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Pudendal Nerve Self-Care
#1
Self-Care for Pudendal Neuralgia by Stanley Antolak, MD

Chronic pelvic pain is a boundary "disease" affecting urology, colorectal, gynecology, physical medicine, neurology and other specialties. When sitting aggravates or causes the pelvic pain (perineum, genitals, coccyx, rectum, and pubic hair) we suspect pudendal neuralgia, often called pudendal nerve entrapment. Pudendal neuralgia is considered in all men and women with pelvic/urogenital pain with or without bladder symptoms or sexual dysfunction. A simple definition is perineal pain aggravated by sitting, reduced by standing, not present when recumbent and generally relieved when seated on a toilet seat.

The striking common feature in pudendal neuralgia patients is that flections activities of the hip (sitting, climbing, squatting, cycling, and exercising) induces or aggravates urogenital pain, chronic pelvic pain, or prostatitis-like pain. Many male patients played American Football, lifted weights and wrestled as teenagers and young adults. Often, the females were active in high school athletics, gymnastics, dance line, or cheerleading.

Our primary hypothesis is that hypertrophy of the muscles of the pelvic floor during the years of youthful athleticism causes elongation and posterior remodeling of the ischial spine. A posterior and medical shift of the ischial spine leads to juxtaposition of the sacrotuberous and sacrospinous ligaments that are normally quite separated at their insertions into the ischium. This change results in the "lobster claw" of two ligaments that can compress the pudendal nerve.

Self-Care - Perineal Hyperprotection

The goal is to stop irritating the nerve. Decreasing the neurotransmitters to the spinal cord lets your pain decrease. The other secondary problems will gradually improve.
This novel but remarkably effective treatment of self-care was based on the observations by the French (Robert and colleagues) that sitting on a toilet seat relieved pain and by our continuing observations of exercise-induced pain. Therefore, treatment is to sit with the weight of the body supported on the ischial tuberosities with the perineum suspended to relieve the pressure of the ischioanal fat against the nerve. Cessation of flexion activities is extremely important.

An office testing procedure, i.e., sitting on two parallel paperback books with the perineum suspended was added to our evaluation treatment of a large cohort of over 600 patients. Reduction of pain, in only a few minutes, can be dramatically effective in over 50% of the patients. Over a period of time this technique can cure pain, bladder irritability, and sexual dysfunction.

WHAT TO DO:

DO NOT SIT!

Go to our website and download and complete the pain, voiding and sexual function scores. These provide important reference information or benchmarks for future comparisons.
Continue your medications. Wear loose clothing that keeps pressure off of your bottom. Stop ALL exercises except on a flat surface or pushups.

DO NOT SIT!

If sitting is necessary, make a "perineal suspension pad". The concept is to sit on a pad that supports your body weight by the "sit bones" or ischial tuberosities to "suspend" the perineum, thus relieving pressure from the pudendal nerve.
Use the sitting pad at work, in your car, at church, at home, and in restaurants. (An alternative is to tuck a small book under one "sit bone" to lift your perineum slightly. One businessman used a leather folder with two tablets. He left it on his chair prior to sitting and tucked it under one sit bone. The second folder contained information for his meeting).
Stand to use your computer, read the paper, or does office work.

DO NOT SIT!

Buy a simple fold-down metal wall shelf to support your computer keyboard.
Lie down as much as possible to watch TV, read, etc.
At work, lie down on your lunch hour or breaks.
Use an extension handle to pick up clothes and objects from the floor.

DO NOT DO THESE ACTIVITIES!!!
  1. Squatting
  2. Lifting
  3. Yoga
  4. Cycling
  5. Bowling
  6. Skiing
  7. Piriformis stretches
  8. Ab crunches
  9. Sit-ups
  10. Gym workouts
  11. Leg presses
  12. Jogging
  13. Stair master
  14. Pilate
  15. Spinning
  16. Ellipse
  17. Step aerobics
  18. Exercise cycle
  19. Avoid climbing stairs.  Use an elevator or escalator whenever possible.
 
Results of self-care treatment

We have demonstrated statistically significant improvements in pain and bladder symptoms. As noted in "Abstracts" and "Importance of Questionnaires" on our website.

From the Prostatitis Foundation website – 2003:

“I suffered from chronic prostatitis for many years and went through all the usual treatments with no effect at all. Then I happened to run across an article by Dr. Stanley J. Antolak, Department of Urology, at the Mayo Clinic.  I am now convinced that my disease was biomechanical in nature and not organic.  I have been pain free for a while now and I suggest that others may benefit from the simple, free, treatment advocated by Dr. Antolak. The highlights of the article are:

  1. Ninety percent of men with prostatitis are considered to have Category III, non-bacterial prostatitis.
  2. Pudendal nerve entrapment (PNE) is frequently identified as the basis for the symptoms of “prostatitis.”
  3. Treatment consists, foremost of perineal hyper-protection. Punctilious avoidance of sitting and cycling and use of special seating pads, which spare the perineum from pressure, is often curative.  I hope this information will prove useful to other sufferers.”

From past patients:

Today is my third week back to work.  As of May 8th or 9th I have NO PAIN. I can’t believe it. I wake in the morning and expect to feel that old feeling and it’s not there. I am really delighted.
  • Rosemary
After 10 years of pain and 5 years of irritable bladder the self-care program has relieved my problems almost completely.  I have no pain. I can sit in a car or plane for over 3 hours.  I can eat at restaurants and drink any type of juice without irritating my bladder.  I do not have pain during or after intercourse.  I want to reduce the amitriptyline to 5 mg at bed time.
  • Teresa
“I drove from Michigan to Daytona Beach in December and returned in February.  I had episodes of tailbone pain during the trip both ways.  It lasted for 1-2 days both ways. I did not have bladder/prostate pain or rectal pain with the travel. I did use the special seat consistently during the driving.  I still take a ½ of a 25mg amitriptyline pill every night.
I feel that I have more penile sensitivity and ejaculate without pain.
Life is good. This treatment has changed my life.
  • Don M.
On June 27th of this year I visited you regarding chronic prostatitis. Since our visit I have followed your three suggestions: 1. Stopped riding my Air Dyne cycle. 2. Stopped lifting weights.  3. Purchased and used a gardener’s pad with the center section removed.  I’ve had zero pain in the prostate area. It’s wonderful not to be taking Bactrim and to be pain free.
  • Mike
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