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Pudendal Neuralgia Tests & Procedures

It is important to note that pudendal neuralgia is largely a “rule out” condition. In other words, because its symptoms can indicate a number of other problems, extensive testing is required to ensure that a different condition is not the source. Common conditions, infections and disorders which are evaluated include:

  • Coccygodynia (pain in or around the coccyx)
  • Piriformis syndrome (spasms and pain in the buttock)
  • Interstitial cystitis (bladder pressure or pain, pelvic pain)
  • Chronic or non-bacterial prostatitis (long term pain and urinary problems)
  • Prostatodynia (inflammation of the prostate)
  • Vulvodynia (pain, burning in vulval area)
  • Vestibulitis (pain in area surrounding entrance to the vagina)
  • Chronic pelvic pain syndrome
  • Anorectal neuralgia (pain in the ano-rectal region)
  • Pelvic contracture syndrome/pelvic congestion
  • Proctalgia (severe pain of pelvic floor muscle)
  • Anorectal pain syndromes such as:
    • Proctalgia fugax
    • Levator ani syndrome.
  • Urinary tract infection
  • Prostate infection
  • Vaginal infection
  • Sexually transmitted diseases (STDs)
  • Lyme’s disease
  • Multiple sclerosis
  • All colorectal cancers

Diagnosing Pudendal Neuralgia

In addition to eliminating other conditions, it is important to determine if the pudendal pain is caused by a true nerve entrapment or other dysfunctions related to compression/tension. Some tests can be used to help diagnose pudendal neuropathy; however, a large part of diagnosis also relies on a methodical study of the symptoms and personal medical history.

Very often there are other painful areas in the surrounding region such as the piriformis muscle or tailbone pain. Most of the time, this is a reaction to the nerve pain. However, in some cases, the piriformis muscle could pinch the nerve, becoming the main cause of pain. Since we are also experts in piriformis nerve entrapment, we are able to determine if this is the cause of the neuropathy, as well.

In addition to a physical exam, testing may be used, such as electromyography to measure the electrical activity of muscle tissue surrounding the pudendal nerve and magnetic resonance neurography (MRN) to image the relevant nerves. Image-guided pudendal nerve block, an injection with a local anesthetic performed by our experts, is the most important diagnostic test to determine if the condition is present.

The final diagnosis of pudendal neuralgia is based on a person having several or all of these criteria:

  • Typical PN symptoms (see above)
  • An abnormal electrophysiological test (MRN, MRI)
  • Pain elicited upon pressing along the anatomy of the nerve
  • Elimination of other diseases or conditions as the cause
  • A positive response to the pudendal nerve block

Pudendal Neuralgia Treatments

General lifestyle changes, pelvic floor physical therapy, and medication, can often manage pain effectively. If symptoms do not respond to milder forms of treatment, your doctor may recommend one of the following:

Pudendal Nerve Block

A pudendal nerve block uses x-ray or ultrasound to inject the area around the pudendal nerve with a local anesthetic and steroid. The injection offers immediate but temporary relief of pain. With repeat injections, you may have success eliminating or substantially reducing the pain. For those who respond well to pudendal nerve blocks, but do not achieve significant long-term results, pudendal nerve decompression surgery may be an option.

Pudendal Nerve Decompression Surgery

Pudendal Nerve Decompression Surgery is a procedure that is often highly effective, typically resulting in patients leaving symptom-free or with their symptoms significantly reduced. To decompress the pudendal nerve and other affected nerves, your surgeon will enter the pelvis through a small incision in the area of the buttocks. Next, they will remove any structures that may be pressing on the nerve to create more space.

You may experience some pain after surgery, which can be managed with anti-inflammatory or prescription pain medication. It is generally recommended that external physical therapy begin approximately one month following surgery and  that pelvic floor rehabilitation begins at three months. Recovery time varies depending on the nerves involved in the procedure. As a general rule of thumb, nerves heal slowly. I may take several months before patients can return to normal activities.

Pudendal Pre-Op

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