Pudendale neuralgia: Pain in the genitals and perineum

Pudendale neuralgia is a condition in which a patient experiences pain, discomfort or numbness in the pelvic area or genitals. A large nerve in the lower body gets damaged or irritated. This nerve damage is caused for example by surgery or injury, but is also possible, for example, by practicing cycling. Most patients with pudendale neuralgia receive treatment with a combination of physiotherapy, lifestyle changes and medication.
  • Causes: By damage to pudendus nerve (pressure on nerve)
  • Risk factors of pudendale neuralgia
  • Symptoms: Pain in the genitals and perineum
  • Diagnosis and investigations
  • Treatment of pain, numbness and other sensations
  • Self-care
  • Physiotherapy
  • Medication
  • Surgery
  • Prognosis

Causes: By damage to pudendus nerve (pressure on nerve)

The pudendus nerve is a nerve that extends from the pubic bone to the tailbone. The nerve sends messages to the brains of the genitals, the anus and other nearby body parts. The nerve is also responsible for the sphincters that open and close during a toilet visit. Damage or irritation to the pudendus nerve causes symptoms such as pain, discomfort and numbness to these areas.

Risk factors of pudendale neuralgia

Various risk factors are known for the damage to the pudendus nerve. Often there is a combination of these factors:
  • chronic constipation
  • a birth (birth trauma)
  • a history of pelvic or perineal trauma
  • an infection
  • a tumor that presses on the pudendus nerve (cancer or benign tumor)
  • an injury
  • gynecological or colorectal surgery
  • repeated heavy physical exertion
  • squat
  • long-term cycling (cycling)
  • long-term riding
  • long-term sitting
  • musculoskeletal problems (pain in bones, muscles and tendons, among others)
  • excessive exercise
  • tension

Symptoms: Pain in the genitals and perineum

The patient usually feels the symptoms of pudendale neuralgia in the lower body, namely the genitals or the perineum (the area between the genitals and the anus). The patient experiences a sharp or burning pelvic pain in these areas. The affected places are more sensitive and provide a more swollen feeling. The patient also has stinging sensations (this resembles the feeling of a sleeping leg). Sometimes numbness occurs. These sensations may worsen if the patient sits down, although sometimes it is not even possible to sit down because of the pain. Some patients also experience pain, discomfort, numbness, and sensations in the abdomen, buttocks, legs, or feet. The patient then has a sudden or frequent need to go to the bathroom (pollakisuria). He also has problems or pain during sexual intercourse and sometimes erection problems also occur.

Diagnosis and investigations

Interview
The patient informs the doctor about the location of the pain complaints. The doctor asks him questions about his medical history and lifestyle in order to get an idea about the possible cause of pudendale neuralgia.
Physical examination
This is followed by a physical examination. The doctor tests the neurological and musculoskeletal functions of the legs, pelvic area and perineum by checking the muscles, joints, posture and reflexes. A gynecological examination or digital rectal examination is needed to see if the nerve pain occurs when the doctor presses on the pudendus nerve with his finger.
Diagnostic research
The doctor may also start an MRI scan. This imaging research uses powerful magnets and radio waves to create an image of the internal organs of the body. Furthermore, with the help of a guided ultrasound or radiography, the patient sometimes gets a nerve block in the pudendus nerve in the pelvic area, with the aim of numbing the nerve. If the symptoms disappear as a result, then there is a real indication that the patient suffers from pudendale neuralgia.

Treatment of pain, numbness and other sensations

Self-care

The patient must sit up more often and also exercise more, because that helps with nerve pain. He does, however, avoid factors that lead to pain, such as squatting, prolonged sitting or cycling. This makes it possible to relieve pressure on the nerve.

Physiotherapy

Physiotherapy benefits most patients. The physical therapist teaches the patient pelvic floor muscle exercises, so that less pressure comes on the pudendus nerve and consequently irritation is less likely to occur. If pudendale neuralgia leads to problems with bladder or bowel control, this can often be remedied through physiotherapy.

Medication

The doctor also uses muscle relaxants to relieve the symptoms of pudendale neuralgia. Furthermore, medicines for the treatment of depression (antidepressants) or epilepsy (anti-epileptics) are sometimes also useful. If these drugs are not effective, the doctor prescribes a dose of drugs that numb the nerve or reduce inflammation. This also lowers the pressure. Sometimes it takes a few weeks for the drugs to reach their full effect. Analgesic injections (painkillers) may be necessary. The injections contain a local anesthetic (anesthetic) and steroid (anti-inflammatory) medication. The effects of these injections usually last for a few months.

Surgery

In rare cases, surgery is recommended to remove anything that presses on the nerve. In addition, it is possible that the doctor applies a small electrical device under the skin. This makes it possible to stimulate the nerve and to interrupt the pain signals to the brain.

Prognosis

No prognostic information was found in the consulted literature in April 2018.

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