By Jovie Murtha, Accelerated/Athletico Women’s Health PT
It can be a real “pain in the rear” to have pain in your “unmentionables.” Yet, many suffer from pelvic, vaginal, rectal, penile, or clitoral pain in silence. Most people do not know that this can be a symptom of a very real problem called pudendal neuralgia (PN).
The pudendal nerve is responsible for the movement and sensation of the muscles and tissues of your pelvis. It originates from the nerves of the sacrum at the bottom of your spine. This nerve has three branches that innervate the clitoris/penis, vagina/scrotum, and anus.
Symptoms of pudendal neuralgia can include pain, itching, burning, aching, stinging, or twitching sensations in any of the areas of the perineum. It can also cause severe pain with ejaculation/ orgasm, rectal pain with bowel movements, or urethral pain with urination. Most patients with PN have increased pain with sitting, especially in the evening. Often they report that they feel they are sitting on a golf ball. Sometimes they get relief sitting on a toilet, where there is no pressure on the pelvic outlets. These patients have difficulty tolerating tight clothing, sitting, long car rides, and intercourse. Each patient has a different presentation, but it is a life-altering problem until it is correctly diagnosed and treated. It can cause severe depression and anxiety, if untreated.
Who gets PN? Anyone can get PN, though it is more common in women than men. Oftentimes, PN runs alongside other disorders, such as bowel or bladder dysfunction, endometriosis, interstitial cystitis, fibromyalgia, and/or irritable bowel syndrome. It is frequently seen in those who cycle or ride horseback. Pregnancy and delivery may also create PN symptoms.
Pudendal neuralgia is often misdiagnosed. If you have any of the above symptoms, please address it with a reputable urologist, gynecologist, women’s or men’s health physical therapist, or pain specialist in your area. There are many excellent providers in the Peoria area who are able to diagnose and treat PN. Your evaluation should be thorough. Make sure to take a list of your symptoms and questions with you to your appointment.
Is this a treatable condition? The great news is…. YES! Treatment will depend on the cause of the nerve irritation. Physical therapy (PT) is a first-line intervention. It includes assessment of possible causes of the neuralgia, such as cycling, muscular tightness, hip inflexibility, pelvic malalignment, nerve damage or compression, spinal issues, or poor posture. They will also address and consider other co-existing conditions, such as fibromyalgia, interstitial cystitis, endometriosis, constipation, prostatitis, or any other bowel and bladder dysfunction.
Depending on the findings, they can use several different treatment approaches, including an abundance of patient education, muscle re-education, manual therapy, trigger point release, stretching, postural correction, electrical stimulation, biofeedback, ultrasound, dry needling, and/or myofascial release. Your physician may prescribe medication to calm the irritated nerve. Nerve blocks can also be performed by a pain clinician and are usually given in a series over several weeks. Your doctor may also use Botox to help relax the pelvic floor muscles. Rarely is surgery indicated, but can include nerve decompression or neurostimulator implantation. Your doctor should also address any signs of depression or anxiety, as these are very common in PN patients.
If you have any symptoms of PN, understand that there is hope and healing for you!
For more answers to your women’s health questions, read my article in Healthy Cells Magazine next month! Feel free to contact our Women’s health specialists here at Accelerated/Athletico at any time for a free consultation. Physical therapy for women’s health issues is available at Accelerated Rehabilitation. Physical Therapist Jovie Murtha is relentless in her mission to help women conquer pain and discomfort so they can be more active. For more information contact 309-683-6900. We are here to help!