HEALTH ADVISER

What is Pudendal Neuralgia?
Pudendal Neuralgia is pain caused by the nerve that supplies the skin between your pubic bone and your tail bone. The pudendal nerve carries the sensations of touch and pain from the skin between the anus and the clitoris, as well as the sphincters (muscles that keep the openings of the bladder and bowel closed).

Causes and Symptoms
Pudendal neuralgia is often caused during childbirth. During vaginal delivery, the pudendal nerve is slightly stretched and may therefore malfunction. It can also be related to intense physical exercise involving the pelvic floor, such as ‘Kegel’ exercises, cycling and weight lifting. Some types of surgery can also lead to persistent pudendal pain.

The most common complaint of this condition is pain when sitting, which gets worse as the day goes on. As the nerve is also involved with bladder and bowel function, other problems such as bladder frequency, feeling of a bladder infection, pain with intercourse and the urgent need to open the bowels, can occur. Typically, the pain resolves during the night or when lying down.

Diagnosis
Most women with pudendal neuralgia have a similar story to tell; they experience pain with sitting that usually starts around midday, worsens as the day goes on, and then resolves during the night. A thorough examination by a doctor aims to define how sensitive the skin of the perineum is and to reproduce the pain by feeling the nerve. Other tests such as ultrasound or MRI may be required to rule out other problems.

Treatment Options
As with any chronic pain condition, pudendal neuralgia is not necessarily ‘cured’, but rather it is managed through a variety of measures, from lifestyle changes to medical procedures. A pudendal nerve block, which is an injection of local anaesthetic and sometimes steroid medication, is injected around this nerve to temporarily reduce pain. After the procedure you will be unable to drive or return to work and you must have someone to accompany you home.

Improving postural awareness – by aiming to sit on your ‘sitting bones’ and modifying your exercise program can be helpful. Physiotherapy treatments to stretch the tight pelvic floor muscles and decrease pressure on the nerve may also be beneficial.

Possible side effects/complications
All medical procedures carry a risk of complication. Precautions are always taken to minimise the risk as far as possible, but the following side effects may occur: failure of the procedure to reduce pain; worsening of pain (temporarily or permanently); numbness; temporary loss of bladder control; bruising, infection and allergic reactions (very rare). Your specialist will work with you to provide the best treatment plan.

Dr. A S Arun MD DNB CCST, FRCOG, FRANZCOG
Waikiki Specialist Centre
221 Wilmott Drive, Waikiki WA
Phone 9550 0300
Fax 9592 9830
Email specialists@waikikiprivatehospital.com
http://www.doctorarun.com.au

DISCLAIMER: This information is intended to be used as a guide of general nature, having regard to general circumstances. The information presented should not be relied on as a substitute for medical advice, independent judgement or proper assessment by a doctor, with consideration of the particular circumstances of each case and individual needs. This information reflects information available at the time of its preparation, but its currency should be determined having regard to other available information. RANZCOG disclaims all liability to users of the information provided. 

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