Conventional Treatments for Pudendal Neuralgia

What is pudendal neuralgia?

Pudendal neuralgia is a condition that occurs when the pudendal nerve, which runs from the back of the pelvis near the base of the penis or vagina, is damaged or irritated. This nerve sends signals to the brain from the genitals, anus and other nearby body parts. It controls the sphincter muscles that open and close when passing urine or emptying the bowels. Once this nerve is damaged, it can cause issues with bladder and anal incontinence or hesitancy, having sex, or simply sitting down.

Treating pudendal neuralgia

Making lifestyle adjustments at work and home, along with certain leisure activities, can reduce the pain experienced from this condition. The main goal of treatment is to reduce the irritation of the pudendal nerve. Treatment options for pudendal neuralgia include the following:

Lifestyle adjustments

Some common lifestyle adjustments include the following:

• Refraining from straining when emptying bowels or passing urine
• Avoiding stimulant laxatives
• Avoiding pressure on the perineum by using alternative seating choices
• Avoiding physical activities that could irritate the nerve, such as cycling, bench pressing or horse riding
• Adapting sex lives

Physiotherapy

One of the most common causes of irritation to the pudendal nerve is over-contraction of the pelvic floor. Physiotherapists, who specialize in pelvic floor physical therapy, can teach individuals with pudendal neuralgia how to relax and stretch the muscles of the pelvic floor; these gentle exercises help to calm the irritation of the nerve. Physiotherapists may recommend using a TENS (transcutaneous electrical nerve stimulation) unit to reduce pain. During physiotherapy, individuals learn specific external exercises and stretches to address posture issues. Individuals also learn about specific activities that may exacerbate the pain from pudendal neuralgia. Physiotherapists can also help plan a daily bladder and bowel management routine.

Medication

Daily medications, such as topical creams and oral medications, help to calm the nervous system. Analgesics, muscle relaxants and anticonvulsants can also be prescribed. Certain types of injections are also used to treat the symptoms of pudendal neuralgia:

• Cortisone injections
• Hyaluronic acid injections
• OnabotulinumtoxinA injections
• Activated platelet extract injections

Nerve block

A pudendal nerve block involves the injection of a local anesthetic and/or steroid into the area that encircles the pudendal nerve. This numbs the nerve for a period of time.

Decompression surgery

Surgical decompression is a procedure that involves decompressing the pudendal nerve and other associated nerve structures. There are four different approaches to decompression surgery for pudendal neuralgia: transperineal, transgluteal, transischirorectal and laparoscopy. Surgery is usually highly effective and often results in significant pain reduction.

Neuromodulation

Neuromodulation devices, such as nerve stimulators, are used to disrupt pain signals sent from the nerves to the brain. When used to treat pudendal neuralgia, a nerve stimulator stimulates the pudendal nerve in the pelvic cavity.

Pulsed radiofrequency

Pulsed radiofrequency is a variation of continuous radiofrequency. It helps to help control pain without destroying the tissue. This technique uses short bursts of radiofrequency current to lower the temperature around the pudendal nerve to “stun” it, resulting in a reduction of pain.

Lipofilling

Lipofilling involves injecting fatty tissue and stem cells into the pudendal canal. This process uses an individual’s own fat as a permanent filler to strengthen and add volume to the soft tissues in the pudendal area.