Pain

Conventional Medical Treatments for Pudendal Neuralgia

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What is pudendal neuralgia?

Pudendal neuralgia is a condition that occurs when the pudendal nerve, which runs from the back of the pelvis near the base of the penis or vagina, is damaged or irritated. This nerve sends signals to the brain from the genitals, anus and other nearby body parts. It controls the sphincter muscles that open and close when passing urine or emptying the bowels. Once this nerve is damaged, it can cause issues with bladder and anal incontinence or hesitancy, having sex or simply sitting down.

Treating pudendal neuralgia

Making adjustments at work and home, along with certain leisure activities, can reduce the pain experienced from this condition. The main goal of treatment is to reduce the irritation of the pudendal nerve.

Conservative lifestyle adjustments

Some common lifestyle adjustments include the following:

  • Not straining when emptying bowels or passing urine
  • Avoiding stimulant laxatives
  • Avoiding pressure on the perineum by making sitting modifications
  • Avoiding physical activities that could irritate the nerve, such as cycling, bench pressing or horse riding
  • Adapting sex lives

The treatment plan for an individual with pudendal neuralgia may involve different specialists, such as a physiotherapist, osteopath or surgeon.

Physiotherapy

One of the most common causes of irritation to the pudendal nerve is when the pelvic floor has been over-contracted. Physiotherapists teach individuals with pudendal neuralgia how to relax and stretch the muscles in the pelvic floor; these gentle exercises help to calm the irritation of the nerve. Physiotherapists may recommend using a TENS (transcutaneous electrical nerve stimulation) unit to reduce pain. During physiotherapy, individuals learn specific external exercises and stretches to address posture issues. Individuals also learn about specific activities that exacerbate the pain from pudendal neuralgia. Physiotherapists can also help plan a daily bladder and bowel management routine.

Osteopathy

Osteopaths help reduce the irritation of the pudendal nerve by relaxing the joints, muscles and soft tissues of the pelvis and lower back. An osteopath teaches individuals with pudendal neuralgia what adaptations should be made in daily movements, such as walking, to reduce irritation on the nerve and pain from tight muscles.

Medication

Daily medications like topical creams and oral medications help to calm the nervous system. Analgesics, muscle relaxants and anticonvulsants can be prescribed. Certain types of injections can also be used for pudendal neuralgia:

  • Cortisone injections
  • Hyaluronic acid injections
  • OnabotulinumtoxinA injections
  • Activated platelet extract injections

A pudendal nerve block is another injection option. A pudendal nerve block involves injecting a local anesthetic into the area around the pudendal nerve.

Surgery

Decompression surgery is a minimally invasive procedure that involves decompressing the pudendal nerve and other associated nerve structures. Surgery is usually highly effective and often results in significant pain reduction.

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