Who’s even heard of Pudendal Neuralgia? How about Pudendal Nerve Entrapment?
(** Added 2/27/15 Please also read the newest blog: 5 Things We Wish You Knew About Pudendal Neuralgia)
During my career, I developed an interest in working with patients with pudendal issues. I joke around that I am famous in small circles – the “pudendal circle” is one.
There’s a tremendous amount of confusion about the diagnoses of Pudendal Nerve Entrapment, Pudendal Neuralgia, and Pudendal Neuropathy. Moreover, though it is a VERY important nerve in the body that controls bowel, bladder, and sexual function, many physicians will admit something along the lines of “I just don’t deal with that nerve”.
Here’s the typical course I see many women and men go through on their “pudendal journey”:
1. You realize you have symptoms in the genital or buttock region that are not so pleasant such as (from tipna.org):
- The chief symptom is pain in the area innervated by the pudendal nerves. Sitting become intolerable.
- The pain is lessened when laying or sitting on a toilet seat.
- The pain can be delayed and stay long after one has identified the source of aggrevation (sat too long, walked too far, did too much, etc.)
- Usually, the pain gradually increases during the day and is the worst at night. Many PNErs feel their best upon waking in the morning.
2. You go to your health care providers to ask about this condition.
Unfortunately, physicians and nurses don’t spend a lot of time in school dedicated to learning about the pudendal nerve and either don’t have the resources or comfort level to treat it; or the patient may go misdiagnosed for years with labels of other conditions such as – prostatitis, bursitis, or vulvodynia.
2b. You begin the pudendal Google search mania.
Many patients go on a variety of websites that offer message boards. The posted messages and live chats can leave even the most upbeat, optimistic person in a pudendal funk. There are a lot of doom and gloom stories without adequate information or hope for treatment. However, I have seen some patients find hope by discussing their concerns with people going through the same struggle. Keep in mind that there are many successful patient stories. The most important thing to remember is that support can be positive. Find good information (see links provided at the end of the article) and keep hope alive.
3. You begin the “pudendal nerve tour”.
Out of desperation, patients seek out dramatic surgeries even if it means traveling across the country. There are a handful of surgeons in the US (and another few across the world) that do Pudendal Decompression surgery. Without going into the gory details – it’s the type of surgery you do when you have exhausted all other conservative options and there is a strong conviction you have true entrapment (repeated and long-term nerve compression). It should not be the starting point! In fact, there’s a good chance you may simply have an irritation of the pudendal nerve from an inflammatory process or muscle spasm or connective tissue thickening near the nerve.
The real pudendal tour should include a thorough examination from a physician in specialties such as Neurology, Gynecology, Urology, Colorectal- particularly someone who is familiar with pudendal neuralgia and the differential diagnoses. It’s also highly recommended to have an examination and possible treatment from a pelvic physical therapist who specializes in the treatment of pelvic pain and pudendal neuralgia. If you go to an orthopedic physical therapist, there’s a good chance they will not know how to treat conditions associated with the pudendal nerve. Look for pelvic therapy specialists who understand pudendal neuralgia (the Pudendal Hope website below lists these specialists).
Over the years, patients have suggested there should be more information on the web offering good resources and optimism surrounding pudendal nerve conditions. If you suspect you have pudendal nerve issues there IS hope! We will continue to provide resources and information. Look for an upcoming blog with a listing of clinicians and resources regarding pudendal nerve conditions.
* Here’s a great article with information about Pudendal Neuralgia: Click HERE
* Check out these websites as resources and references for information:
* Tracy Sher and Loretta J. Robertson are now teaching a full Pudendal Neuralgia course to health professionals nationally and internationally: Course Info
Tracy Sher, MPT, CSCS Private Practice Owner in Orlando, FL; International Speaker/Faculty. Passionate about treating pelvic pain and all pelvic floor disorders – bowel, bladder, sexual function. Secretly hoping to be a circus clown or rock, paper, scissors champion some day. Check out Pelvic Guru on Facebook or Twitter @pelvicguru1