There is hope for women with a de­bil­i­tat­ing con­di­tion that can cause misery for suf­fer­ers, says Pro­fes­sor Ker­ryn Phelps.

The Australian Women's Weekly - - Contents -

the best treat­ment op­tions

Nerve pain is dif cult to deal with at the best of times, but for suf­fer­ers of pu­den­dal neu­ral­gia, the pain is only ex­ac­er­bated by the frus­trat­ing and lengthy process of be­ing cor­rectly di­ag­nosed. How­ever, once a di­ag­no­sis has been made, suf­fer­ers can ex­pe­ri­ence in­cred­i­ble re­lief at dis­cov­er­ing the cause, par­tic­u­larly when they learn that the ma­jor­ity of cases can be suc­cess­fully treated with a sim­ple course of phys­io­ther­apy.

“Pu­den­dal neu­ral­gia is a con­di­tion that is des­per­ate for pub­lic and pro­fes­sional aware­ness,” phys­io­ther­a­pist An­gela James of Syd­ney Pelvic Clinic, who spe­cialises in the treat­ment of pelvic pain, ex­plained to me. “When I rst started treat­ing PN over 10 years ago, I found many of my pa­tients had their pain for many years and had been mis­di­ag­nosed and poorly man­aged, and of­ten had been told they just had to live with it, or take med­i­ca­tions and try in­ef­fec­tive surg­eries. I feel it is slowly start­ing to im­prove, but there is a long way to go to have peo­ple un­der­stand PN the way they un­der­stand sci­atic pain.”

What is pu­den­dal neu­ral­gia?

The pu­den­dal nerve is one of the main nerves in the pelvis, pro­cess­ing sen­sa­tions from the per­ineum

(the area be­tween the gen­i­tals), the but­tocks and rec­tum.

The nerve, which runs from the sacrum in the lower back and along the in­side of your “sit bones” in the pelvis, can be­come trapped by spasm in sur­round­ing mus­cles or tight lig­a­ments. This mus­cle over­ac­tiv­ity might be set off by cy­cling, sit­ting for long pe­ri­ods, horse rid­ing or even con­sti­pa­tion.

Pre­vi­ous pelvic surgery or pelvic frac­ture can ir­ri­tate the nerve.

The nerve can also be dam­aged in child­birth. Men can also suf­fer from pu­den­dal neu­ral­gia.

There is a need for much greater aware­ness of pu­den­dal neu­ral­gia be­cause it is more com­mon than most peo­ple re­alise, and ef­fec­tive treat­ment is avail­able. Some­times an un­der­ly­ing cause is not found, but once you have a di­ag­no­sis you can start to work out how best to treat it.

What are the symp­toms?

The main symp­tom is pain or strange sen­sa­tions in any of the ar­eas sup­plied by the pu­den­dal nerve.

One of the rea­sons for the di­ag­nos­tic con­fu­sion, and the of­ten long de­lays in get­ting treat­ment, is that pu­den­dal neu­ral­gia can man­i­fest in many ways. I have heard pa­tients de­scribe it as a shoot­ing elec­tric shock, con­stant ir­ri­tat­ing itch or a zzing sen­sa­tion in the vulva or around the anus when there is no rash or other ex­ter­nal sign.

Pa­tients also talk of a burn­ing or raw sen­sa­tion in the vagina or rethra, shoot­ing pain in the pe­nis, an aching in the rec­tum or painful or­gasm.

There might be numb­ness, tin­gling or itch in the pelvic area, or in­creased sen­si­tiv­ity to touch. Some peo­ple feel a sud­den urge to go to the toi­let, uri­na­tion can be painful or there may be pain dur­ing sex. Women can feel as though there is a lump in the vagina or rec­tum, and have con­vinced them­selves they have a pro­lapse or bowel cancer.

What does treat­ment in­volve?

Some peo­ple are mis­tak­enly treated for thrush, uri­nary tract in­fec­tion or back prob­lems, but if pu­den­dal neu­ral­gia is left un­di­ag­nosed and un­treated it can be­come worse over time, and the stress of liv­ing with the con­di­tion can also have a signi cant im­pact on your phys­i­cal and men­tal health if it’s not treated.

The happy news is that once this con­di­tion is prop­erly di­ag­nosed, there are treat­ments avail­able. Di­ag­no­sis is usu­ally made by lis­ten­ing to the symp­toms, rather than ex­pen­sive scans or other in­ves­ti­ga­tions.

Your GP would al­ways start with the low­est level of in­ter­ven­tion, which just hap­pens to be the most ef­fec­tive – phys­io­ther­apy. Pu­den­dal neu­ral­gia has cre­ated an en­tire new area of phys­i­cal ther­apy, with spe­cialised phys­io­ther­a­pists fo­cused on re­liev­ing this con­di­tion.

Treat­ment in­volves teach­ing you how to re­lax or stretch your pelvic oor mus­cles, ad­just­ing your daily ac­tiv­i­ties, ad­just­ing your pos­ture and the way you sit, and man­ag­ing your toi­let habits.

The pain and other sen­sa­tions can be very dis­tress­ing, so med­i­ca­tion may be needed un­til treat­ment pro­vides re­lief.

If pelvic phys­io­ther­apy isn’t ef­fec­tive, you may be re­ferred to a gy­nae­col­o­gist with an in­ter­est in pu­den­dal neu­ral­gia for fur­ther in­ves­ti­ga­tion. This might in­volve rul­ing out un­com­mon causes, in­clud­ing be­nign or ma­lig­nant growths press­ing on the nerve, or scar tis­sue from pre­vi­ous pelvic surgery or trauma. They can dis­cuss other in­ter­ven­tions such as ul­tra­sound, nerve block in­jec­tions or surgery.

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