The pudendal nerve is the main supplier of feeling and muscle control to the pelvic floor. It is important for bowel and bladder control as well as sensation of the sexual organs.
The nerve, which contains both sensory and motor fibers, travels out of the spine in the lower back. The sensory fibers branch into three smaller nerves:
- Inferior rectal nerve
- Perineal nerve (which supplies the perineum, vagina, scrotum, labia, and urethra)
- Dorsal nerve of the clitoris or penis.
The motor fibers of the nerve supply the external anal sphincter, sphincter muscles of the bladder, and the muscles of the pelvic floor.
The nerve is most commonly injured in childbirth, but it can also be damaged by other forms of trauma in both women and men of any age. Injury to the nerve can cause loss of function, numbness or tingling, and pain. Pain associated with an injured nerve is called neuralgia.
Signs & Symptoms of Pudendal Neuralgia
Pudendal neuralgia is the irritation of the pudendal nerve and is commonly described as pain with sitting.
Common signs and symptoms of pudendal neuralgia may include the following:
- Pelvic pain with sitting, but improvement with standing or sitting on a toilet seat
- Burning, stabbing pain in the vagina, labia, clitoris, penis, scrotum, perineum, anus, and rectum
- Tailbone pain
- Feeling of foreign object in vagina and/or rectum
- Urinary, bowel and/or sexual dysfunction
- Discomfort with tight clothing like jeans, pants, panty hose
How is the Pudendal Nerve Treated?
Physical therapy for pudendal neuralgia includes manual therapy techniques to decrease pain, improve nerve mobility, and decrease muscle spasms and tone. It also includes instruction of relaxation techniques, breathing mechanics, and postural re-education. The patient is taught a home exercise program which includes stretching and strengthening of muscles of the core (abdominal wall, low back, hip, and pelvic floor).
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