Pudendal Neuralgia

What is pudendal neuralgia?

The pudendal nerve originates in the sacrum, at the base of the spine, and runs to the pelvic floor. It enables contraction and relaxation of the pelvic floor muscles and allows you to feel touch in this area. Pudendal neuralgia is the sensation of pain in the area served by this nerve.

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What are the causes of pudendal neuralgia?

The causes vary:

• Spasm of the pelvic floor muscles;
• Tension in the ligaments near the pudendal nerve;
• Scar tissue near the pudendal nerve;
• Sports training, especially sports in seated positions (e.g. cycling);
• Trauma (e.g. childbirth, surgery, fall on the buttocks, etc.);
• Infection (e.g. urinary tract infection, shingles, etc.);
• Another medical condition (e.g. diabetes, alcoholism, rheumatoid arthritis, etc.).

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What are the symptoms associated with pudendal neuralgia?

• Pain and/or numbness in the genital and perineal area;
• Pain that is worse when sitting but relieved when sitting on the toilet;
• Pain relieved by standing and lying down, and which generally does not wake you up at night;
• Pain that increases throughout the day;
• Decreased or increased sensitivity in the genital and perineal area;
• A sensation of a foreign object inside the rectum or vagina.
• Constipation, the need to strain to pass stools, and/or pain during bowel movements.
• Increased frequency of urination, pain when the bladder is full, and/or burning sensation when urinating.
• Erectile dysfunction, pain during arousal, and/or after orgasm.
• Change in temperature perception in the genital area and perineum.

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How is pudendal neuralgia diagnosed?

Diagnosis is made through a subjective and physical examination in the clinic. There are also medical tests that can be prescribed by a doctor.

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How can physiotherapy help with pudendal neuralgia?

Your pelvic floor rehabilitation physiotherapist will first conduct a thorough assessment (e.g., lifestyle habits, posture, breathing, contraction/relaxation of pelvic floor muscles, etc.) to determine the cause(s) of the pain.

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Based on the assessment results, your physiotherapist will:

• Mobilize the muscles and soft tissues in the abdomen and pelvic floor;
• Provide you with specific exercises to do at home to address the cause of the problem;
• Teach you how to properly manage your daily activities and hobbies to optimize healing;
• Provide advice on lifestyle habits, posture, and movements.
• Refer you, if necessary, to a doctor or other healthcare professional.

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When should you consult a physiotherapist for pudendal neuralgia?

You should consult a physiotherapist if you have symptoms as described above or if your doctor has already ruled out any other cause that may be responsible for your pain.

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You do not need to see a doctor before consulting a physiotherapist. If your condition requires you to see a doctor, your physiotherapist will be able to tell you.

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What can you do at home for pudendal neuralgia?

• For cyclists: modify or even temporarily stop cycling, and ensure you wear good cycling shorts, have a suitable saddle, and that the bike is properly adjusted.
• Avoid prolonged sitting and change positions regularly throughout the day. 
• If you must sit, try rolling up two towels and placing them under your buttocks, aligned with your thighs.

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To learn more...

You can listen to the podcast "Parle-moi de santé" created by one of our physiotherapists, Alexis Gougeon.

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Episode #23 discusses perineal and pelvic rehabilitation:

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Find the episode on YouTube :

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Click below to listen to episodes on podcast platforms:

https://open.spotify.com/episode/4K8MhluZYTYDzmFNn2dDAt?si=a7a8e4a1a64f4cbd

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https://podcasts.apple.com/ca/podcast/23-r%C3%A9%C3%A9ducation-p%C3%A9rin%C3%A9ale-avec-jennifer-l%C3%A9vesque/id1525206710?i=1000527277477&l=fr-CA

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