What is pudendal neuralgia?
The term pudendal neuralgia is formed from the word trunks pudendal and neuralgia. Neuralgia is the name of an attacking nerve pain, pudendal refers to the pudendal nerve.
This originates in the lower spinal cord. It has three branches that innervate the anus, the external anal sphincter, the perineum, the muscles of the penis roots, the urethral muscle, the glans and the labia with clitoris. Also, the control of the pelvic floor muscle is the task of the pudendal nerve.
Patients describe the pain that can be felt in the abdomen or the sole of the foot as pinprick, stinging, pulling or burning. The skin in these regions is very sensitive to pain and highly sensitive. Delineated is the pudendal neuralgia of the pudendine neuropathy, in which permanent complaints occur.
The most common cause of pudendal neuralgia is the mechanical damage and constriction of the pudendal nerve. Its causes include lengthy operations in the lower pelvic region, a long duck on the nerves that can occur while riding a bicycle, and injuries. In some patients, a narrowing of the connective tissue channel was found on the spinal column.
Rarely, pudendal neuralgia is caused by inflammation of the nerve. These are caused by herpes zoster viruses, tumors in the pelvic region or in diabetic nerve diseases. Diabetic polyneuropathy is the most common cause of inflammation and is the result of poorly controlled diabetes mellitus or damage to the small blood vessels. Diabetics represent a special risk group for neuralgias.
Symptoms, complaints & signs
Typical for a pudendal neuralgia are violent pains in the genital area, which are described by those affected as stinging, burning or oppressive. In women, they usually go from the outer vagina to the anus; Men feel the pain mainly in the perineal area, the penis can be affected.
The symptoms are usually unilateral, but can change the sides - only occasionally is the pain symptoms at the same time on both sides. The pain, which is perceived as agonizing, is sometimes associated with sensory disturbances or muscle paralysis, which can severely affect bowel movements and urination. In severe cases, pudendal neuralgia can cause urinary and fecal incontinence.
Often, the pain also occurs during intercourse and then continue for a while, men sometimes have erectile dysfunction. As a rule, discomfort increases when sitting, which is often only possible with the help of a seat ring.
Sporting activities as well as prolonged standing lead to an aggravation of the pain symptoms, while sitting on the toilet leads to a relief of the patient. When lying down, the complaints also subsided, an undisturbed sleep is generally possible. Often, the disease takes a chronic course, as the pudendal neuralgia hardly responds to the usual painkillers.
Diagnosis & History
When diagnosing pudendal neuralgia, the physician must first rule out other conditions that could cause pain in the affected area. These include, in particular, skin inflammations. Diabetes mellitus must also be excluded on the basis of a blood test.
By means of imaging techniques, a tumor is examined. Standard is also the question of psychological causes of pain in the genital area. If these factors could be excluded, the further diagnosis is carried out by a neurologist. Based on his medical history and clinical examination, he usually receives sufficient information on the diagnosis, which he can support by means of technical examination methods.
The measurement of the nerve conduction velocity of the pudendal nerve or the measurement of electrical activity in the external anal sphincter are rarely effective.
Another diagnostic method is the injection of a local anesthetic into the nerve canal during computed tomography. If the pain subsequently decreases significantly, pudendal neuralgia must be diagnosed.
Due to the pudendal neuralgia sufferers usually suffer from very severe pain. This pain mainly occurs in the intestine or in the genitals and are very unpleasant for most people affected. If this pain persists for a longer period, it can lead to mental discomfort or even depression.
Most patients also appear irritated or slightly aggressive. Sometimes the pain manifests as burning or stinging. In some cases, this can lead to restricted mobility and inflammation on the skin. Even certain activities in everyday life are no longer easily possible for the patient or are always associated with severe pain.
If it does not come to a treatment, the nerve can be irreversibly damaged by the pudendal neuralgia. The treatment of pudendal neuralgia is done with the help of medication. Complications do not occur. However, a regeneration of the nerve is necessary so that the pain does not recur. Pudendal neuralgia does not usually reduce the life expectancy of the patient.
When should you go to the doctor?
The pudendal neuralgia should always be examined and treated by a doctor. In most cases, there is no self-healing and pudendal neuralgia can not be treated by self-help measures. Medical treatment is therefore essential. A doctor should be consulted if the victim suffers from lightning-like and very severe, stinging pain. This pain can occur in different situations and also in different parts of the body. However, this pain usually occurs in the area of the intestine and the upper abdomen. The pudendal neuralgia can also lead to discomfort when urinating, the patients often also show paralysis of the muscles or even erectile dysfunction. Even with these complaints, a doctor must be consulted.
The first diagnosis of pudendal neuralgia may be made by a general practitioner or a urologist. However, further treatment is carried out by a specialist.
Treatment & Therapy
The injection of local anesthetics is not only diagnostic, it is also the main therapy of pudendal neuralgia. Since the effect usually wears off after a few weeks, a continuous supply by means of a catheter can also take place. In some cases, cortisone is administered instead of local anesthetics.
This method is preferred by most physicians before the drug therapy, since the active ingredient is taken regularly. The drugs used are tricyclic antidepressants, which have been successful in the treatment of nerve pain in low doses, and anti-epileptic drugs.
Some neurologists are of the opinion that only a combination of both drugs promises lasting therapeutic success. The Transcutaneous Electrical Neurostimulation (TENS) in the genital area, which the patient performs regularly at home, also promises good prospects of healing.
The treatment of the underlying disease is also important, but not sufficient in advanced disease as a single measure. As a last resort after failure of all medical and non-drug conventional medicine therapies remains the operation. In the so-called neurolysis, an attempt is made to expose the nerve in its canal, thereby relieving it of mechanical pressure.
In addition to conventional medicine, victims also find help in traditional Chinese medicine with relaxation exercises and acupuncture.
Because of the wide range of causes, neither predictions can be made about the course of the disease nor can preventive measures be mentioned. Important is the timely, even psychological, care to counteract a chronification. Also, a healthy lifestyle with sufficient exercise seems helpful.
Pudendal neuralgia is based on different causes. The acute treatment must be pain-relieving, but also related to the causative disorder. Therefore, the aftercare of pudendal neuralgia is very individual. Often a multiple pudendal blockade helps to relieve the pain. In the aftercare the lasting treatment success must be secured and checked.
If it is a long-term condition, therapy with stronger painkillers may be required. The aftercare concerns then above all a good attitude of the medicines, in order to maintain the absence of pain, as well as the observation of side effects of these medicines. The pain relievers often need to be taken over a long period of time and the dose may, under certain circumstances, be individually tailored to the patient.
In the long-term and supportive, after the acute treatment of pudendal neuralgia, consideration may be given to resorting to concomitant measures that may help relieve the symptoms. Here, above all, the psychological accompaniment of pain therapy by learning and applying relaxation techniques to call. Other supportive therapies such as TENS, acupuncture, and homeopathic remedies should be considered by a qualified physician and presented to the patient.
You can do that yourself
The treatment of pudendal neuralgia can be supported by the patients through dietary measures and a general lifestyle change. Which steps make sense in detail depends primarily on the causative disorder and the doctor's advice. If the symptoms are based on diabetes mellitus, the physician will recommend an appropriate insulin medication, which can be supported by a change in diet. If a tumor in the pelvis is causative, it must first be removed. After surgical removal of the tumor, bed rest is applied first.
The sufferer should also consult the doctor regularly so that any recurrences or other complications can be detected quickly. For acute attacks of pain in addition to acetaminophen and Co. also help natural painkillers such as St. John's wort or aloe vera. In addition, anticonvulsants should be taken, for example, sage and various herbal teas.
Accompanying this, various relaxation methods are available. These include measures such as yoga and physiotherapy, but also osteopathy, homeopathy and acupuncture. Pudendal neuralgia can be well treated by using these measures. In individual cases, such as severe pain or side effects that make physical exercise impossible, home remedies should be avoided. The patient must then adhere strictly to the medical guidelines and be treated if necessary in a hospital.