Pudendal neuralgia is pain associated with the pudendal nerve, one of the main nerves in the pelvis that carries sensation to the area encompassing the genital area, anus, and perineum. Irritation or compression of this nerve can lead to chronic, debilitating pain. The symptoms of painful pudendal neuralgia can be very debilitating, and they may prevent the person from sitting, walking, or even showering.
Thankfully, specific Pudendal Neuralgia treatment in pelvic floor physiotherapy has proven to be an effective and non-invasive solution to help manage pain and improve quality of life.
The sharp, burning or aching pain along the route of the pudendal nerve from the lower back to the pelvis describes pudendal neuralgia. The symptoms include severe pain or tenderness of the pelvic region, heaviness or pressure in the pelvis, pain during sitting or after sitting, painful movements like cycling or sitting, and numbness in the genitals.
Pudendal neuralgia arises due to more than average pressure applied on the pudendal nerve in most cases. This generally arises because of long cycles, surgeries, injuries or even pelvic diseases. Therefore, diagnosis requires imaging tests and a physiotherapy examination by either a pelvic health physiotherapist or a doctor.
A newer and more important Pudendal Neuralgia treatment is pelvic floor physiotherapy, which directly works with muscles, ligaments, and tissues surrounding the pudendal nerve. Physiotherapy aims to decrease the pressure on the nerve and reduce muscle tension to enable normal pelvic function. Following are some ways through which pelvic floor physiotherapists can be of help to patients struggling with pudendal neuralgia:
The tension in the pelvic floor muscle may put additional stress on the pudendal nerve, which results in pain. In managing such clients, pelvic floor physiotherapists make use of several techniques in order to relax and let go of these muscles in maximal mobility of the nerve without causing any discomfort. Relaxation of the muscles will also reduce involuntary muscle cramping, which is a common characteristic of a person living with chronic pain.
Manual therapy, including myofascial release, is often utilized by physiotherapists in the treatment of tightness in the connective tissues around the pelvic floor and the pudendal nerve. It stretches and manipulates the fascia to loosen adhesions and scar tissue, improving nerve function and pain relief. It is very effective in areas that cannot be accessed through standard stretches or exercises.
Malalignment of the pelvis and spine increases pressure on the pudendal nerve. Physiotherapists will guide their patients to identify and correct posture issues, which subsequently reduce irritation of the nerve. Good posture and alignment also help in spreading out pressure evenly across the pelvis, reducing the probability of recurrent nerve compression.
Nerve mobilization or "nerve gliding" is the application whereby the therapist moves the nerve gently along its usual course to break down adhesions and facilitate the improvement of circulation around the nerve. In the context of Pudendal Neuralgia treatment, this exercise helps nerve mobilization with applications for pain reduction by making movements of the nerve.
Physiotherapists also provide educational inputs as to how to care for pudendal neuralgia at home. For this, proper body mechanics must be taught, the pace must be maintained in relation to activities, and breathing with the diaphragm technique must be practiced to relax the pelvis. Self-management tools make patients feel stronger since they can regain pain again and continue the outcome seen in physiotherapy settings.
It is a non-invasive treatment method for pain management in which physiotherapy is accompanied by a Pudendal Neuralgia treatment protocol. Here, patients don’t depend on medication use and invasive procedures, but the physiotherapist lets them return to natural nerve and muscle function. Most patients who undergo pelvic floor physiotherapy notice a reduction in pain, an increase in range of mobility, and an improved quality of life.
Pudendal neuralgia can be a very painful condition, but with the help of an experienced pelvic floor physiotherapist, relief can be offered. Specialized physiotherapy treatments will focus on reducing pressure on the pudendal nerve, relaxation of tight muscles, and improvement in posture.
Dr. Leena Daware is a very experienced physiotherapist and a senior practitioner working at Sion LTMG hospital, Mumbai, and works specifically with pelvic rehabilitation. She collaborates with the leading consultants of gynecology, urology, gastroenterology, and the like to make a totally comprehensive and sympathetic treatment profile for those patients who experience the problem of pudendal neuralgia.