Pain is not just limited to physical suffering and pelvic pain is associated with many other occurings as well. It might get difficult to work continuously sitting or lying down in one particular position as it cause a lot of pain in your pelvic area. This can even lead to difficulties in travelling by bus or train because he/she is not aware when he may need to use the toilet. These are true patient experiences that exist in the world of pelvic pain. It can leave a major impact on an individual's quality of life, affecting careers as well as personal life.
One of the main causes behind pelvic pain is Pudendal nerve pain. It is also known by other names such as cyclist syndrome, Alcock’s canal syndrome, and pudendal nerve entrapment. Pudendal nerve is one of the main nerves in the pelvis that is important for many bodily functions like genital sensation, urinary and bowel functions. Irritation or damage of this nerve often can lead to pain or less sensation in the genital, rectal region or deep inside the pelvis. Though this health condition is not gender specific, but it is mostly seen in young and middle aged women. It is not unusual for patients to feel dejected as most of the specialists tell them that they cannot find anything wrong. Onlymyhealth editorial team spoke to Dr. Amod Manocha, Senior Consultant & Head, Pain Management Services, Max Hospital, Saket, about the symptoms, causes, diagnosis and treatment of pudendal neuralgia.
Pudendal Neuralgia symptoms
The most common sign in patients suffering from this condition is pain in the areas connected to the pudendal nerves. This is mostly indicated as a burning sensation, shooting, aching, prickling or itching, that can worsen on sitting and may feel better while lying or standing. Pain is usually associated with an increased sensitivity, pins and needles sensation in the affected region. Other symptoms include the feeling as if an individual is having a urinary tract infection with an increased urge to urinate and pain on passing urine, rectal pain with a want to open the bowels more frequently, pain during sex, arousal and ejaculation.
Pudendal Neuralgia causes
It is not always easy to reach to the root cause of such a condition. It can occur due to compression or entrapment of pudendal nerve because of simple day to day activities such as cycling, prolonged sitting or intense physical movement of pelvic floor and surrounding muscles. Stretching of this nerve during childbirth or injury or damage to the nerve due to trauma or surgeries such as gynaecological, colorectal, orthopaedic and urology procedures can also be a factor behind chronic pelvic pain. Anatomical changes in the path of the nerve can also put the nerve at risk of compression or injury, as can biochemical reasons such as diabetes and herpes infection in that area.
Pudendal Neuralgia diagnosis
Due to lack of specific tests, the diagnosis of this condition is very difficult and can go undiagnosed in some cases. Investigations are going on constantly to support the diagnosis and rule out any other diseases which may have similar symptoms. These particular tests include MRI scans and nerve tests. Treatment of pain a diagnostic nerve block, even if temporary, helps in the diagnosis of pudendal neuralgia. Moreover, pudendal Neuralgia is also known to be linked with many other conditions such as dysfunctional voiding, painful bladder syndrome, Chronic Pelvic Pain Syndrome, chronic prostatitis etc.
Chronic Pelvic pain treatment
Management of this condition demands active patient participation and including a combination of lifestyle moderations and some medical procedures. According to Dr. Amod, here are some treatment options for chronic pelvic pain:
1. Lifestyle changes
Lifestyle changes are focused on protecting the nerve and on reducing the irritation or damage of the nerve. Firstly, all the patients are suggested to avoid daily activities such as cycling, bike riding, prolonged sitting etc. One should also try and avoid constipation and tight clothes.
2. Multidisciplinary approach
Multidisciplinary approach mainly suggests a strong combination of lifestyle changes along with effective medications, physiotherapy and psychological support and pain relieving interventions such as injections. All these are combined together to make a treatment option for chronic pelvic pain.
Special type of painkillers (neuropathic medicines) that work on nerves can also help in reducing the symptoms. However, these painkillers generally require a good amount of time to start working.
Supervised specialist physiotherapy under an expert's guidance is also aimed at pelvic floor muscles and can help in treating muscle spasms, imbalances and in fixing many other dysfunctions.
5. Psychological support
Psychological support is mostly required to treat maladaptive behaviours, believes and for developing self management techniques. This may also include cognitive behaviour therapy, mindfulness meditation and relaxation therapies.
6. Pain reliving Interventions
Pain relievers also play a vital role in providing a complete diagnosis and alleviating the symptoms of this condition. Commonly used options include pudendal nerve block, radiofrequency treatment and pelvic floor injections. These injections are performed using ultrasound, X-rays or CT scans to be sure about the accuracy and chances of providing relief in the symptoms. In most of the cases, these can help in reducing the symptoms and in controlling pain for longer periods.
These were the symptoms, causes, diagnosis and treatment for Pudendal Neuralgia or chronic pelvic pain by Dr. Amod Manocha. In some cases with severe symptoms which stay untreated with above modalities, options such as neuromodulation or pudendal nerve release surgery is considered as a treatment option if required. Taking into account a number of symptoms, the patients may try to visit a number of different specialists including Urologists, Neurologists, Colorectal surgeons, Gynaecologists, General Physicians and general surgeons, but the condition usually remains undiagnosed because of less awareness about this medical condition.
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