Pudendal neuralgia is a rare chronic condition affecting the pudendal nerve, a very important peripheral nerve that allows for both function and sensation in the genitals and anus.

This nerve passes through the pelvis and affects a lot of different ligaments and nerves in the area. It allows you to urinate, defecate, and feel sensations to the penis, scrotum, vagina, clitoris, labia, anus, and perineum.

When this nerve becomes compressed or irritated, an individual may experience a range of symptoms or dysfunction in these areas as a result.

Pudendal neuralgia usually creates symptoms of sharp, shooting pain in the pelvis, genitals, perineum, buttocks, or anus. Sitting can exacerbate the pain, and it may also last for long periods of time.

Pain from pudendal neuralgia can also worsen throughout the day. Although the main symptom of pudendal neuralgia is pain, this condition can cause many other symptoms such as:

• Constipation
• Painful urination
• Painful bowel movements
• Frequent urination
• Painful sex
• Urinary urgency
• Fullness in the anus or perineal area
• Erectile dysfunction
• Difficulty with orgasm

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Pudendal neuralgia is usually caused by activities that cause damage, compression, or irritation to the pudendal nerve.

The nerve can be compressed by nearby tissues during mild activities such as biking or prolonged sitting, or may actually be damaged by other experiences such as childbirth or injury. Some other causes include:

• Strain on the pelvic area from activities such as horseback riding, biking, squatting exercises, or prolonged sitting
• Constipation
• Broken bones in the pelvis, tailbone, or lower back
• Damage from surgery or injury
• Tightness, weakness, and other imbalances in the pelvic floor (known as pelvic floor dysfunction)
• Some types of infection can irritate the pudendal nerve

Physical therapy is often used alongside other medical interventions to provide a multidisciplinary treatment approach for individuals with pudendal neuralgia.

This means in addition to physical therapy, your primary provider may also suggest medications, nerve blocks, botox injections, neuromodulation, and in severe cases, surgical decompression.

These treatment options will often be necessary alongside physical therapy in order to provide an effective treatment experience. With that being said, let’s look at some ways that pelvic floor physical therapy is used for treatment!

As mentioned before, pelvic floor dysfunction can cause as well as worsen pudendal neuralgia symptoms.

Pelvic floor physical therapy for pudendal neuralgia focuses on decompressing the pudendal nerve by relaxing and stretching tight muscles in the pelvic area, and optimizing the health of the pelvic floor overall. 

Improving the health of the pelvic floor muscles allows for not only better symptom relief, but also healthy pelvic floor functions such as urination, defecation, and sexual appreciation.

To achieve this, your pelvic floor physical therapist at Hive Therapy and Wellness will utilize a variety of techniques such as the following:

Manual therapy: Your pelvic floor physical therapist will utilize many manual techniques to help relax a range of muscles in the pelvic region.

This can include soft tissue mobilization to the gluteals, low back, adductors, and pelvic floor, as well as internally to the pelvic floor if necessary. They can use manual techniques to release trigger points in more sensitive areas of tissue, and mobilize scar tissue if applicable for your needs.

Your physical therapist may also utilize other techniques as a part of manual therapy, such as dry needling or cupping, which can help reduce pain from pudendal neuralgia.

Neuromuscular re-education and biofeedback: To reduce tension in the pelvic area, it is important for patients to gain better control of their pelvic floor muscles. These treatments will help patients be able to properly contract and relax their muscles, preventing tension from building and alleviating pressure from the pudendal nerve.

Joint mobilization: Joint mobilization helps to improve range of motion and muscle activation, and can help further reduce stiffness in areas such as the pelvis, sacrum, hip, and lumbar areas. 

Behavioral modifications: To alleviate pain and prevent future compression of the pudendal nerve, it is essential for your physical therapist to correct any harmful postures or habits that may be contributing to your nerve irritation.

This can include modifications to exercises or activities that can irritate the nerve. In some cases, such as when bowel conditions or constipation exacerbates pudendal neuralgia, your physical therapist may suggest changes to bathroom habits and toilet posture.

Education: Your physical therapist can provide a wealth of information during your care—about the pudendal nerve, the pelvic floor, your symptoms or condition, pain neuroscience, and more. The physical therapists at Hive Therapy and Wellness want you to feel confident and heard, and are happy to answer your questions! 

Additionally, they can provide recommendations for useful pain relief tools for you to utilize outside of the clinic. This can be supportive aids, medications, or sitting cushions that you can use to manage your condition and symptoms.

Exercises: In order to optimize pelvic alignment and core stability, you may be given a stretching and exercise routine that will help improve the strength and mobility of the muscles in your hips, abdomen, and lower back. 

Relaxation techniques: Because tension and tightened muscles can affect the pudendal nerve, your physical therapist may teach you relaxation techniques such as deep breathing, which helps to reduce stress and relax your pelvic floor muscles.

As you can see, physical therapy can be very effective at relieving pain, reducing tension, and helping prevent future symptoms or worsening of pudendal neuralgia!

The physical therapists at Hive Therapy and Wellness understand that pudendal neuralgia can be confusing and frustrating—they are here to support you with a holistic and comprehensive plan of care that will help relieve your symptoms.

In order to best support patients with pudendal neuralgia, Hive’s physical therapists may utilize any of the following treatments:

• Manual therapy
• Exercise prescription 
• Dry needling 
• Cupping 
• Behavioral modifications 
• Therapeutic activities 
• Electrical muscle stimulation
• Therapeutic modalities 
• Biofeedback