Dr. Stanley
Antolak, Jr.
Center for Urologic and Pelvic Pain
Lake Elmo, MN, USA
1. What is Pudendal Neuralgia?
Pudendal neuralgia is pain in the territory of the pudendal nerve
and may be on one or both sides of the body. Pains can be in the
lower abdomen or pelvis, in the genitals, perineum, anus or coccyx.
The pains often both the inner thighs. Pains are aggravated by
sitting, driving and other activities. The pains typically are
reduced by standing, lying down, or sitting on a toilet seat.
Bladder, bowel, and several problems are common, but pain may
be the only complaint.
2. Is pudendal nerve entrapment different?
Entrapment means that the nerve is "fixed" by body
tissues and compressed. Entrapment can only be diagnosed at surgery.
Men and women with pudendal neuralgia that is relieved by non-surgical
treatments do not have entrapment. Less than half of patients
treated at the Center for Urologic and Pelvic Pain need surgery.
The others have control or cure of their pudendal neuralgia by
treatments discussed below.
3. What
causes pudendal neuralgia?
Compression of the nerve (squeezing inside the body) slows blood
flow in the nerve and leads to pain. This can occur during sitting,
cycling, exercise, and childbirth. If two ligaments in the buttocks
are too close together the nerve may become entrapped where no
treatment other than surgery can relieve the problem. Pain may
begin after a fall onto the buttocks. Simple or complex pelvic
surgeries can send signals that start the pudendal neuralgia pains
even though the nerve has not been touched. We see some patients
where radiation therapy causes the pudendal neuralgia. Stretching
of the nerve during activities also cause neuralgia.
4. Is pudendal neuralgia common?
International studies show that about 15% of women have chronic
pelvic pain. Many of them probably have pudendal neuralgia. In
a recent report 10% of men in a large prepaid health plan have
pains typical of pudendal neuralgia.
5. What
kind of people get pudendal neuralgia?
Men and women from teen age years into the 80s can have pudendal
neuralgia. Most of our patients have been youthful athletes. Others
are active adult exercisers. Sitting at a computer for hours daily
is a common process that causes pain. Moving furniture and lifting
toddlers starts the problem in some people.
6. Why
don't doctors recognize pudendal neuralgia?
Physicians throughout the world are often unaware of this problem.
Often the pains in men are misdiagnosed as Prostatitis. In women,
the pains may be mistaken as endometriosis or ovary problems.
Patients may see many physicians and have multiple treatments
before pudendal neuralgia is suspected. Medical books often do
not mention pudendal nerve problems. The Pudendal Neuralgia Foundation
is committed to physician education because early diagnosis leads
to better responses to treatment.
7. How
is pudendal neuralgia treated?
Two conservative treatments are useful.
1) Prevention of nerve damage is most important. Stop sitting,
stop cycling, stop exercising except for walking. Use a pad without
a center for keeping pressure off of the perineum. If pain continues
to be bothersome, injections around the nerve are recommended.
One woman with terrible pains for 10 years remains cured
after six years of self-care.
Treatment
response in 16 people after self-care. The score used is the National
Institutes of Health Prostatitis Symptom Index (NIH-CPSI). Scores
were measured at consultation (Cons) and after one to 24 months.
2) The second
conservative treatment is a series of injections around the nerve
using a local anesthetic (like Novocain) and an anti-inflammatory
corticosteroid drug. The longest measured cure from injections
is almost five years. Some people have a successful response to
a second series of injections one or two years after the first.
Several people are now pain-free for two or more years after the
second treatment.
Surgical treatment
is offered when injection treatments do not provide complete relief.
There are different approaches to the nerve. Experience at the
Center for Urologic and Pelvic Pain consistently shows that surgical
patients have true pudendal nerve entrapment.
