Pudendal Neuralgia: Symptoms, Causes, and How Pelvic Floor Physical Therapy Can Help

Chronic pain (like that caused by conditions such as Pudendal Neuralgia) is real. Let’s talk about finding relief together.

(graphic used with permission from Pelvic Guru).

What is Pudendal Neuralgia (PN)?

“Neuralgia” means nerve pain. Pudendal neuralgia is pain that happens when the pudendal nerve, which controls sensation and muscles in the vulva, penis, scrotum, rectum, and perineum, becomes irritated or compressed. This can cause sharp, burning, stabbing pain in these areas, making sitting or certain movements like squatting or walking uphill uncomfortable. The pain often worsens with deep hip movement or sitting for long periods.

What causes PN?

PN can be caused by direct injuries to the pudendal nerve during childbirth, pelvic surgery, or falls, as well as indirect causes like heavy lifting or chronic constipation, which lead to muscle tension and nerve pressure. It can be exacerbated by staying in the same position for a long time. An evaluation by a pelvic floor physical therapist can help identify specific causes based on your history and symptoms.

Is PN hard to diagnose?

Pelvic burning or sitting pain might suggest PN, but issues with other nerves like the ilioinguinal, obturator, and genitofemoral can also cause pelvic pain. Diagnosis relies on a detailed assessment of symptoms and medical history, as imaging and nerve tests can be unreliable. A pelvic floor specialist can help differentiate it from other nerve issues and develop an effective treatment plan.

Does PN cause any other issues?

Beyond pain, PN may cause bowel or bladder issues and sexual dysfunction. Symptoms vary depending on which three branches of the nerve (which control different functions) are affected. Any of these symptoms can significantly impact overall mood and quality of life.

Does PN ever go away on its own?

Pudendal neuralgia may improve on its own if the underlying cause is mild and resolves quickly. However, for persistent or severe cases, medical treatment is usually necessary, which may include pelvic floor physical therapy, lifestyle adjustments, pain management strategies, and sometimes medications.

What exercises should I avoid?

Anything that involves deep hip flexion, increases pelvic pressure, or requires prolonged sitting. This includes high impact movements with running or jumping, deep squats, hamstring stretches, stair climbing, heavy weightlifting with breath-holding, and cycling. These activities can stress the pudendal nerve and worsen symptoms.

What exercises can I still do?

Safe exercises include gentle activities like walking, swimming with a light kick, using an elliptical, modified yoga or Pilates, and light strength training. Remember - lighter, low impact exercise can still be incredibly effective! Certain core strengthening moves may be helpful, but it’s important to work with a pelvic floor physical therapist to develop a personalized exercise routine that addresses your specific needs and symptoms.

Is there anything else I can try at home to help manage symptoms?

Yes! The pudendal nerve is special because it has both motor and sympathetic sensory fibers. This means it can be exacerbated by stress BUT it also means it can be calmed down through relaxation. Techniques like diaphragmatic breathing (see Dr. Alex demonstrate HERE) and meditation can help ease stress, lower cortisol levels, and help bring the nerve back to normal function. You can also try gentle yoga stretches like happy baby pose, cat-cow pose, cobra pose, child’s pose and modified bridge pose. These methods are most effective when used in conjunction with other treatments.

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Are you experiencing any of the above symptoms? We're currently accepting new patients and would love to help you feel better! Visit www.bostonpelvicpt.com to schedule your initial evaluation, or email us with any questions: info@bostonpelvicpt.com.