Pudendal nerve neuralgia symptoms

Pain and numbness in your pelvis? Let’s talk pudendal nerve neuralgia. 

If you have pudendal nerve neuralgia we don’t need to tell you have 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’s 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 fibres which do three different things. Not only does it have motor fibres, which make your muscles do the things, and sensory fibres, 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 the pudendal nerve (thanks) that our pelvic floor muscles keep a degree of tone. This keeps us from running to the toilet right after a lunch date. 

What are the symptoms of pudendal nerve neuralgia?

Pudendal nerve neuralgia can have some pretty erky symptoms that can be localised as well as feel like something more emotional. 

Symptoms can include:

  • 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 sometimes people 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 chat to your doctor or get some advice from your pelvic physiotherapist. Don’t be shy with asking your specialist for help (they hear it all the time). Getting to the bottom of the symptoms means can start mapping out a plan for your recovery, and getting back to enjoying your life pain free.

We really get how you’re feeling about your pudendal nerve neuralgia diagnosis, as our own Emma (Founder of Pelvic Hub) has her own lived experience. Your pelvic floor is in great hands (pun intended).

What causes it?

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. It doesn’t stretch like our muscles.  So when the 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. 

Here are some of the most common reasons why irritation to the pudendal nerve happens:

  • 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

We have purpose-made products to help you take care of your pudendal nerve neuralgia

Pain associated with pudendal nerve neuralgia 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 chat to 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 like cycling or lights-out disco dancing. 

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 (why not) so we encourage you to try different positions. Also, ask your pelvic floor physiotherapist 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 haemorrhoids, 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 mag 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 Pariday’s TendHer 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 EndoFEMM therapy pad, which is like a warm and cosy hug for your pelvis.

Remove the discomfort of sitting down

Relieving pressure on the pelvic floor can help ease the pain associated with pudendal nerve 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.