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The Role of Physical Therapy in Managing Pudendal Neuralgia
Reviewed by Kenneth Barron, MD
Living with pudendal neuralgia can feel extremely uncomfortable and limiting, especially when sitting or walking. Even basic daily activities can trigger discomfort. This condition affects the pudendal nerve, frequently leading to achy pain or burning sensations in the pelvic area. If you're struggling with these symptoms, physical therapy offers a non-invasive and the most researched approach to finding relief. By addressing muscle imbalances, nerve irritation, and posture-related issues, a skilled pelvic floor physical therapist can help ease pain and improve function.
What is Pudendal Neuralgia?
Pudendal neuralgia occurs when a pudendal nerve (there is a left and a right one) 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 symptoms only in the anus/rectum, while others have vulvar/labial and clitoris symptoms. These can include shooting pain when sitting, while others feel ongoing achy/burning/stinging discomfort that worsens over time.
Common symptoms of pudendal neuralgia 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
Can Physical Therapy Provide Relief for Pudendal Neuralgia?
Yes, physical therapy can help ease the pain and discomfort caused by pudendal neuralgia. In fact, it is the first line treatment when the condition is diagnosed. Since this condition often stems from nerve irritation, muscle tightness, or postural imbalances, physical therapy can reduce pressure on the pudendal nerve and improve mobility, and prevent flairs.
It involves hands-on techniques, guided exercises, and posture adjustments. A pelvic floor physical therapist evaluates your muscle tension, joint mobility, and any nerve sensitivity before creating a treatment plan. This might include manual therapy to release tight pelvic floor muscles, stretches to improve flexibility, and biofeedback to retrain movement patterns that contribute to nerve irritation.
Specific Ways Physical Therapy Can Provide Relief
- Relaxing overly-tight pelvic floor muscles through manual therapy
- Improving posture to reduce nerve compression
- Teaching relaxation techniques to ease muscle tension
- Using nerve glides to promote healthy nerve movement
- Strengthening core muscles for better pelvic stability
- Encouraging proper sitting posture to relieve pressure
- Guiding gentle stretches for increased flexibility
- Incorporating biofeedback to improve muscle control
- Releasing myofascial trigger points in the pelvic area
- Addressing scar tissue that could be irritating the nerve
Additional Treatments for Pudendal Neuralgia
While pelvic floor physical therapy can play an important role in managing pudendal neuralgia, some individuals need additional treatments to help control symptoms and improve their quality of life. Combining multiple approaches can address different aspects of pudendal nerve pain and often provide long-term relief.
- Medications to manage nerve pain: Certain medications such as gabapentin, pregabalin, or amitriptyline can help calm pudendal nerve irritation and reduce discomfort.
- Nerve blocks or injections to calm irritation: Pudendal nerve blocks, trigger point injections and botulinum toxin injections (Botox) can provide relief by reducing inflammation and interrupting pain signals.
- Lifestyle changes to avoid activities that worsen symptoms: Modifying daily routines, such as using a cushion when sitting or avoiding prolonged cycling, can ease chronic pelvic pain.
- Nerve Stimulation: Implantation of a peripheral nerve stimulator on the pudendal nerve can be very effective in reducing or eliminating pain symptoms by scrambling the pain signals traveling down the nerve.
- Surgery: In severe cases of pudendal nerve entrapment, surgical intervention might be necessary to release compressed nerves and restore function.
Support for Lasting Relief at The Center for Advanced Gynecology
Managing pudendal neuralgia symptoms requires a targeted approach that addresses the underlying cause of your pelvic pain. At The Center for Advanced Gynecology, our team specializes in diagnosing and treating conditions like pudendal nerve entrapment syndrome, offering personalized care to help you regain comfort and mobility. Whether you're seeking physical therapy, medication management, or pudendal nerve blocks, our team is here to support you.