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Bladder and Pelvic Pain

Pudendal neuralgia


Pudendal Neuralgia is a painful condition thought to result from compression, inflammation or tension of the pudendal nerve in the pelvis. Some patients descibe events that trigger the condition such as chilbirth, pelvic surgery or trauma or chronic constipation, or cycling.

Symptoms include;

  • Pelvic pain or burning especially with sitting that may be relieved standing, lying down or sitting on the toilet seat.
  • Increased or reduced sensitivity of the perineum.
  • Sexual dsyfunction including pain with arousal, intercourse or orgasm.
  • Difficulty or pain with passing urine or using the bowels that can even result in loss or bladder or bowel control.
  • A feeling as if there is something inside the vagina or rectum.

Dignosis involves excluding other causes for these symptoms including interstitial cystitis, chronic prostatitis, vulvodynia and other conditions.

Treatment includes;

  • Avoiding aggravating activities like prolonged sitting, cycling, horseriding, constipation, heavy weight lifting.
  • Biofeedback and physical therapy inlcuding pelvic floor relaxation, trigger point therapy and myofascial release. (Note intensive pelvic floor strenghtening exercises as recommeded to patients with urinary incontinence may aggrevate this conditon.)
  • Medications including amitryptyline, gabapentin and other pain killers.
  • Pudendal nerve blocks can provide symptom relief and help confirm the diagnosis.
  • Neuromodulation.
  • In some patients with nerve entrapment relief from surgical decompression has been described.
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