Irritation or damage of Pudendal nerve can lead to a condition called Pudendal neuralgia which is marked by recurrent persistent episodes of pelvic pain. This nerve majorly runs along the pelvic region and organs including buttocks, vagina, vulva, penis, anal region, coccygeal region etc.
Understanding Pudendal Nerve Neuralgia
Try to visualize the areas when you ride a bike or sit down. Those are the same areas that are supplied by Pudendal nerve, including all the muscles, skin and fascia covering the region. This nerve also controls and registers the sensory and motor functions of genitals, anus and the sphincter muscles. These are the same muscles that help in voluntary control of urinary motion and defecation. So when there is neuralgia of Pudendal nerve, this entire region and its functions are affected. There is usually pain that worsens with prolonged sitting. This is also many- a- times interrelated with pelvic floor dysfunctions as well.
Pudendal nerve has 3 different branches that supply rectal area, perineum and clitoral/ penile area. Depending on the branch affected, the symptoms of neuralgia might differ. The symptoms experienced in this condition are described as follows-
• Stabbing or shooting pain
• Burning or aching pain
• Tingling or numbing pain
• Usually hurts more towards the end of the day and gets better in morning
• Worst intensity while sitting or driving
• Improves when change the position to side lying or standing
• Difficulty in putting on underwear and experiencing pain while doing the same
• Feeling of foreign object touching the genitals consistently ( kind of swollen feeling)
• Painful sex and bowel/ bladder movements
• Painful or difficult to achieve orgasms
• General loss of sensation or pain in the gluteal fold or buttock region
• Urgent need to urinate
What Incidents Incite Pudendal Neuralgia?
The damage to Pudendal nerve can occur due to a number of reasons which majorly includes being involved in activities that expose the pelvic region to constant strain. This includes activities like cycling, horseback riding, squatting activities or sudden episodes of chronic constipation. All of these activities lead to increased strain of pelvic area and thereby causing damage of Pudendal nerve. Another major cause of Pudendal nerve damage is trauma to pelvic region and perineum that is associated with child birth, fracture or surgical procedure like prostatectomy. Overly tight muscles in the pelvic region can also lead to damage and entrapment of Pudendal nerve.
Role of Physiotherapy in managing Pudendal Neuralgia
Physiotherapy can help in relieving and managing pain due to pudendal neuralgia. It specially helps with relaxing the pelvic floor and adding strength to the weak musculature if any.
Exercise therapy– There are a few exercises that can help build up your core and relieve pressure off the pelvic region. These exercises include wide leg pelvic bridges, cat camel exercises, arching, side lying hip abduction exercises etc. Some exercise need to be avoided such as crunches, dead lift, or any exercise that targets hip flexors in general. A safe and effective exercise plan should be devised with the help of a physiotherapist.
Electrotherapy– Use of interferential therapy and transcutaneous electrical stimulation therapy can be particularly helpful with managing pain and weird sensation in the genital area.
Neurodynamic exercises– Nerve flossing techniques for Pudendal nerve and local stimulation of nerve via various dry needling protocols might help.
Pelvic floor relaxation techniques– Pelvic floor relaxation techniques that are performed one to one by physical therapists play a very important role in easing of the tight muscle of the groin, genital and rectal area and therefore helps in releasing the entrapped Pudendal nerve.