • Numbness or pins and needles
  • Increased sensitivity
  • Dyspareunia (painful sex)
  • A feeling that there’s swelling or something lodged in your perineum (hot poker anyone?)
  • Constantly needing to go to the bathroom

And, because of the complexity of the nerve pathways in that area, some people may have uneasy feelings when their pain spikes which can feel similar to an anxiety attack. 

These symptoms include:

  • sweating
  • goosebumps
  • increase in heart rate
  • rise in blood pressure
  • agitation and anxiety

If you’re experiencing any of these symptoms, we encourage you to talk to your doctor or get some advice from your pelvic physiotherapist. (If you don’t already have one, check out the Pelvic Health Network and find a provider in your area!) Don’t be shy with asking your specialist for help; they hear it all the time. Getting to the bottom of the symptoms means you can start mapping out a plan for your recovery and some pain relief. With pelvic floor physical therapy, you can get back to enjoying your life free of this chronic pain.

What Helps Treat Pudendal Neuralgia?

Pain associated with neuralgia in your pelvic nerve can be managed with our purpose-made products and some adjustments to your daily life. Like all of the conditions mentioned here at The Pelvic Hub, we encourage you to speak with your doctor or pelvic physiotherapist ASAP and get treatment and a self management plan. Getting to the bottom of your symptoms is the first and most important step towards healing.

Avoid or modify certain activities

First things first. We need to calm down the affected area and modify some of your activity. Yes, (sigh), it might mean reducing or even taking out some activities you love, such as cycling or lights-out disco dancing to reduce the chance of pudendal nerve entrapment, irritation, or other types of pelvic floor dysfunction.

Some of the most irritating activities for a pudendal nerve are:

  • sitting/bending
  • trampoline jumping
  • bench pressing
  • excessive core muscles exercises 
  • bicycling (or any repetitive activity where you bring your knee towards your chest AKA hip flexion)

These are activities to swap out in the meantime:

  • walking (may need to stick to more flat terrain walking as inclines can also be irritating)
  • swimming 
  • upper body exercises
  • gliding exercises

You might also need to change how you have sex so we encourage you to try different positions. Also, ask your physical therapy provider if they have any recommendations for new positions. Don’t be shy - they’re used to handling intimate questions with sensitivity and professionalism.

Manage your sitting

Learning good toilet habits also means working on your posture, position and breathing so you’re avoiding pushing and straining as much as possible. Because straining can lead to hemorrhoids, nerve damage and even prolapse—yikes!

So what’s a good position? The Continence Foundation of Australia recommends getting into a squat position where your knees are higher than your hips (a stool can help), leaning forward with your elbows on your knees, straightening your spine, relaxing and letting your tummy settle onto your thighs. We recommend a good magazine and relaxed breathing.

Embrace the power of heat and cold

We all know there’s nothing better than a little slice of warmth or soothing cold when you’re feeling uncomfortable. We love reusable feminine pads, because they can be warmed up or cooled depending on your needs. The best part is you can wear them whenever you want and nobody has to know. 

We’re also big fans of the using therapy pads, which is like a warm and cozy hug for your pelvis.

Remove the discomfort of sitting down

Relieving pressure on the pelvic floor can help ease the pain associated with pudendal neuralgia. If you’re experiencing nerve pain (or even any other pelvic floor dysfunction symptoms), you’ll want to add a cushion to your arsenal of pain-relieving tools to make sitting down less of a pain.