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