Dear Doctors: I have seen my doctor and gynecologist for pain in my groin area that gets worse when I'm sitting or if I squat. It worsens at the end of the day. I'm told it could be pudendal neuralgia. I've never heard of that. Can you please explain what that is?
Dear Reader: The term “neuralgia” refers to abnormal sensations that arise in a nerve pathway. They can range from numbness, tingling or burning to pain that is described as sharp, stabbing or like an electrical shock. Some people also become hypersensitive to cold or to touch. When this occurs, something as minor as lightly brushing the skin can result in pain or discomfort.
Causes include inflammation, infection and the effects of certain chronic diseases. Physical pressure on a nerve, or on the tissues or structures adjacent to a nerve, can also cause the condition. That's the case with pudendal neuralgia.
The pudendal nerve originates in a bundle of nerves located at the lower back of the pelvic wall and runs through the pelvic region and buttocks. It is a paired nerve, which means it is present on both sides of the body. The nerve and its branches animate and provide sensation to much of the pelvic region. It is crucial to passing urine and feces, and to sexual sensation and function.
Damage or injury to the nerve can cause the pain and other sensations you have described. It can also interfere with voiding the bowels or bladder, and with sexual function.
The path and location of the pudendal nerve leaves it somewhat vulnerable to injury. This includes from prolonged sitting and activities such as cycling or horseback riding.
Childbirth, during which the nerve is repeatedly stretched, can also play a role. Typically, any symptoms related to the pudendal nerve recede within a few weeks of giving birth. But in some cases, such as during a difficult or prolonged labor, the nerve can become inflamed or even damaged.
Diagnosis of the condition begins with a physical exam, including a vaginal or rectal exam. Scans, such as an MRI, can be helpful in identifying possible points of nerve entrapment. In some instances, a nerve block may be used as a diagnostic aid. This involves disabling the nerve with an injection and then gauging if the symptoms have abated.
Treatment is a mix of behavioral changes, physical therapy and the use of medications to manage pain and inflammation. It's also important to avoid any painful stimuli. In your case, this includes sitting and squatting, and any activities that involve hip flexion. For patients whose pain arises from muscle spasms, physical therapy can be helpful.
Medications to manage nerve pain, including analgesics, muscle relaxants, antidepressants and anticonvulsants, may be prescribed. Studies show that a nerve block that includes an anesthetic plus a corticosteroid can confer pain relief that lasts for up to a month.
When nerve entrapment has been confirmed, surgical decompression may be needed. This now includes several minimally invasive laparoscopic techniques. For a diagnosis, seek out a neurologist familiar with this condition.
(Send your questions to firstname.lastname@example.org, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)