The pudendal nerve is a key nerve in the pelvis. It helps control muscles and provides sensation in the areas around the genitals, anus, and lower buttocks. This nerve may become damaged or irritated due to injuries, prolonged sitting, surgery, or repeated strain.
This condition, known as pudendal neuralgia, causes symptoms such as pain, numbness, or tingling in the pelvic area. Sometimes, it can also cause bladder and bowel control or sexual dysfunction.
At Centeno-Schultz Clinic, our physicians specialize in using advanced diagnostic tools to identify the root cause of symptoms and develop personalized, non-invasive treatment plans that support your body’s natural healing abilities. Our goal is to help you manage symptoms, restore function, and lower the risk of surgery.
What “Damage” Actually Means In Nerve Science
The pudendal nerve originates from the sacral spinal nerve roots (S2–S4) in the lower back and terminates in the perineum, supplying the genitals, anus, and surrounding pelvic structures. It travels inside a tunnel called the pudendal (Alcock’s) canal, which protects it.
This nerve has several functions:
- Provides sensation to the genitals, anus, and parts of the buttocks.
- Controls muscles that help with bladder and bowel function.
- Supports sexual function by helping manage sensation and muscle control in the genitals.
When the pudendal nerve is compromised or injured, it can affect any or all of these functions. Nerve injuries can vary in severity and type:
Neuropraxia
Neuropraxia is the mildest form of nerve injury. In this case, the pudendal nerve is stretched, compressed, or irritated, but not cut or deeply damaged. The nerve’s structure remains mainly intact.
Symptoms may include pain, tingling, or temporary weakness, but there is usually no permanent loss of function. Most people recover fully, often with rest, physical therapy, or modifications to their activity level.
Axonotmesis
Axonotmesis is a more serious nerve injury. Here, the inner part of the nerve fiber (the axon) is damaged, but the outer covering is still preserved. This type of injury can happen due to severe compression, crush injuries, or trauma.
Symptoms can be more intense and may persist for a longer period. They may include pain, numbness, and muscle weakness. The right treatment is crucial in this case. The axon can regenerate itself, allowing function and sensation to return.[1]
Neurotmesis
Neurotmesis is the most severe form of nerve injury. In this case, the pudendal nerve is fully cut or torn, with damage to both the inner axon and the outer sheath.
Complete loss of nerve function may happen in the affected area. This kind of injury is rare but can result from major trauma or surgical complications. Recovery is difficult, and sometimes surgery or advanced interventions are needed to restore some function.
How Often Nerve Damage Happens And Why It Is Missed
Pudendal neuralgia is often identified only after years of ongoing pain, during which patients may have tried various tests, medications, treatments, and sometimes even surgeries.[2]
There are several reasons why pudendal nerve injuries are commonly missed:
- Overlapping Symptoms: Pudendal nerve problems can look like other conditions, including back pain, bladder issues, or even prostate and gynecological conditions. This overlap can make it difficult to identify the true source of symptoms.
- Limited Awareness: Not all physicians are familiar with the pudendal nerve or its role in pelvic pain. As a result, it may not be considered early in the diagnostic process.
- Mixed or Spreading Symptoms: It is possible to feel pain, numbness, or tingling in more than one area, which makes the cause less obvious.
- Challenges in Testing: Pudendal neuralgia is often a clinical diagnosis, as there are limited types of scans or lab tests that can show pudendal nerve damage. Physicians usually rely on your description of symptoms and a detailed physical exam.
- Delayed Reporting: Sometimes, people put off talking about pelvic pain or related symptoms because the topic feels sensitive or uncomfortable, which can delay diagnosis and treatment.
However, with the right approach and diagnostic processes, it is possible to identify pudendal nerve damage and the factors contributing to it.
Typical Symptoms Patients Report
Damage or irritation of the pudendal nerve interferes with the transmission related to motor control and sensation. This can lead to symptoms that are localized to the pelvic area or spreading to the back, hips, and legs. Common symptoms include:
- Sharp or burning pain: The pudendal nerve carries pain signals from the pelvic region. Damage causes abnormal nerve signals, leading to intense, burning pain in the pelvis, buttocks, or genitals.
- Pain worsens while sitting: Sitting puts pressure on the pelvis and the pudendal canal, where the nerve travels. This can increase irritation and trigger or intensify pain.
- Sensation of swelling or fullness: Even without visible swelling, nerve damage can make the brain “feel” abnormal sensations, such as fullness or pressure in the pelvis. This is a response known as neuropathic sensation.
- Pain during sexual intercourse: The pudendal nerve controls sensation in the genitals and pelvic floor muscles. Injury can make these tissues more sensitive or painful during intercourse, interfering with sexual function. It may also cause disorders such as persistent arousal, erectile dysfunction, premature ejaculation, ejaculation pain, and vulvodynia.
- Frequent or urgent need to urinate: The nerve also supports bladder and sphincter function. Damage may disrupt normal signals, causing discomfort during, or changes in the urgency and frequency of, urination.
Causes Of Pudendal Nerve Damage
Several conditions or events can lead to pudendal nerve injury. Understanding these causes helps identify risk and inform treatment decisions.
Chronic Constipation
Chronic constipation increases pressure in the pelvic area. Additionally, straining during bowel movements puts undue stress on the pudendal nerve and the structures that protect it. Over time, this can irritate or compress the nerve.
Trauma To The Nerve Due To Childbirth
The pudendal nerve can be stretched or compressed during childbirth, especially in vaginal deliveries that are instrument-assisted, or long or difficult.[3]
This trauma can cause temporary or, in rare cases, lasting nerve damage, resulting in pain, numbness, or changes in bladder and bowel function.
Trauma To The Pelvis
Injuries from accidents, falls, or direct blows to the pelvis can damage the pudendal nerve. The nerve may also become trapped or pinched due to other events involving the pelvis that lead to structural changes or stress. These include fractures, pelvic surgeries, or even pelvic radiation treatments.
This trauma may directly disrupt the nerve fibers or cause swelling that increases pressure on the nerve.
When Does The Damage Tip Toward Irreversibility?
Many cases of pudendal nerve damage can improve on their own with conservative care or lifestyle modifications. However, certain factors can increase the risk of permanent injury. Irreversible damage occurs when the nerve’s structure is severely harmed, chronically compressed, or unable to heal on its own.
Key risk factors include:
- Compression: Prolonged or severe pressure on the nerve, such as from a pelvic mass, scar tissue, or chronic entrapment in the pudendal canal, can cut off blood flow and damage nerve fibers. The longer the compression lasts, the higher the risk of permanent nerve function loss.
- Radiation‑Induced Neuritis: Radiation therapy to the pelvis, for cancer treatment, can damage nerves by causing nerve inflammation and scarring. This injury may develop slowly and often leads to irreversible changes in the nerve tissue.
- Metabolic Comorbidities: Chronic health conditions such as diabetes or severe vitamin deficiencies can damage nerves throughout the body. High blood sugar or poor blood flow may cause the death of nerve fibers and slow healing, making pudendal nerve damage more difficult to reverse.
Effective Management And Treatment Approaches
A comprehensive care plan for pudendal neuralgia should focus on relieving symptoms, but also on protecting nerve health and addressing the root cause. The right treatment depends on the severity of the injury and each patient’s unique needs. Common approaches include:
Medication
Certain medications can reduce nerve pain and inflammation. Neuropathic pain medications, such as gabapentin or pregabalin, work by calming overactive nerve signals. Anti-inflammatory drugs may also be used to reduce swelling and discomfort. In some cases, local anesthetic or steroid injections can temporarily block pain signals from the nerve.
Lifestyle Changes
Changes in daily habits can relieve pressure on the pudendal nerve and help prevent further injury. Key recommendations include:
- Using cushioned or specially designed seats to reduce pelvic pressure while sitting.
- Avoid prolonged sitting or taking frequent breaks.
- If cycling, choose padded saddles and take breaks as needed.
- Managing constipation through diet (higher fiber), hydration, and regular activity to avoid straining.
- Support nerve health by managing underlying conditions that could damage nerves, such as cardiovascular conditions and diabetes.
Physical Therapy
Specialized physical therapy helps improve the strength and coordination of the muscles in the pelvic floor. In turn, a stronger pelvic floor can support the organs in the pelvis, preventing them from dropping and shifting. This can help alleviate the pressure on structures located underneath, such as the pudendal nerve.
Physician therapy can also improve flexibility and posture, which helps the body distribute loads more effectively during movement. This can prevent conditions like nerve entrapment and sciatica.
Surgery
Surgery is typically reserved for severe cases when other treatments have failed. The main goal is to relieve nerve compression or repair damaged nerve tissue.
Surgical options may include decompression of the pudendal nerve or removal of scar tissue to prevent further damage. If the compression is caused by abnormal growths, such as tumors nearby, more specific surgical procedures may be suggested.
Get The Expert Care You Need With Centeno-Schultz Clinic
Effective treatment for pudendal nerve symptoms starts with an accurate diagnosis. At Centeno Schultz Clinic, we use advanced diagnostic tools to identify nerve injuries. Our non-invasive, personalized care plans use interventional orthopedic approaches to support the body’s ability to heal, aiming to prevent further damage and support long-term nerve health.
Experiencing symptoms of pudendal nerve damage? Learn how Centeno-Schultz manages and treats the symptoms of this condition.
References:
- Huebner EA, Strittmatter SM. Axon regeneration in the peripheral and central 10.1007/400_2009_19. PMID: 19582408; PMCID: PMC2846285.
- Leslie SW, Antolak S, Feloney MP, et al. Pudendal Neuralgia. [Updated 2024 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562246/
- Mahoney, C.K., Reid, F.M., Smith, A.R.B. et al. The impact of pregnancy and childbirth on pelvic sensation: a prospective cohort study. Sci Rep 13, 1535 (2023). https://doi.org/10.1038/s41598-023-28323-7
