Taking The Shame Out Of Pudendal Neuralgia

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Taking The Shame Out Of Pudendal Neuralgia

http://www.medicalnewstoday.com/medicalnews.php?newsid=54832

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 s

Ms. Violet s has a Bachelor's degree in nursing and has been

an active member of a Pudendal Neuralgia forum for 2 ½ years. Having

suffered with Pudendal Neuralgia, she has seen a 75% improvement in

quality of life since her pudendal nerve decompression surgery in

France two years ago. Married with two children, Ms. s

resides in Southwestern United States. You can usually find Violet

at pudendal.info/phpBB2.

Further information is available at spuninfo.org or

tipna.org/forum/index.php.