Pudendal Neuralgia | Donna Sarna

What is Pudendal Neuralgia?

Pudendal neuralgia, also known as Alcock’s syndrome” or pudendal canal syndrome, refers to pain originating from irritation of the pudendal nerve. The pudendal nerve originates in the pelvis and provides sensory and motor innervation to the muscles and tissue of the pelvic floor. It has 3 branches that innervate , the front, middle and back of the pelvic floor. Irritation of one of the branches or the nerve root as a whole can cause pain in its respective area, including the rectum, anus, urethra, perineum, clitoris, mons pubis, vulva, labia and lower 1/3 of the vagina. It also may cause referral of pain or altered sensation down the back of the leg. The International Pudendal Neuropathy Association estimates the incidence of this condition as 1/100,000, but it is reported by clinicians treating this condition to be much higher. The pudendal nerve can be injured or become irritated as a result of the following:

Tension or traction of the nerve that may occur with activities such as chronic constipation and or straining with bowel movements, childbirth, organ prolapse and strenuous squatting especially if repetitive.

Compression of the nerve that may occur with activities such as cycling, horseback riding, prolonged sitting or even a fall on the tailbone.

Entrapment of the nerve due to tight soft tissue, including the muscles and associated fasciae as well as degenerative joint changes.

Chronic infections of the bladder and vagina (yeast or bacterial).

Surgical injury that may occur during pelvic floor procedures.

What are the Signs and Symptoms?

Itching, burning, tingling, stabbing or shooting pain in the genital area including the vagina, labia, clistoris and /or the anus along the distribution of the nerve

Hypersensitivity of the skin to touch or pressure

Increased sensitivity of the nervous system in which the body interprets significant pain to a light physical stimulus like touch

Pain with sitting, but improvement with standing

Pain on the inner aspect of the sitz bone (ischial tuberosities) with sitting, which may refer down the back of the leg on the affected side

Discomfort when wearing tight clothing

Feeling of fullness in the rectum or vagina

Bladder and/or bowel symptoms (hesitancy, frequency, urgency, retention, constipation, incompete evacuation of stool, pain with voiding)

Dyspareunia (painful sex)

Sexual dysfunction

How Can Donna Sarna Physiotherapy Help?

At Donna Sarna Physiotherapy & Rehabilitation, a pelvic floor assessment is a two-part process with a global approach taken both with assessment and treatment. During the assessment process, a detailed history as well as an internal and external evaluation will occur incorporating not just the pelvic floor, but also assessment of posture, breathing, as well as range of motion and strength of the torso, back, hips, pelvis, and lower extremities and examination of the associated musculature and fascia as well as the nerves and joints. The pelvic floor component will include an external evaluation of the skin and connective tissue in the perineal and genital area as well as an internal examination of the vagina and possibly the anal canal if indicated. The pelvic floor muscles and sphincters are tested for muscle tone and tightness, strength, endurance, trigger points, and tissue integrity. The pelvic floor is also assessed in conjunction with the rest of the core to ensure that timing of activation and sequencing of the muscles is optimal. Position of the pelvic organs and integrity of their supporting ligaments and fasciae are also evaluated. You are always welcome to have a trusted individual present during assessment or treatment.

An individualized treatment program will be developed based upon the assessment findings. It may include education regarding posture, pain management strategies including breathing and relaxation exercises, activities to avoid, proper seating options, and appropriate toileting postures and bowel movement regime. Manual techniques including myofascial release, mobilization of joints and tissue, visceral manipulation, manual biofeedback and nerve/dural release and glides will be incorporated. An individualized home exercise program to release, lengthen and/or strengthen will also be introduced as appropriate. Modalities such as acupuncture, heat and cold may be utilized as well as a home biofeedback unit to aid with relaxation of the pelvic floor and associated muscles.

Pudendal neuralgia is a complicated condition, which is best treated with a multi-disciplinarian approach, including the family physician, physician specialists ie. obs/gyns, as well as psychologists. The team at Donna Sarna Physiotherapy will facilitate referrals to the appropriate specialists to ensure optimal care.