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Pudendal Neuralgia is a painful neuropathic condition that is caused by inflammation of the pudendal nerve. Triggers for the sensitivity include trauma secondary to childbirth, surgery, cycling, squatting exercises, bio-mechanical abnormalities (e.g., sacro-iliac joint dysfunction, pelvic floor dysfunction), chronic constipation, repetitive vaginal infections and direct falls on the tailbone.  Pudendal neuralgia is known in some circles as ‘cyclist’s syndrome’, ‘pudendal canal syndrome’ or ‘Alcock’s syndrome.’

Primary symptoms of Pudendal Neuralgia include:

· Pelvic pain with sitting that may be less intense in the morning and increase throughout the day.  Symptoms may decrease when standing or lying down.  The pain can be perineal, rectal or in the clitoral / penile area; it can be unilateral or bilateral.

· Sexual dysfunction.  In women, dysfunction manifests as pain or decreased sensation in the genitals, perineum or rectum.  Pain may occur with or without touch.  It may be difficult or impossible for the woman to achieve orgasm.  In men, dysfunction presents as pain during erection, difficulty sustaining an erection or painful ejaculation.

· Difficulty with urination / defecation.  Patients may experience urinary hesitancy, urgency and/or frequency.  Post-void discomfort is not uncommon.  Patients may feel that they have to ‘strain’ to have a bowel movement and the movement may be painful and/or result in pelvic pain after.  Constipation is also common among patients with pudendal neuralgia.  In severe cases, complete or partial urinary and/or fecal incontinence may result.

· Sensation of a foreign object being within the body.  Some patients will feel as though there is a foreign object sitting inside the vagina or the rectum.

It is important to note PN is largely a “rule out” condition.  In other words, because its symptoms can be indicative of another problem, extensive testing is required to ensure that your symptoms are not related to another condition.  Common conditions that should be evaluated include coccygodynia, piriformis syndrome, interstitial cystitis, chronic or non-bacterial prostatitis, prostatodynia, vulvodynia, vestibulitis, chronic pelvic pain syndrome, proctalgia, anorectal neuralgia, pelvic contracture syndrome/pelvic congestion, proctalgia fugax or levator ani syndrome

In addition to eliminating other diagnoses, it is important to determine if the pudendal neuralgia is caused  by a true entrapment or other compression / tension dysfunctions.  In almost all cases, pelvic floor dysfunction accompanies pudendal neuralgia.  Electrodiagnostic studies will help the practitioner determine if the symptoms are caused by a true nerve entrapment or by muscular problems and neural irritation.  It is crucial to a successful treatment outcome to acknowledge both dysfunctions and treat accordingly.  In the event of a true entrapment, surgical decompression followed by post-operative physical therapy will be necessary to restore patient health.  In cases of pudendal neuralgia, pudendal nerve blocks and physical therapy can alleviate the symptoms and resolve the original problem.

A diagram was created and copyrighted by Dr. Jacques Beco in 1998 which clearly illustrates the pathway of the pudendal nerve.  In this diagram, we have overlayed the most likely sites of a nerve entrapment.  This original diagram is available on www.pudendal.com

The Resources section of this website contains many links to sites containing detailed clinical information surrounding this condition, including how to contact treating physicians to discuss a specific clinical issue.  The Patients’ Resources section of this site contains information about how to contact treating physicians for an appointment.

NOTE:  This information was authored and approved by the physicians on our Board of Directors, but it is not a substitute for a visit with your physician. 

References:

http://www.pudendal.com, a website containing information collected and presented by GEP.

http://www.urmc.rochester.edu/smd/Rad/Pudendal.pdf., a website containing information collected and presented by Dr. Fred Howard and Dr. P-L Westesson.

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