Pudendal Neuralgia & Other Posts

The following information is taken from Medical News Today which was written by Ms Violet Mathews and provides an outstanding explanation of what Pudendal Neuralgia entails:

Taking The Shame Out Of Pudendal Neuralgia
What could possibly be worse than struggling with a painful condition and   feeling ashamed to discuss the problem because of its intimate nature? Such   is the case for many suffering with pudendal neuralgia, a little known   disease that affects one of the most sensitive areas of the body. This area   is innervated by the pudendal nerve, named after the Latin word for shame.

Due to the location of the discomfort combined with inadequate knowledge,   some physicians make reference to the pain as psychological. But nothing   could be further from the truth. Unfortunately, discussing the condition with   gynecologists, urologists and neurologists often proves fruitless since most   know nothing about the condition and therefore cannot diagnose it.

What is Pudendal Neuralgia?

Pudendal neuralgia is a chronic and painful condition that occurs in both men   and women, although studies reveal that about two-thirds of those with the   disease are women. The primary symptom is pain in the genitals or the   anal-rectal area and the immense discomfort is usually worse when sitting.   The pain tends to move around in the pelvic area and can occur on one or both   sides of the body. Sufferers describe the pain as burning, knife-like or aching,   stabbing, pinching, twisting and even numbness.

These symptoms are usually accompanied by urinary problems, bowel problems   and sexual dysfunction. Because the pudendal nerve is responsible for sexual   pleasure and is one of the primary nerves related to orgasm, sexual activity   is extremely painful, if not impossible for many pudendalites. When this   nerve becomes damaged, irritated, or entrapped, and pudendal neuralgia sets   in, life loses most of its pleasure.

Where is the pudendal nerve?

It lies deep in the pelvis and follows a path that comes from the sacral area   and later separates into three branches, one going to the anal-rectal area,   one to the perineum, and one to the penis or clitoris. Since there are slight   anatomic variations with each person, a patient’s symptoms can depend on   which of the branches are affected, although often all three branches are   involved. The fact that the pudendal nerve carries sensory, motor, and   autonomic signals adds to the variety of symptoms that can be exhibited.

Diagnosis

Because pudendal neuralgia is uncommon and can be similar to other diseases,   it is often misdiagnosed, leading some to have inappropriate and unnecessary   surgery. Early in the diagnosis process, it is crucially important to undergo   an MRI of the lumbar-sacral and pelvic regions to determine that no tumors or   cysts are pressing on the nerve. In addition, the patient should be screened   for possible infections or immune diseases, as well as having an evaluation   by a pelvic floor physical therapist to determine the health of the pelvic   floor muscles and to uncover whether skeletal alignment abnormalities exist.   An accurate patient history is needed to assess whether there has been a   trauma or an injury to the nerve from surgery, childbirth, or exercise. Tests   that offer additional diagnostic clues include sensory testing, the pudendal   nerve motor latency test, and electromyography. A nerve block that provides   several hours of relief is another tool that helps to determine if the   pudendal nerve is the source of pain.

Pudendal Neuralgia and Depression

One of the most common symptoms that accompanies pudendal neuralgia is severe   depression. Some people with the disease have committed suicide due to the   intractable pain. For that reason, it is important to consider   antidepressants, as they can help lessen the hypersensitivity of the genital   area in addition to relieving bladder problems. Certain anti-seizure drugs   reportedly help to alleviate neuropathic pain while anti-anxiety drugs   provide substantial relief of muscle spasms and assist with sleeping.

Uninformed physicians are reluctant to prescribe opiates for an illness that   shows no visible abnormality, yet the desperate nature of genital nerve pain   requires that opiates be prescribed for these patients. While medications are   not always satisfactory, they do help take the edge off of the pain for many   people. Until the correct treatment is determined, it is imperative that   patients with pudendal neuralgia receive adequate pain management since the   pain associated with this illness can be intense.

Treatment

Treatment depends on the cause of distress to the nerve. When the cause is   not obvious patients are advised to try the least invasive and least risky   therapies initially.

Physical therapy that includes myofascial release and trigger point   therapy internally through the vagina or rectum assists with relaxing of the   pelvic floor, especially if pelvic floor dysfunction is the cause of nerve   irritation. If no improvement is found after six to twelve sessions, nerve   damage or nerve entrapment might be considered.

Botox is now used in medical settings to relax muscles and shows   promise when injected into pelvic floor muscles; though finding a physician   adept at this treatment is difficult.

— Pudendal nerve blocks using a long-acting analgesic and a steroid   can reduce the nerve inflammation and are usually given in a series of three   injections four to six weeks apart.

— If physical therapy, Botox, and nerve injections fail to provide adequate   relief, some patients opt for pudendal nerve decompression surgery.

There are three published approaches to pudendal nerve decompression surgery   but there is debate among members of the pudendal nerve entrapment community   as to which approach is the best. Since there are advantages and   disadvantages to each approach, patients face considerable confusion when   deciding which type of surgery to choose. Because there are only a handful of   surgeons in the world who perform these surgeries, most patients have to travel   long distances for help. Moreover, the recovery period is often painful and   takes anywhere from six months to several years since nerves heal very   slowly. Unfortunately, early statistics indicate that only 60 to 80 percent   of surgeries are successful in offering at least a 50 percent improvement.   Patients whose surgeries are not successful or who do not wish to pursue   surgery have the option of trying an intrathecal pain pump which delivers   pain medication locally and helps to avoid some of the side effects of oral   medications. Others pursue the option of a neurostimulator either to the   sacral area or directly to the pudendal nerves. These are relatively new   therapies for pudendal neuralgia so it is difficult to predict success rates.   Some pudendalites have devised ingenious contraptions for pain relief ranging   from u-shaped cushions cut from garden pads all the way to balloons filled   with water, frozen, and inserted into the vagina. Most have a favorite   cushion for sitting and many have special computer set-ups for home and   office use in order to avoid sitting. Generally speaking, jeans are a no-no,   so patients revise their wardrobes to include baggy pants and baggy underwear   – if they are able to tolerate wearing underwear.

Clearly more research is required to find effective methods to better manage   the pain and debilitation of pudendal neuralgia. But in the meantime, friends   and family close to those who have this devastating illness play a huge role   in helping patients cope, thereby maintaining the best quality of life   possible. Support, love and understanding are of primary importance for those   suffering with this affliction.

Written by: Ms. Violet Matthews


Article URL:   http://www.medicalnewstoday.com/releases/54832.php

Main News Category: Women’s Health   / Gynecology


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8 Comments

8 thoughts on “Pudendal Neuralgia & Other Posts

  1. I came by to thank you for following my blog FullCircledMe and found this awesome post. I knew a womean years ago that was going through so much grief trying to get diagnosed and treated.
    She felt she knew for certain what it was after much of her own reasearch, and at first her doctor was irriitated with her. Then he came around to her way of doing things and he began treatement. Then I slowluy lost contact with her.

    I applaud you for talking about this, making more people aware.

    Again thanks for following my blog, I hope you found the post helpful in some way. Or maybe reassuring that we are all fighting this fight.I wish you’d left a comment so I know where you are coming from. Oh well.. Take care and hope you are doing okaty ~ BB

    • Aaahh! I had just written a long reply and lost the comment box. This happens somewhat regularly when working in bed, it’s 3.40am here in Sydney, Australia. Hoping to cross paths with you more regularly, as you would understand, medication dictates the hours that are best for writing while at other times it’s reading and retweeting/reblogging only. Health & Happiness 🙂

      • I so hate losing comments and posts. It seems that WP has gremlins every once in a while.

        I look forward to our paths crossing a lot. Reading your blog is on my list to do. I want to absorb your whole blog. During the night when I am not sleeping I am reading blogs, commenting on blogs, and quite often writing on my blog.

        I think it’s great that someone is awake in a far off counntry when I am.
        See you soon friend ! BB

  2. Thanks for sharing this. I hadn’t heard of it, but I do have vulvodynia (yep, neurological pain in the vulvar area) and skin down there that’s so thin and dry it has it’s own diagnosis.

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