A Simple Guide to Pudendal Neuralgia, Diagnosis, Treatment and Related Conditions

This book describes Pudendal Neuralgia, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family ClinicPudendal neuralgia is a disorder characterized by chronic pain in the pudendal nerve, which is a major nerve that supplies sensation to the genital area, perineum, and anus. Pudendal neuralgia is long-term pelvic pain that originates from damage or irritation of the pudendal nerve which supplies areas including the:Lower buttocksArea between the buttocks and genitals (perineum)Area around the anus and rectumVulva, labia and clitoris in womenScrotum and penis in menSimply put the pudendal neuralgia is a pain in the butt!Pudendal neuralgia can occur in male and female even though about 67% of patients are female.
Internationally there is no racial or ethnic group preference observed. Causes:Pudendal neuralgia can take place if the pudendal nerve is injured, irritated or compressed. Nerve entrapment:Compression of the pudendal nerve by nearby muscles or tissue (Alcock canal syndrome)Nerve irritation or injury:Trauma, repetitive strain, childbirth, or surgery in the pelvic area can lead to nerve irritation or injury.
Inflammation:Disorders like pelvic inflammatory disease or chronic inflammation of the pelvic organs can cause pudendal neuralgia. Idiopathic:In some patients, the cause may not be known. Risk Factors:Pelvic trauma and surgeryProlonged sittingRepetitive activitiesOther risk factors are:A non-cancerous or cancerous growth pressing on the pudendal nerveExcessive physical exercisePast pelvic or perineal traumaStrainingMusculoskeletal issuesPostureStressPudendal neuralgia pain may:Have a burning, crushing, shooting or prickling sensationDevelop gradually or suddenlyBe continuous but may become worse at some times and better at othersBe worse when sitting down and disappear when standing or lying downAdditional symptoms are pain during sex and needing to urinate frequently and urgently.
Pinprick sensation is examined at each branch bilaterally:Dorsal nerve (clitoris and glans penis), Perineal nerve (posterior labia and posterior scrotum) andInferior anal nerve (posterior perianal skin). Diagnostic criteria are often used. Pain limited to the region of innervation of the pudendal nervePain predominant during sittingPain does not awaken the patient from sleepNo objective sensory defectsA positive effect of anesthetic infiltration of the pudendal nerveUnfortunately there is no "cure" for pudendal neuralgia.
At present the medical treatments of pudendal neuralgia involve drug therapy, pudendal nerve block, and nervous regulation by the implanted pulse generator, radiofrequency ablation, spinal cord electrical stimulation, pudendal nerve decompression. Physical therapy with specialists in pelvic floor therapy is often the first line of treatment. Patients are also given exercises and lifestyle modifications to use at home.
Manage the sitting position with coccyx-cut-out memory foam cushionsProper the bladder or bowels emptyingOther conservative treatments involve heat, massage, rest, TENS, muscle relaxants and anti-inflammatory medicinesInjection of local anesthetics or steroids around the pudendal nerve can provide temporary relief. Surgical intervention, such as pudendal nerve decompression or neurectomy, may be indicated in severe or refractory casesTABLE OF CONTENTIntroductionChapter 1 Pudendal NeuralgiaChapter 2 CauseChapter 3 SymptomsChapter 4 DiagnosisChapter 5 TreatmentChapter 6 PrognosisChapter 7 Occipital NeuralgiaChapter 8 Trigeminal Neur...