Pudendal Neuralgia Symptoms

 

(PN) is pain in the pudendal nerve area. The most common diagnosis of PN is Pudendal Nerve Entrapment (PNE). However, PN can also be the result of peripheral nerve damage or other conditions.

Some tests can be used to diagnose PNE, as described in Pudendal Neuralgia Diagnosis . However a large part of diagnosis relies on systematic study of the symptoms. This page is aimed at helping patients and doctors determine the strong possibility of PNE from study of symptoms alone.

Possible Causes of PNE

Most of the time the pain has settled without one knowing, sometimes preceded by paraestesia (numbness, lost of sensations) in the same territory. Overall, sitting at work and frequent long drives are the main cause of compression of the nerve. In younger people, sports involving the legs like heavy weight lifting, childbirth, running and – most of all - cycling are the leading favorable risk factor for the development of the condition. In the sports medicine community it is sometimes called the “cyclist syndrome”.

Most people who have PNE were predisposed to have it and many people who are predisposed never develop the condition. For some, the pudendal nerve can follow an irregular path. One’s anatomy in this particular area of the body can lead to the compresion of the nerve when bending, sitting or doing such or such movement. Tight muscles, tendons can lead to constant friction with the nerve. Pressure, inflamation and scar tissues that can possibly harm the nerve over time. However, often the cause remains unknown.

Many people however (1/3) recall one event in particular as the begining of their symptoms. Some recall the feeling of a lightning electrical shock after a bad move. It is rarely due to a direct shock like a fall on the buttock. Sometimes it is due to a surgery in the same territory even though it did not touch the nerve directly.

Symptoms

One of the best descriptions that I have seen about Pudendal Neuralgia was from the Mayo Clinic. Here is what they had to say.

"Pudendal neuralgia is frequently caused by a mechanical and/or inflammatory damage to the nerve. Symptoms can include vague pains, stabbing pains, burning sensations, pin pricking, numbness, twisting cold sensations and pulling sensations. Other people have reported that they have felt like their vagina or rectum was "falling out". The area involved could be the rectum, anus, urethra, and perineum. In women, the vagina and vulva (genital region seen externally), the vaginal entrance, the minor and major labia, the mons veneris, and the clitoris. In men, the penis and scrotum may be similarly affected. Pains and paraesthesias symptoms may extend as far as the groin, inner leg, buttocks, and abdomen. The pain and paraesthesia may be perceived in only one of these areas, in several, or in all of them. These symptoms may be unilateral or bilateral or more distinct on one side than the other, and they usually exacerbated by sthe sitting position. Utilization of a "doughnut" iillow and/or sitting on a toilet seat often provides some degree of comfort, as this lessens the pressure on the pudendal nerve. The skin ovelrying some of this region may react with extreme sensitivity to the slightest touch (hyperesthesia and allodynia), such that the affected person may avoid wearing certain items of clothing to avoid such discomfot.

Difficulty with normal voiding, with hesitancy or extreme urgency may cause repeated trips to the bathroom. Bowel function may be abnormal, as well as painful.

Constipation is reported more frequently among those individuals diagnosed with pudendal neuralgia. Sexual intercourse may be problematic as penetration for the woman may be extremely painful, and for the males erectile dysfunction and/or pain with with orgasm may predominate."

There have been other suffers with long term pain for hours and/or days after having an orgasm. Or, having an orgasm may be difficult.

As for most people this condition develop gradualy, it is important to understand it's symptoms to prevent further damage to the nerves.

Here is an overview of the symptoms.

-The chief symptom is pain in the area inervated by the pudendal nerves such that sitting become intolerable.

-The pain is lessened when sitting on a toilet seat.

-The pain is often not immediate but delayed and continious and stays long after one has remedy to the source of the problem (stop sitting, running...).

-Usually the pain gradualy decreases at night and is least in the morning.

The most common type of pain is a burning sensation. Other type of pain often experienced are: twisting, pulling sensations, vague pains, stabbing pains, pin pricking, electric shocks, numbness and cold sensations. Althought the pain level can vary slightly from time to time, the nature of the pain is constant.

PNE symptoms can also include :

- Pain in perineum.

- Intolerence to tight pants.

- Friction and inflamation feeling along the course of the nerve when walking for too long or running. However, walking reasonably helps to relax the muscles and reduce the pain for most people with PNE.

- Pain at the standing position for 20% of the people with PNE.

- Problem with urinary retention after urination. Need to push to empty bladder. Harder to detect the feeling of urine when passing through the uretha.

- Pain after bowel movement when the rectal banch of the perineal nerve is affected. Sometimes sufferers also report pain prior to and during the bowel movement.

- Constipation.

- Sexual problem. Men complain of a diminution of sensations without alteration of erection. Pain after ejaculation is possible. For womens pain during and after intercourse is ofter reported. Impotence could be a PNE symptom but pain during or after intercourse can affect sex life.

-Scrotum/Testicular pain is possible. The testicle itself is inervated by another nerve however the difference in pain from scrotum/testicle can be hard to notice.

- Buttock Sciaticia and everything that goes with it: numbness, coldness, sizling sensation in legs, feet,.buttock. This is more often due to a reaction of the surrounding muscle to the pain in th pelvis region. It could also be from the "cross talk" of the nerves. If one nerve becomes overloaded, sometimes other nerves will try and help out, thus getting the pain signals and it results in the person having pain in these different areas.

-Low back pain resulting from irradiation of the pain.

The symptoms can be unilaterl or bilareral. If the entrapment is only on one side, the pain can also be reflected to the other side.

The evolution without treatments over time show a progressive worsening of symptoms starting from a small perineal discomfort to a more and more cronical and constant pain that is least decreased when standing and even lying down.

It can be frightening for the newcommer to read all these symptoms and can lead to self rationalization that his/her condition can not be such because it is not so bad at the moment. Remember that most people do not have all the clasical symptom and for most of them the problem started with a small discomfort. Nerves can reacts in a variety of ways to the entrapment before complaining. So pain is often not the first symptom.