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Pudendal neuralgia a medical condition characterised by long term pain and discomfort. It is called pudendal neuralgia because the pain originates from damage or injury to the pudendal nerve. For a complete understanding of pudendal neuralgia and its associated symptoms, it is important to understand the pudendal nerve and its role in the nervous system.
The pudendal nerve is the nerve responsible for carrying sensation from the external genitalia in both men and women. It also supplies motor functions to several of the pelvic muscles, including those responsible for controlling urination and defecation. The specific parts that the nerve supplies can be divided into five:
Like several other nerves, the pudendal nerve is a crucial part of the nervous system, and any damage or injury to it affects nearly all the areas it supplies.
Neuralgia is a term that refers to intense pain along the course of a nerve. It is a blanket term that refers to different kinds of pain of nervous origin, ranging from stabbing, aching, and burning to even electric-shock-like pains. You can differentiate neuralgia from other types of pain by the way the pain travels along the course of the nerve.
Putting the two together, Pudendal neuralgia is long term pain (aching, burning, stabbing) along the course of the pudendal nerve. Pudenda neuralgia is particularly uncomfortable because of the place the pudendal nerve is located.
Neuralgia is not a term that’s exclusive to damage to the pudendal nerve. As mentioned earlier, pain originating from a nerve is known as neuralgia, and several major types of neuralgia can affect the nerves of the human body. They are very similar in the way they display symptoms, and the only difference is in the location of the pain. The other types of neuralgia include:
Postherpetic neuralgia: This is specifically nerve pain that is caused by shingles. Since shingles is a viral infection that can appear anywhere on the body, postherpetic neuralgia too can happen anywhere on the body.
Trigeminal neuralgia: This is neuralgia localised to the trigeminal nerve in the face
Glossopharyngeal neuralgia: This is pain originating from the glossopharyngeal nerve—the nerve of the throat.
Causes of pudendal neuralgia
In many situations, the causes of pudendal neuralgia are unknown. Several factors and occurrences have been linked to its origin, and they are listed below. However, even though these are often present in neuralgia, there are also patients who experience neuralgia without having any of these conditions. The other causes of shingles include
Several patients with multiple sclerosis have also been known to develop neuralgia. This is thought to be because multiple sclerosis is a disease caused by the degeneration or deterioration of the myelin fibre of nerves. This exposure of the nerves is also assumed to predispose them to neuralgia.
The prevalence of pudendal neuralgia is unknown. However, it is estimated that one in every 100,000 people suffer from the condition. Because pudendal neuralgia is known to affect the pudendal nerve, it affects both men and women equally. However, women may be more predisposed to the condition because of childbirth. Glowm.com reports that 7 out of even ten cases of pudendal neuralgia they have seen have been women.
The main symptom of pudendal neuralgia is pain. This pain often manifests in several ways, and may even give rise to other symptoms. As mentioned earlier, the pain experienced in pudendal neuralgia is highly variable, and can include burning, aching, prickling, shocking, shooting, and even shocking sensations. These are felt along everywhere that the nerve supplies. They are very uncomfortable because of their location.
People that are suffering from pudendal neuralgia may often have trouble sitting down due to discomfort. Sometimes, the pain might even be debilitating and prevent people from functioning normally.
Besides these symptoms. Patients suffering from pudendal neuralgia have also been known to report some of the following:
When examining a patient with severe nerve pain, the process often follows the normal procedure for testing and diagnosing for several other medical conditions.
A physical exam
The physical exam could include a vaginal or rectal exam. During the exam, the doctor applies pressure to the nerve to see if it produces any kind of pain, similar to what the individual has been experiencing.
A scan is also be done to check for problems and rule out causes like compressed trapped nerves. An MRI can also identify an inflammation along the course of the nerve. The results of an MRI can pinpoint the source of the pain, and that’ll inform the best course of action in treating the condition.
Nerve conduction studies
A nerve conduction study is a medical test that is used to examine the functioning of a nerve. A small device is inserted into the rectum and used to stimulate the pudendal nerve. The nerve’s response is then measured.
Nerve block injections
A nerve block injection can also be used to diagnose pudendal nerve neuralgia. An anaesthetic is injected into the pudendal nerve to see if the pain changes. If the pain reduces, then the pudendal neuralgia is confirmed. Otherwise, it may be another condition mimicking pudendal neuralgia.
The treatment of pudendal neuralgia is multifaceted and often includes several modalities across several medical disciplines. Some of them include:
Often, rest is enough to reduce many painful symptoms that manifest in medical conditions. Particularly in pudendal neuralgia, the patient is also advised to avoid symptoms that make the condition worse, like cycling, and prolonged sitting.
Analgesics are often prescribed to help individuals with the condition manage the pain associated. Sometimes, analgesics are prescribed in addition to other treatment modalities like physical therapy.
Physiotherapists prescribe various kinds of exercises to people suffering from pudendal neuralgia as a way to help them manage the pain. The exercise can also help to increase the mobility of the joints, and improve control over the muscles supplied by the nerve. Remember that pudendal neuralgia can also affect the function of the muscles in the region. Exercises are a way to regain control.
Local anaesthetics and steroid injections can be used to numb the pudendal nerve, and reduce the pain felt by the individual
If the neuralgia is caused by nerve compression, decompression surgery might be conducted to relieve pressure and reduce the pain.
Neuralgia is similar to several other disorders of the nervous system in that it doesn’t have a cure. As a result, several treatment modalities like the ones listed above are being employed to manage it, and reduce the pain and symptoms as much as possible. Several individuals have reported improvements in their pain levels and overall quality of life, after receiving treatment using these modalities.
Additionally, new findings are being made every year, and better treatment methods continue to develop to tackle the condition.
Prevalence of pudendal n: Spinosa JP, de Bisschop E, Laurencon J, Kuhn G, Dubuisson JB, Riederer BM. [Sacral staged reflexes to localise the pudendal compression: an anatomical validation of the concept]. Rev Med Suisse 2006;2(84):2416-8, 20-1