Pudendal nerve is a major nerve which is located in the pelvic region and supplies to essential organs including the external genitalia. In females the nerve supplies to the rectum, vagina, vulva, labia, clitoris and perineum (i.e. the area between the rectum and the vulva).
In males the nerve supplies to rectum, scrotum, penis and the perineum (i.e. the area between the rectum and the scrotum). Pudendal neuralgia is a condition associated with the inflammation of the nerve. The condition is also referred to as the ‘cyclist’s syndrome’, Alcocks Syndrome or pudendal canal syndrome.
Causes Of Pudendal Neuralgia
In principal the cause of the neuralgia is injury or trauma to the nerve, however there are certain factors that can aggravate or trigger the manifestation of the symptoms,
- Trauma or injury which is associated with childbirth or caused due to a fall affecting the sacrum.
- Pelvic surgery including gynecological surgery including hysterectomy, incontinence surgery or repair of prolapsed bladder or vagina.
- Trauma caused during cycling or performing squatting exercises.
- Biomechanical abnormalities including pelvic floor dysfunction or sacro-iliac joint dysfunction.
- Chronic constipation
- Repeated vaginal infection
Signs And Symptoms Of Pudendal Neuralgia
Some of the key symptoms associated with pudendal neuralgia include the following,
- Pelvic pain, affecting the perineum, rectum and external genitalia is one of the most common symptoms. The pain is less in intensity during morning and increases as the day passes. The pain is alleviated when standing or lying down but aggravated on sitting. The pain is usually unilateral in about 70% of the cases, while in remain cases, the pain is bilateral. In some cases, the symptom of pain may be replaced by a reduced sensation of the affected parts.
- The condition is associated with sexual dysfunction characterized by inability to achieve orgasm in females and pain during erection in males. In some cases, the condition may be associated with painful ejaculation.
- Most of the patients experience some form of difficulty during defecation and urination. The symptoms include urgency, increased frequency, post void discomfort and urinary hesitancy. Constipation forcing the patient to strain and resulting in painful defecation is also a common symptom. In several cases fecal incontinence is a common symptom.
- Many patients complain of foreign body sensation in the rectum or the vagina.
In most cases, the symptoms have a gradual onset and become progressively worse over the years. Pudendal neuralgia caused due to surgical injury usually has a sudden onset.
How To Treat Pudendal Neuralgia?
It is important to first confirm the pudendal neuralgia, as it is primarily a rule out condition. The condition has manifestations which are very similar to a host of other conditions including piriformis syndrome, interstitial cystitis, prostatitis, vestibulitis and chronic pelvic pain syndrome. Electrodiagnostic studies need to be performed in order to confirm entrapment of the nerve before the treatment can be initiated. CT scan or MRI scan may be required to confirm the diagnosis.
While surgical intervention is inevitable in severe cases, one should remember that in almost 30% of all cases, surgical depression doesn’t provide relief. There are certain home remedies and natural treatment options that can prove beneficial,
- Consume the mixture of honey, chamomile and elder berries in equal proportions, at least once a day.
- Local application of ginger oil with eucalyptus oil is considered beneficial in alleviating the symptoms.
- Wood betony is a nerve tonic and should be consumed with warm water at least once a day.