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What a Pain in the Rear!

by Jovie Murtha, PT, Women's Health SpecialistLeave a Comment

You are going to physical therapy for pain in your WHAT?! Let’s be real. Most people don’t think about going to physical therapy for pain in the “unmentionables.” Yet, so many people suffer needlessly from pelvic, vaginal, rectal, scrotal or clitoral pain every day. Twenty percent of women will suffer with pelvic pain at some point in their lives, and up to two million men in the U.S. alone experience pelvic pain.1,2,3 These painful symptoms can be a sign of a problem called pudendal neuralgia (PN).

What is Pudendal Neuralgia?

The pudendal nerve is responsible for the movement and sensation of many of the muscles and tissues of the pelvic area. It originates from the nerves of the sacrum at the bottom of your spine. It has three important branches that innervate the clitoris/penis, vagina/scrotum and the anus. PN occurs when the nerve gets entrapped, damaged, irritated or compressed. PN is more common in women. It often runs alongside other disorders of the pelvis, such as endometriosis, vulvodynia, interstitial cystitis, fibromyalgia, piriformis syndrome and irritable bowel syndrome. Pregnancy, pelvic surgery, stressful lifestyles, prolonged sitting, cycling and horseback riding have been associated with PN.

Symptoms of PN include a feeling of swelling, pain, itching, burning, aching, stinging, cramping or twitching of any of the areas mentioned above. It can also cause severe pain with intercourse, pain with ejaculation/ orgasm, rectal pain with bowel movements, difficulty getting an erection, urinary urgency, pain with sitting or long car rides, or urethral pain with urination. Oftentimes, it is uncomfortable to wear tight-fitting pants or underwear. Some people report feeling as though they are sitting on a golf ball. Oftentimes, relief is felt when sitting on a toilet, where there is no pressure on the perineum.

What are Treatment Options?

PN is unfortunately often misdiagnosed. If you have any of these symptoms, please contact a reputable urologist, gynecologist, pelvic floor physical therapist or pain specialist in your area. Your evaluation should be thorough, including a subjective history of your problem, and a thorough exam of the area innervated by the pudendal nerve. Make sure to take a complete list of your symptoms and questions to your appointment.

So, is this a treatable condition? The great news is…YES! Treatment will depend on the cause of the nerve irritation. Physical therapy is a first-line treatment for PN. Your specialized therapist will assess the possible causes of your pain, including bicycle cycling, muscular tightness, hip inflexibility, pelvic malalignment, spinal issues, sacroiliac problems or poor posture. Your physical therapist will also assess the tissue mobility around the nerve in the pelvis, as well as the function of the muscles that are controlled by the pudendal nerve. They will ask about your urinary and bowel habits, as they can be greatly affected by PN.

Depending on the findings, there are several treatment options available. Those include behavioral modification (limited sitting or cycling), muscle re-education, manual therapy, myofascial release, massage, trigger point release, stretching, postural correction, electrical stimulation, biofeedback, ultrasound or dry needling. Your therapist will also help you determine ways to make your day more comfortable, such as suggesting using a standing desk at work. They will work with you to assist in bowel and bladder problems, as well as painful intercourse. Your therapist will also corroborate with your physician to determine if there are pain-relieving creams or medications that may calm the irritated nerve. Nerve blocks or Botox injections can be given by a pain clinic doctor in extreme cases, but only if conservative therapies have failed.

If you have any symptoms of pudendal neuralgia, there is relief waiting for you! Contact your local Athletico for a free assessment by a specialized women’s or men’s health physical therapist.

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The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.

References:
1. Apte G et al. Chronic Female Pelvic Pain: Part 1: Clinical Pathoanatomy and Examination of the Pelvic Region. Pain Practice 12(2012). 88-110.
2. Habermachker, G et al. Chronic Prostatitis/ Chronic Pelvic Pain Syndrome. Annual Review of Medicine 57 (2006): 195-206.
3. Prendegast S, Rummer E. Pelvic Pain Explained. Lanham: Rowmann and Littlefield; 2016.

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