Pudendal neuralgia


Pudendal neuralgia is one of the causes of chronic pelvic pain. We can try to treat it with pulsed radiofrequency when exercise and painkillers fail. Surgery is a last resort.

What are the symptoms of pudendal neuralgia?
  • Burning sensation and sharp pain 
  • Felt over buttock, groin or thigh
  • Worse when sitting
  • Better when lying down or standing
  • Can be over one or both sides
  • There may be some numbness or change in sensation as well
  • Usually associated with overactivity of the pelvic floor, with effects on urination, defecation and sexual intercourse
What are the causes?
  • Entrapment of the pudendal nerve as it travels between muscle planes
  • Happens over the piriformis, between the gluteus maximus and sacrospinous ligament, or between the sacrospinous ligament and the superior gemellus , or in the pudendal canal
  • Affects people who sit too long like taxi drivers, cyclists and women who have given bith normally
  • Can also be due to trauma on a bicycle or motorbike
How to treat pudendal neuralgia?
  • Not easy to determine cause or to find exact point of entrapment
  • Aim is for pain management and improvement of quality of life
  • Changes in lifestyle
    • Soft cushions
    • Stop sitting so long, stop cycling
    • Walk around every 20-30 min at the office
  • Pelvic floor exercises and physiotherapy
  • Medications
    • Acetaminophen, NSAIDs and etoricoxib, celecoxib
    • Pregabaline and gabapentin
    • Amitriptyline
    • Weak opioids like tramadol
  • Pain procedures:
    • Injections to relax the muscles
    • Nerve blocks
    • Pulse radiofrequency
      • may improve symptoms
      • can be effective but may need to be repeated
      • aim is for a 50% reduction in pain
  • Surgery to free the pudendal nerve

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