The pudendal nerve is responsible for transmitting signals between the brain and the pelvic region. It controls muscles and transmits sensations in areas like the genitals, bladder, and rectum. This nerve can become injured or compressed due to prolonged sitting, cycling, childbirth, or trauma. This condition, called Pudendal Neuralgia, can cause pain, sharp or burning sensations, numbness, and bladder or sexual dysfunction.
At Centeno-Schultz Clinic, we specialize in non-invasive treatments to relieve Pudendal Neuralgia, focusing on addressing the root causes of your pain. Our advanced regenerative orthopedic techniques, combined with precise diagnostics and personalized lifestyle guidance, support your body’s natural healing ability.
Exploring Its Anatomy
The pudendal nerve is a major nerve in the pelvic region. It starts in your lower back from a group of nerves called the sacral plexus, which stems from the sacral vertebrae (S1 to S4) and parts of the lumbar vertebrae (L4 and L5).
Specifically, the pudendal nerve comes from spinal roots S2, S3, and S4. It travels through the pelvis, passing through openings in the pelvic bones called the greater and lesser sciatic notches, and through a tunnel called the pudendal canal.
The pudendal nerve provides sensation to areas such as the genitals and the skin around the anus. It also controls muscles that aid in urination, bowel movements, and sexual function. Because of these important roles, injury or compression of the pudendal nerve can lead to pain, numbness, and problems with bladder control and sexual function, impacting daily life.
Nerve Branches
The pudendal nerve divides into three main branches as it travels through the pelvis:
- Inferior Rectal Nerve: This branch passes through the fat tissue around the anus and lower rectum. It controls sensation and movement in these areas, helping with bowel control.
- Perineal Nerve: This branch travels across the perineum, the area between the anus and the genitals, supplying sensation and muscle control.
- Dorsal Nerve: This branch runs along the underside of the penis in men or the clitoris in women. It provides sensation to these organs, which is important for sexual function.
Functions Of The Pudendal Nerve
The nervous system consists of two main parts: the central nervous system and the peripheral nervous system. The central nervous system comprises the brain and spinal cord, which serve as the body’s control center, interpreting information and issuing instructions.
The peripheral nervous system is composed of nerves that branch out from the spinal cord. These nerves connect the brain and spinal cord to the rest of the body, enabling sensation and movement. The pudendal nerve is a peripheral nerve that helps connect your pelvic organs and skin to your nervous system. Its main functions include:
- Controls the pelvic floor muscles to support bladder and bowel function. The pudendal nerve plays a crucial role in regulating muscle strength and coordination. This helps control urination and bowel movements, and prevents leakage or incontinence.
- Provides sensation to the genital area. This nerve transmits signals to the brain relating to sensations such as touch, temperature, and pain in the genitals, the perineum, and the surrounding area around the anus.
- Supports sexual function and reflexes. The pudendal nerve carries signals essential for arousal, orgasm, and other sexual responses.
- Regulates voluntary control of urination and defecation. It allows you to start or stop urination and bowel movements, helping you control these daily functions.
Common Problems Affecting The Pelvic Region
Problems with the pudendal nerve can happen suddenly, such as from an injury, or over time. Causes range from accidents and surgeries to prolonged sitting. Issues related to childbirth, diabetes, inflammation, or even your posture can also affect this nerve.
Risk Factors For Pelvic Nerve-Related Pain
Factors that may increase the risk of pudendal nerve pain include:
- Surgical complications: Surgeries in the pelvic region, such as those involving the bladder, rectum, or reproductive organs, can sometimes lead to nerve injury or scar tissue that can press on the nerve. Surgery to repair prolapsed pelvic organs is considered the most common cause of pudendal neuralgia.
- Chronic inflammation: Chronic inflammatory conditions, like infections, arthritis, or inflammatory bowel diseases, can cause swelling. This can cause tissues to press on and irritate nearby nerves in the pelvis.
- Postural issues and muscle tightness: Poor posture or weak core muscles can put extra pressure on the pelvis when sitting. Tight muscles near the pudendal nerve may compress it, leading to symptoms of pudendal neuralgia.
- Diabetes and neuropathy: High blood sugar over time can damage nerves, including the pudendal nerve. This damage is called neuropathy and often results in disrupted nerve signals, causing numbness, tingling, or burning pain in the pelvic area.
- Difficult labor and delivery: Childbirth, especially due to long or difficult deliveries, can stretch or compress the pudendal nerve. This is more likely in instrument-assisted vaginal deliveries.
Nerve Compression Syndrome
Nerve compression, also called entrapment, occurs when something presses on the nerve, such as:
- Tight muscles
- Fragments after a bone fracture
- Scar tissue that develops after injury or surgery.
- Swollen or inflamed tissue
- Abnormal tissue growth, such as bone spurs, cysts, or tumors.
Nerve compression disrupts the transmission of signals to the brain, resulting in symptoms like burning, tingling, or stabbing pain. If the pudendal nerve is affected, symptoms are felt in the pelvis area and can radiate to the lower limbs. They worsen with activities like sitting or cycling. You might also notice changes in bladder, bowel, or sexual function.
Pelvic Floor Dysfunction
Your pelvic floor is a group of muscles and ligaments at the bottom of your pelvis that acts like a sling, supporting your pelvic organs—including the bladder, uterus, and rectum. It also helps control urination and bowel movements.
If these muscles are weak, too tight, or not working correctly, you may develop pelvic floor dysfunction. This can cause organs to prolapse or shift position, affecting their function and compressing nearby structures. Symptoms are many, and can also include urinary or bowel incontinence, pain with sitting, or difficulty with sexual activity.
Trauma Or Injury
Direct injuries to your pelvis, such as from falls or car accidents involving the spine or pelvis can damage the pudendal nerve and other important structures. Injury can also occur due to repetitive stress, such as from long-distance biking.
Symptoms may include sudden, sharp pain, numbness, or muscle weakness in the pelvic region.
Pudendal Neuralgia
Pudendal neuralgia occurs when the pudendal nerve becomes irritated or injured, leading to chronic pelvic pain. People with this condition often report burning, stabbing, or shooting pain in the pelvis, which may get worse when sitting and improve when standing or lying down.
Pudendal neuralgia can also cause problems with urination, bowel movements, or sexual function. Causes include nerve compression, trauma, surgery, or certain diseases.
How Pudendal Nerve Conditions Are Diagnosed
Diagnosing pudendal neuralgia remains a challenge because it is not well known and is often mistaken for other pelvic floor problems. Because of this, a comprehensive approach is essential to identify and treat the root cause of symptoms accurately.
Common diagnostic tools include:
- Patient history and symptom review: Reviewing your medical history and symptoms helps physicians identify factors that may contribute to nerve pain, such as underlying medical conditions, specific activities like cycling, previous surgeries, or a difficult delivery.
- Physical examination: Your healthcare provider checks for tender areas, altered sensation, and muscle tightness in your pelvic region.
- Pudendal nerve block: This diagnostic tool involves injecting a small amount of anesthetic near the pudendal nerve. If your pain improves afterward, this suggests the nerve is involved in your symptoms.
- Electrophysiological testing: These tests measure how quickly and effectively signals travel along your nerves and muscles, helping detect signs of nerve injury or compression.
- Imaging studies: Imaging studies, such as MRI or CT scans, provide detailed images of the inner aspects of the pelvis. They help identify nerve compression, inflammation, scarring, or other injuries affecting the pudendal nerve.
- Diagnostic ultrasound: This imaging test uses sound waves to visualize the pudendal nerve and surrounding tissues in motion, looking at how different parts of the pelvis interact with one another. It can help detect compression, inflammation, or entrapment.
- Sensory testing, also known as quantitative sensory testing: Your physician will use specialized tools to assess whether you can detect changes in temperature or vibration in areas supplied by the pudendal nerve. This helps identify loss or changes in sensation.
- Diagnostic criteria: Your symptoms and all test results are compared against standard guidelines to understand how the pelvis is impacted.
How Are Conditions Relating To This Nerve Treated?
When it comes to treating problems with the pudendal nerve, the first and most important step is getting an accurate diagnosis. This is essential because simply relying on medications to numb symptoms can lead to side effects, letting an underlying problem go unaddressed.
Your specific symptoms, medical history, and test results help guide your physician in choosing the treatment that is most likely to benefit you. Centeno-Schultz Clinic utilizes advanced approaches, including Platelet-Rich Plasma (PRP) and pudendal nerve injection, to support your body’s natural healing abilities and target the root of your pain.
Platelet-Rich Plasma (PRP)
Platelet-Rich Plasma, or PRP, is a treatment that uses your own blood components to support healing. In this procedure, a small sample of your blood is processed to concentrate the platelets, which are rich in growth factors that support tissue repair. The PRP is then injected near the pudendal nerve or surrounding tissues to help reduce inflammation, support nerve recovery, and alleviate pain.
Pudendal Nerve Injection
A pudendal nerve injection serves both diagnostic and therapeutic purposes. It involves carefully injecting medication, often a combination of a local anesthetic and anti-inflammatory agent, around the pudendal nerve. The goal is to calm irritated tissue, reduce swelling, and relieve pain. This procedure is often performed with image guidance, such as ultrasound or fluoroscopy, to enhance accuracy and safety.
Care Tips For Your Pelvic Nerve Health
Some lifestyle changes and prevention strategies can help reduce symptoms and reduce the risk of pudendal nerve issues. These include:
- Maintain proper posture: Proper posture helps the body distribute loads evenly and redistribute them, easing pressure on nerves.
- Use cushions for sitting: Using supportive cushions or donut pillows when sitting for long periods to protect your pelvic region and limit direct pressure on sensitive nerves.
- Incorporate pelvic floor exercises: Gentle contractions and relaxations (like Kegel exercises) can strengthen pelvic floor muscles. This prevents organ prolapse, improves bladder and bowel control, and eases pressure on nerves.
- Avoid repetitive strain: Limit activities that put constant pressure on your pelvis, such as prolonged cycling or heavy lifting, to reduce irritation.
- Stay active with low-impact exercises: Activities like walking, swimming, or gentle yoga improve blood flow, strengthen muscles, and support your nervous system without excessive strain.
- Manage stress and tension: Practices such as mindfulness, meditation, or breathing exercises can help relax the pelvic muscles. This eases pressure on nearby nerves. It also helps reduce stress levels, which helps alleviate muscle tightness and pain perception.
- Seek physical therapy if needed: Physician-guided exercises can improve muscle strength and flexibility, supporting overall pelvic health.
- Follow a nerve-friendly diet: Prioritize whole grains, lean proteins, fruits, and vegetables, and stay hydrated. Proper nutrition supports nerve health and helps decrease inflammation throughout your body.
These lifestyle changes, combined with an accurate diagnosis and a targeted treatment plan, can help ease symptoms and support pelvic health in the long term.
At Centeno-Schultz Clinic, our team of specialized physicians can empower your journey with a personalized, non-invasive treatment plan designed to reduce symptoms and address the root cause of your pain without the need for medications.
Consult with us if you’re experiencing conditions such as pudendal neuralgia; we can help.