Pudendal neuralgia is a rare disease that causes severe, sometimes sudden, shooting pain in the genital and perineal regions. The disease is preceded by mechanical or inflammatory damage to the pudendal nerve. The aim of therapy is to regenerate the nerve in order to alleviate the symptoms.
What is pudendal neuralgia?
The term pudendal neuralgia is formed from the word stems pudendal and neuralgia. Neuralgia is the term for seizure-like shooting nerve pain, Pudendus refers to the pudendal nerve. See topbbacolleges for Definitions of Hypospadias.
This originates in the lower spinal cord. It has three branches that innervate the anus, the external anal sphincter, the perineum, the muscles of the roots of the penis, the urethral muscle, the glans, and the labia with the clitoris. The pudendal nerve is also responsible for controlling the pelvic floor muscle.
Patients describe the pain, which can extend to the abdomen or the soles of the feet, as pinprick-like, stabbing, pulling or burning. The skin in these regions is very sensitive to pain and highly sensitive. Pudendal neuralgia must be distinguished from pudendal neuropathy, in which permanent symptoms occur.
The most common cause of pudendal neuralgia is mechanical damage and consequent narrowing of the pudendal nerve. Its causes are lengthy operations in the area of the lower pelvis, prolonged pressure on the nerve, as can occur when riding a bicycle, and injuries. A narrowing of the connective tissue canal in the spine could be detected in some patients.
Less commonly, pudendal neuralgia is caused by inflammation of the nerve. These are caused by herpes zoster viruses, tumors in the pelvic region or in diabetic nerve diseases. Diabetic polyneuropathy is the most common cause of inflammation and is the result of poorly controlled diabetes mellitus or damage to the small blood vessels. Diabetics are therefore a special risk group for neuralgia.
Symptoms, Ailments & Signs
Pudendal neuralgia is characterized by sudden, severe pain in the genital area, which those affected describe as stabbing, burning or oppressive. In women, they usually run from the outer vagina to the anus; Men feel the pain mainly in the perineal area, but the penis can also be affected.
The symptoms usually occur on one side, but can change sides – only occasionally do the pain symptoms occur on both sides at the same time. In some cases, the pain, which is perceived as very excruciating, is accompanied by sensory disturbances or muscle paralysis, which can severely impair bowel movements and urination. In severe cases, pudendal neuralgia can cause urinary and fecal incontinence.
The pain often occurs during sexual intercourse and lasts for a while afterwards. Men occasionally experience erectile dysfunction. As a rule, the symptoms increase when sitting, which is often only possible with the help of a seat ring.
Sporting activities as well as standing for long periods lead to an aggravation of the pain symptoms, while sitting on the toilet relieves the patient. The symptoms also subside when lying down, and undisturbed sleep is generally possible. The disease often takes a chronic course, since the pudendal neuralgia hardly responds to the usual painkillers.
Diagnosis & History
When diagnosing pudendal neuralgia, the doctor must first rule out other conditions that could be causing pain in the affected area. These include, in particular, skin inflammation. Diabetes mellitus must also be ruled out with a blood test.
Imaging is used to check for a tumor. The question of psychological causes of the pain in the genital area is also standard. If these factors can be ruled out, further diagnostics are carried out by a neurologist. Based on the anamnesis and clinical examination, he usually receives sufficient clues for the diagnosis, which he can support using technical examination methods.
However, measuring the nerve conduction velocity of the pudendal nerve or measuring the electrical activity in the external anal sphincter is rarely effective.
Another diagnostic method is the injection of a local anesthetic into the nerve canal during a computed tomography. If the pain then subsides significantly, a pudendal neuralgia must be diagnosed.
Because of pudendal neuralgia, those affected usually suffer from very severe pain. This pain occurs mainly in the intestines or in the genitals and is very uncomfortable for most of those affected. If this pain lasts for a longer period of time, it can lead to psychological problems or even depression.
Most patients often appear irritated or slightly aggressive. Sometimes the pain manifests itself as burning or stabbing. In some cases, this can also lead to restricted movement and inflammation of the skin. Certain activities in everyday life are no longer easily possible for the patient or are always associated with severe pain.
If there is no treatment, the nerve can be irreversibly damaged by pudendal neuralgia. Treatment of pudendal neuralgia is carried out with the help of drugs. There are no complications. However, regeneration of the nerve is also necessary to prevent the pain from reoccurring. Pudendal neuralgia, as a rule, does not lead to a reduction in the patient’s life expectancy.
When should you go to the doctor?
Pudendal neuralgia should always be evaluated and treated by a doctor. In most cases, self-healing does not occur and pudendal neuralgia cannot be treated by self-help measures. Medical treatment is therefore essential. A doctor should be consulted if the person affected suffers from lightning-like and very severe, stabbing pain. This pain can occur in different situations and also in different parts of the body. However, this pain usually occurs in the area of the intestines and upper abdomen. Pudendal neuralgia can also lead to problems with urination, patients often also show paralysis of the muscles or even erectile dysfunction. If you have these symptoms, you should see a doctor.
The initial diagnosis of pudendal neuralgia can be made by a general practitioner or by a urologist. However, further treatment is carried out by a specialist doctor.
Treatment & Therapy
The injection of local anesthetics is not only used for diagnosis, it is also the most important therapy for pudendal neuralgia. Since the effect usually wears off after a few weeks, continuous care can also be provided using a catheter. In some cases, cortisone is administered instead of local anesthetics.
Most doctors initially prefer drug therapy to this method, since the active ingredient is taken regularly. The drugs used are tricyclic antidepressants, which show good results in the treatment of nerve pain even at low doses, and antiepileptics.
Some neurologists are of the opinion that only a combination of both drugs promises long-term therapeutic success. Transcutaneous electrical neurostimulation (TENS) in the genital area, which the patient regularly carries out at home, also promises good prospects of recovery.
Treatment of the underlying disease is also important, but is not sufficient as the only measure in advanced disease. Surgery is the last option after all drug and non-drug conventional medical therapies have failed. In the so-called neurolysis, an attempt is made to expose the nerve in its canal and thus free it from mechanical pressure.
In addition to conventional medicine, those affected can also find help in traditional Chinese medicine with relaxation exercises and acupuncture.
Due to the wide range of causes, it is not possible to make any predictions about the course of the disease, nor can preventive measures be named. Timely, including psychological, care is important in order to counteract chronification. A healthy lifestyle with sufficient exercise also seems to help.
Pudendal neuralgia has different causes. The acute treatment must be pain-relieving, but also related to the causative disease. Therefore, aftercare for pudendal neuralgia is very individual. A repeated pudendal blockade often helps to relieve the pain. The long-term success of the treatment must be secured and checked during follow-up care.
If it is a long-term condition, therapy with stronger painkillers may be necessary. The follow-up care then mainly concerns a good adjustment of the medication in order to maintain freedom from pain, as well as the observation of side effects of these medications. The pain relievers often have to be taken over a long period of time and the dose has to be individually adjusted to the patient under certain circumstances.
After the acute treatment of pudendal neuralgia, it can be considered in the long term and as a supportive measure to resort to accompanying measures that can help alleviate the symptoms. Above all, the psychological support of the pain therapy by learning and applying relaxation methods should be mentioned here. Further supportive therapy measures such as TENS, acupuncture and homeopathic remedies should be considered by a competent physician and presented to the patient.
You can do that yourself
Patients can support the treatment of pudendal neuralgia with dietary measures and a general change in lifestyle. Which steps make sense in detail depends primarily on the causative disease and the advice of the doctor. If the symptoms are caused by diabetes mellitus, the doctor will recommend appropriate insulin medication, which can be supported by changing your diet. If a tumor in the pelvis is the cause, it must first be removed. After the surgical tumor removal, bed rest applies first.
The patient should also visit the doctor regularly so that any recurrences or other complications can be detected quickly. In addition to paracetamol and the like, natural painkillers such as St. John’s wort or aloe vera also help with acute pain attacks. In addition, antispasmodics should be taken, for example sage and various herbal teas.
There are a variety of relaxation techniques that can be used. These include measures such as yoga and physiotherapy, but also osteopathy, homeopathy and acupuncture. Pudendal neuralgia can be treated well by applying these measures. In individual cases, such as severe pain or side effects that make physical exercise impossible, home remedies should be avoided. The patient must then strictly adhere to the medical instructions and, if necessary, be treated in a hospital.