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Pudendal neuralgia is a condition caused by an injury to the pudendal nerve.
It is a condition similar to carpal tunnel syndrome where nerves supplying a hand are compressed between the ligaments going to fingers. The pudendal nerve is one of the major nerves in the pelvis, leading to the pelvic floor and external genitalia.
Treatment of pudendal neuralgia consists of conservative measures, medications, injections and surgery.
The first line treatment is avoidance of nerve re-injury. Patients are asked to stop all the activities which aggravate pain, such as prolonged sitting.
If there is no improvement in pain, the next step is physical therapy. Our physical therapist is experienced in pelvic floor dysfunction. Together with physical therapy, medications like Neurontin or Lyrica are used to facilitate regeneration of the nerve and decrease pain.
If those treatment modalities are not successful, patients are offered a series of 3 CT guided injections 6 weeks apart.
If there is no long term relief of pain, patients are offered surgery.
Surgery designed to decompress the injured pudendal nerve is done through 3-4 inch incisions on the buttocks, called transgluteal pudendal neurolysis.
There are other surgical approaches to decompress the nerve such as through the vagina or through an incision around anus. We strongly feel that the transgluteal approach gives the best visualization of the nerve. It also protects against future scar tissue and allows placement of a pain pump catheter to deliver a steady dose of local anesthetic around the nerve for 10 days after surgery.
After surgery, it is important to continue use of medications and physical therapy for at least one year. Please see the post-operation instructions.
Outcomes from pudendal nerve decompression surgery depend on multiple factors such as length, degree and cause of nerve injury.
Approximately 40% of patients who undergo transgluteal pudendal decompression have significant improvement in pain, 30% of patients have some improvement in pain, 30% have no change in pain and 1% may get worse.
It is important to remember that improvement is usually felt 4-6 months after surgery and maximum improvement is 12-18 months after surgery.
To learn more about our pelvic pain specialists, call 602.406.7564.