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What could possibly be worse than struggling with a painful condition and feeling ashamed to discuss the problem due to its intimate nature? Such is the situation for many suffering with pudendal neuralgia, just a little known ailment that affects one of the most sensitive areas of the body. El born area is innervated through the pudendal nerve, named following the Latin word for shame. Due to the location from the discomfort coupled with inadequate knowledge, some physicians make reference to the pain sensation as psychological. But nothing could be further from the truth. Unfortunately, discussing the condition with gynecologists, urologists and neurologists often proves fruitless since most have no knowledge about the condition and for that reason cannot diagnose it.
Pudendal neuralgia is really a chronic or painful condition occurring both in women and men, although research shows that about two-thirds of these with the disease are women. The primary symptom is pain within the genitals or even the anal-rectal area and the immense discomfort is usually worse when sitting. The pain has a tendency to move about in the pelvic area and can occur on one or both sides of the body. Sufferers describe the pain sensation as burning, knife-like or aching, stabbing, pinching, twisting as well as numbness. These symptoms are usually accompanied by urinary problems, bowel irregularity and erectile dysfunction. Since the pudendal nerve accounts for sexual pleasure and is one of the primary nerves associated with orgasm, sexual activity is incredibly painful, otherwise impossible for a lot of pudendalites. When this nerve becomes damaged, irritated, or entrapped, and pudendal neuralgia sets in, life loses most of its pleasure.
So, where exactly may be the pudendal nerve? It lies deep in the pelvis and follows a path which comes from the sacral area and later separates into three branches, one visiting the anal-rectal area, someone to the perineum, and one to the penis or clitoris. Because there are slight anatomic variations with each person, a patient�s symptoms can depend which of the branches are affected, although often all three branches are participating. The fact that the pudendal nerve carries sensory, motor, and autonomic signals adds to the variety of symptoms that may be exhibited.
Because pudendal neuralgia is unusual and could be much like other diseases, it is usually misdiagnosed, leading some to possess inappropriate and unnecessary surgery. Early in the diagnosis process, it is crucially important to undergo an MRI from the lumbar-sacral and pelvic regions to find out that no tumors or cysts are pressing on the nerve. In addition, the individual should be screened for possible infections or immune diseases, as well as having an evaluation by a pelvic floor physical therapist to look for the health from the pelvic floor muscles and also to uncover whether skeletal alignment abnormalities exist. A precise 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 gives hrs of relief is another tool that can help to find out if the pudendal nerve may be the source of pain.
Probably the most common symptoms that accompanies pudendal neuralgia is severe depression. Many people using the disease have committed suicide due to the intractable pain. Because of this, you should consider antidepressants, as they possibly can help decrease the hypersensitivity of the sex organs along with relieving bladder problems. Certain anti-seizure drugs reportedly assistance to alleviate neuropathic pain while anti-anxiety drugs provide substantial relief of fits 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 methods are determined, it's imperative that patients with pudendal neuralgia receive adequate pain management because the pain associated with this illness can be intense.
Treatment depends upon the reason for distress towards the nerve. When the cause is not obvious people are advised to test the least invasive and least risky therapies initially.
Physical therapy which includes myofascial release and trigger point therapy internally with the vagina or rectum assists with relaxing from the pelvic floor, particularly if pelvic floor dysfunction is the reason for nerve irritation. If no improvement is located after six to 12 sessions, nerve damage or nerve entrapment might be considered.
Botox is now utilized in medical settings to unwind muscles and shows promise when injected into pelvic floor muscles; though finding a physician skilled 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 go for pudendal nerve decompression surgery.
You will find three published methods to pudendal nerve decompression surgery but there's debate among members of the pudendal nerve entrapment community as to which approach is the best. Since there are advantages and disadvantages to every approach, patients face considerable confusion when deciding which type of surgery to choose. Because there are merely a handful of surgeons on the planet who perform these surgeries, most sufferers have to travel long distances for help. Moreover, the recovery period is usually painful and takes anywhere from 6 months to many years since nerves heal very slowly. Unfortunately, early statistics indicate that only 60 to 80 percent of surgeries are successful in offering a minimum of a 50 percent improvement. Patients whose surgeries aren't successful or who do not desire to pursue surgery have the option of trying an intrathecal pain pump which delivers pain medication locally helping to prevent some of the negative effects of oral medications. Others pursue the option of a neurostimulator with the idea to the sacral area or directly to the pudendal nerves. They are relatively recent therapies for pudendal neuralgia so it is hard to predict success rates. Some pudendalites have devised ingenious contraptions for pain relief which range from u-shaped cushions cut from garden pads all the way to balloons filled with water, frozen, and inserted into the vagina. They have a popular cushion for sitting and lots of have particular computer set-ups for office and home use in order to avoid sitting. In most cases, jeans are a no-no, so patients revise their wardrobes to include baggy pants and baggy underwear - if they're in a position to tolerate wearing underwear.
Clearly more scientific studies are required to find effective methods to better manage the pain and debilitation of pudendal neuralgia. On the other hand, family and friends 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 all those struggling with this affliction.
