Pudendal Neuralgia Symptoms

By Pierre Gauvin - October 16, 2003

This page is under construction. Suggestions are welcome!

Pudendal Neuralgia (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. This pages focuses on PNE.

Some tests can be used to diagnose PNE, as described in Pudendal Neuralgia Diagnosis (Not yet created). 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.

Since most cases of PN are improperly diagnosed (except in France) and early treatment (within weeks of onset) can usually cure the conditon, the correct consideration of early symptoms is critical.

Possible Causes of PNE

(Edited up to here. The rest is rough draft.)

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, 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. (see Anatomical Images àhttp://www.pudendal.info/info/anatomical_images/index.htm) Tights 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. Other times, the nevralgia seems to result of childbirth.

Statisticaly, six out of ten subjects are womens and the begining of the problem happens in average between 50 and 70 years old.

Symptoms

As for most people this condition develop gradualy, it is important to understand it’s symptoms to prevent further damage to the nerves. Here are the classical PNE symptoms:

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

-The pain is leasened 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...).

-Even in the most critical cases 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, 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.

- Consticipation. (When other symptoms started at the same time)

- Frequent hémorroïd (Caused by consticipation)

- 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 is not 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 Schiaticia 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.

-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.