Pudendal neuropathy is a painful disorder that affects the pudendal nerve in the lower pelvis. If the main nerve or one if its branches becomes compressed, damaged, or inflamed, it can cause sharp pains and other symptoms in the genitals and rectum. Pudendal neuropathy is usually caused by a major trauma to the site, though problems can also develop if a person constantly puts pressure on the area, as can occur with daily bicycle riding. Treatment depends on the severity of symptoms, and a patient may need to take medications, engage in physical therapy, or undergo surgery to find relief.
Many cases of pudendal neuropathy are caused by traumatic events in which a great deal of pressure is placed on the groin and anus region. A bicycle crash, a fall onto a fence, or an especially difficult childbirth are possible causes. In some instances, nerve compressions happens gradually over time due to overexertion. Avid cyclists are at an especially high risk of developing slow-onset pudendal neuropathy. Pelvic surgical procedures may also lead to neuropathy if the procedure causes extensive swelling or if the pudendal nerve is accidentally damaged.
Sharp, shooting pains in the external genitals, anus, or the area in between is the most common symptom of pudendal neuropathy. Pain is typically worsened when sitting down or touching the area. A person may also have very difficult, painful, or burning urination or bowel movements. Some men and women experience sexual dysfunction as well, such as an inability to become aroused or a noticeable decrease in sensitivity in their genitals.
A doctor might suspect pudendal neuropathy after reviewing a patient's symptoms and performing a quick physical exam. X-rays and computerized tomography scans are usually performed to look for damaged tissue and nerves in the pelvis. If it is not clear where the problem lies, a shot of local anesthetic might be given along a suspicious site in the nerve to see if pain subsides. Doctors base treatment decisions on the location, nature, and intensity of pudendal neuropathy.
People with minor symptoms are usually able to recover with a period of rest and taking over-the-counter painkillers. Pelvic floor exercises may be recommended after a few weeks to gradually build strength and resilience in the pelvic muscles. If pain is severe, a patient may need to receive a steroid injection to temporarily relieve inflammation and pain. Surgery to decompress the pudendal nerve is only necessary if symptoms frequently return or fail to get better with medical care and exercise.