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Can Pudendal Neuralgia Be Cured? Exploring Long-Term Solutions
Reviewed by Kenneth Barron, MD
Living with pudendal neuralgia can feel very frustrating and exhausting. The sharp, burning, or aching pain in the pelvic region can disrupt your daily life, making even simple activities uncomfortable. If you're searching for answers, the good news is that pudendal neuralgia can often be managed and for some, long-term relief is possible. The right combination of treatments can reduce your symptoms and improve your quality of life.
What is Pudendal Neuralgia?
Pudendal neuralgia occurs when a pudendal nerve (there is a left and a right one), which runs through the pelvis, becomes irritated or compressed. This nerve is responsible for sensation and some muscular function in the genitals, perineum, and anus. When it becomes inflamed or entrapped, it can cause chronic pain. Some people experience shooting pain when sitting, while others feel ongoing achy/burning/stinging discomfort that worsens over time.
Several factors can contribute to pudendal neuralgia, including prolonged sitting, bicycle riding, pelvic trauma, a fall, surgery, or conditions like pelvic floor muscular dysfunction. Because symptoms can vary, getting the right diagnosis is important to finding the best approach to treatment.
Symptoms of Pudendal Neuralgia Can Include:
Pudendal neuralgia affects everyone differently, but common symptoms can include:
- Burning, aching, or sharp pain in the pelvic region
- Numbness or tingling in the perineum, genitals, or rectum
- Increased pain when sitting, which improves when standing, lying down, or sitting on a toilet
- Feeling like there’s a foreign object in the rectum or vagina
- Pain that worsens after activities like cycling or prolonged sitting
- Difficulty with urination or bowel movements due to discomfort
- Increased sensitivity or discomfort during sex, orgasm, or ejaculation
Symptoms can be mild or severe and might fluctuate throughout your day. And are usually only on one side of the pelvis.
Can Pudendal Neuralgia Be Cured?
Yes, pudendal neuralgia can be cured. However, there isn’t a one-size-fits-all approach for the condition. Many people find lasting relief with a combination of treatments. The goal is to reduce nerve irritation, relieve pain, and improve your daily function. Your provider might recommend one or more of the following approaches:
Medications to Manage Nerve Pain
Certain medications, such as gabapentin, pregabalin and amitriptyline, help calm nerve activity and reduce pain. These medications target nerve-related discomfort without relying on opioids, which typically aren’t effective for this type of pain.
Nerve Blocks or Injections
Pudendal nerve blocks involve injecting anesthetic and sometimes anti-inflammatory medication near the affected nerve to reduce irritation. These injections can provide prolonged temporary relief and help confirm that the pudendal nerve is the source of the pain.
Lifestyle Changes
Avoiding activities that worsen symptoms can make a very big difference. Sitting for long periods, cycling, or certain exercises might aggravate nerve irritation. Using a cushion designed to reduce pelvic pressure or adjusting daily habits can help minimize discomfort.
Physical Therapy for Pelvic Floor Relaxation
A pelvic floor physical therapist can guide you through stretches and exercises that relax tight muscles around the pudendal nerve. Manual therapy, posture adjustments, and biofeedback techniques can all contribute to pain relief.
Nerve Stimulation
Implantation of a peripheral nerve stimulator on the pudendal nerve can be very effective in reducing or eliminating pain symptoms.
Surgical Options
If conservative treatments don’t provide relief, surgery might be an option. Decompression surgery aims to release the nerve from any entrapment, which could improve symptoms for some people. This is typically considered only after other approaches have been exhausted.
Finding the right combination of treatments takes time, but many people experience significant improvement with a well-rounded approach.
Are there Risks to Treatment?
Like any medical approach, treatments for pudendal neuralgia come with some potential risks. Medications can cause side effects such as drowsiness or dizziness. Pudendal nerve blocks provide temporary pain relief but don’t always work long-term.
Pelvic floor physical therapy is generally very safe. In rare cases, pudendal nerve release surgery can lead to complications like infection or nerve damage.
Who is a Candidate for Treatment?
If you experience any of the below symptoms, you could be a candidate for treatment:
- Chronic pelvic pain
- Discomfort related to pudendal nerve entrapment
- Burning or shooting pain in the pelvic region
- Pain that worsens with sitting
- Pain during or after sexual activity
- Increased sensitivity or hypersensitivity in the pelvic area
- Difficulty with bowel movements or a feeling of incomplete evacuation
- Urinary urgency or difficulty urinating
- Pain that radiates to the buttocks, perineum, or thighs
- Tingling or pins-and-needles sensation in the pelvic region Muscle spasms or tightness in the pelvic floor
As mentioned, you might benefit from pelvic floor physical therapy if pelvic floor dysfunction contributes to your symptoms. Those with persistent genital arousal disorder or chronic pelvic pain syndrome might also find relief through nerve-focused treatments. In cases where conservative methods fail, pudendal nerve entrapment syndrome might require surgical intervention.
Receive Lasting Relief at The Center For Advanced Gynecology
Living with chronic pain from pudendal neuralgia can feel isolating, but the right treatment plan makes a difference. Whether you need pudendal nerve blocks, physical therapy for pelvic floor muscles, or guidance on lifestyle changes, our team at The Center for Advanced Gynecology can help.