Physical Therapy and Pudendal Neuralgia

What is Pudendal Neuralgia?

Pudendal Neuralgia is an irritation of the pudendal nerve that can cause pain with sitting, pain with intercourse, urinary hesitancy, or pain with passing a bowel movement or after.

What is the difference between pudendal nerve entrapment and pudendal neuralgia?

Often the term “pudendal nerve entrapment” is overused and signifies that the pudendal nerve is actually entrapped by something like scar tissue or a muscle. Pudendal nerve entrapment is actually rare and will usually only occur post a pelvic surgery complication or if there is direct scarring over the nerve from an accident. Usually the symptoms were never had before the surgery, and after the surgery the patient will have a large amount of pain. However, you can also have pudendal neuralgia after a pelvic surgery and not true entrapment.

I was diagnosed with pudendal neuralgia, is it possible it could also be something else?

In order to truly have pudendal neuralgia, patients must have all the following 5 inclusion criteria: pain in the area that is innervated by the pudendal nerve, pain more severe with sitting, pain that does not wake the patient up at night, pain with no objective sensory impairment, and pain relieved by a pudendal nerve block. If another source to the patient’s pain is found, it is possible the patient was misdiagnosed with pudendal neuralgia. There are many nerves that supply the pelvic area, and misdiagnosis can be easy.  

How can conservative treatment like physical therapy help me with my pudendal neuralgia?

The main goal of physical therapy treatment is to try and address what factors drive the irritation of the pudendal nerve and its associated branches. Treatment begins with a thorough medical history and questions about your lifestyle to begin to explore possible factors that lead to the pain.  A thorough orthopedic screen and assessment should be done to rule out any orthopedic issues such as hip labral tears/abnormalities, low back pathology, and abdominal pathology to name a few. Additionally, the physical therapist may assess your pelvic floor muscle function if needed. Treatment may include manual therapy to improve scar tissue mobility and relieve tension in tight muscles, strengthening to the pelvic girdle muscles to improve pelvic mechanics, working on pelvic floor muscle coordination, lifestyle advice and modifications, and a home exercise program. Treatment can vary greatly from person to person and there is no “one size fits all model.” For example, one patient with pudendal neuralgia may have treatment directed at their hips to get better, and another patient may have treatment directed at their pelvic floor muscles and increased life style advice like switching to a sit stand desk if they have a desk job.