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The pudendal nerve is a nerve that runs through the pelvis. Many people have different types of pain in the pelvis, with many contributing factors. However, a diagnosis of pudendal neuralgia refers to a specific type of set of symptoms due to injury of this nerve. 

The following symptoms must be present to diagnose pudendal neuralgia: Sitting-Pudendal-Neuralgia

  • Pain in the territory of the pudendal nerve: from the anus to the penis or clitoris 
  • Pain is mostly experienced while sitting 
  • The pain does not wake the person up at night 
  • No change or loss of sensation 
  • Pain relieved by diagnostic pudendal nerve block 

People with pudendal neuralgia can also report a variety of other symptoms. These include urinary frequency, urgency, painful ejaculation, painful vaginal penetration, painful nocturnal orgasms, and persistent sexual arousal. However, the pain cannot be labeled as pudendal neuralgia if the criteria above aren’t met.

What causes pudendal neuralgia?

  • Pelvic surgery
  • Direct trauma to the buttocks
  • Childbirth 
  • Chronic constipation
  • Excessive cycling 
  • Prolonged sitting

While nerves are meant to withstand compression and stretch, they are injured when those forces are especially high and/or chronic. Due to the location of the pudendal nerve, compression from bike saddles and hard seats can also contribute. 

How is pudendal neuralgia treated?

  • In the short term, we want to make you as comfortable as possible! Many use a special cutout cushion such as the Theraseat to better tolerate sitting. 
  • In cases related to acute trauma or childbirth, time is a huge factor in healing. Nerves heal slowly, so improvements can occur for a year or longer. Biking-Pudendal-Neuralgia
  • When someone has pudendal neuralgia due to chronic constipation, it’s critical to make stool soft and regular. A pelvic PT can also teach techniques to reduce straining with bowel movements. Without addressing the underlying cause, it will be hard to make improvements in pain! See our article on constipation for places to start.
  • For pudendal neuralgia due to cycling, it’s important to get the bike properly fit and increase padding to the area between the sit bones. Decreasing training volume or taking a break completely may help reduce symptoms.
  • Medical interventions such as pudendal nerve blocks can help temporarily or permanently. Prescription nerve pain medications are also helpful. 
  • Pelvic physical therapists are important team members in diagnosing and managing pudendal neuralgia. Your PT will work with you to determine contributing factors and a plan to address them. They will also develop an exercise program focused on the low back, pelvis, and hips. Getting the area around the nerve moving is a hugely beneficial! Finally, they provide hands-on therapy for pain relief. Our goal is to keep you moving and participating in your life as normally as possible!

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