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When is Pelvic Pain a Sign of Pudendal Neuralgia?

When is Pelvic Pain a Sign of Pudendal Neuralgia?

Are you experiencing stabbing or shooting pain radiating from the end of your spine throughout your pelvic floor, genitals, or perineum? You might be one of the 1% of people with pudendal neuralgia, a condition that develops from irritation, damage, or compression of the pudendal nerve.

Pudendal neuralgia is often misdiagnosed, as there are limited imaging studies or special tests to check for this condition. Accurate diagnosis often requires examination and evaluation by a specialist. Once it has been suspected by your neurologist, there are a few tests which need to be performed to confirm the diagnosis. 

If conservative therapy and treatment has failed, surgical decompression of the nerve might be an option to help decrease the pain. 

If you’re struggling with chronic pelvic pain, take a moment to learn what you need to know about pudendal neuralgia — including the signs you may have this debilitating condition.

What is pudendal neuralgia?

You have a large nerve running from the base of your spine through your pelvic floor. This nerve, called the pudendal nerve, carries messages between your genitals, pelvis, and brain. You can develop pudendal neuralgia when something irritates, damages, or compresses this nerve.

While this condition occurs in women and men, about two-thirds of those diagnosed are female. The disease is excruciating but is often misdiagnosed or dismissed, as many physicians aren’t trained to look for this nerve condition. 

If you suspect you might have pudendal neuralgia, or if you’re struggling with chronic pelvic pain, you will want to be seen by a neurologist familiar with this condition to help with the work-up to confirm this condition. 

Common causes of pudendal neuralgia

There are different ways something can damage, irritate, or compress your pudendal nerve, including but not limited to:

An infection, tumor, or swollen tissue that compresses or irritates this nerve can also trigger pudendal neuralgia. For some people, a specific cause can’t be determined.

Signs of pudendal neuralgia

Pudendal neuralgia causes chronic pelvic-area pain. Here’s a look at some of the signs your pelvic pain may indicate pudendal neuralgia:

Pain from pudendal neuralgia may be constant, or it may come and go. 

How is pudendal neuralgia diagnosed?

Unfortunately, diagnosing pudendal neuralgia can be difficult, as the tests for the condition are not routinely performed or offered in all cities or by all physicians. If the symptoms are suspected, then a neurologist specializing in EMGs should perform the nerve study to look for compression of the nerve. An MRI-Neurography can be helpful in localizing the compressed or damaged segment of the pudendal nerve, which can further support this diagnosis. 

A pain management physician will then likely perform a series of nerve blocks to the nerve to see if the nerve will respond to the local anesthetic and steroid. For more severe cases, the pain management physician might be able to offer a radiofrequency ablation (RFA) of the nerve. 

For patients, who have completed the above work-up with their neurologist, are under the care of a pain management physician, and who have only had temporary relief from the blocks or RFA, might be a candidate for surgical decompression. 

Dr. Echo reviews your medical history in detail, reviews your symptoms, and if appropriate will have the patient schedule a clinic appointment for evaluation. He will perform a physical examination to better localize the pain and see if additional conditions might be present. Additional tests might be necessary to help confirm the diagnosis before finalizing a surgical plan.

How is pudendal neuralgia treated?

The right treatment for pudendal neuralgia depends on the severity of your pain, the cause of your neuralgia, and how your pain responds to different therapies. Each treatment plan is personalized based on your current health, medical history, symptoms, and specific diagnosis. 

Conservative treatments

Your primary care physician or neurologist will usually begin with conservative treatments designed to alleviate pain and avoid further irritation of the pudendal nerve, including:

Other conservative measures may include electrical stimulation, ultrasonography, and biofeedback (any of which should be ordered and managed by your neurologist).

Minimally invasive treatments 

If your pudendal neuralgia doesn’t respond to conservative treatments, your neurologist might recommend adding minimally invasive therapies, such as Botox® injections, steroid injections, or CT-guided pudendal nerve blocks. Radiofrequency ablation of the nerve may be an option if your pain management physician deems it appropriate.

Surgical interventions

If Dr. Echo believes your pelvic pain is caused by pudendal nerve compression or entrapment, and you have failed the other treatments, then he may recommend surgical intervention. Dr. Echo performs surgical decompression of the affected nerve using neurolysis of the pudendal nerves at the sacrospinous ligament and the sacrotuberous ligaments to remove the pressure on the nerve itself. Recovery is prolonged, due to the highly sensitive nature of these nerves. 

If you have completed the work-up for pudendal neuralgia and are currently under the care of a pain management physician, you can submit your records to see if you might be a candidate for surgical evaluation by Dr. Anthony Echo. 

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