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.