Pudendal neuralgia / Cyclist’s syndrome
Pudendal neuralgia is a type of Chronic neuropathic Pelvic pain which originates due to entrapment or irritation of the Pudendal nerve. It is seen both in males and females with 2/3 rd preponderance in females.
The pudendal nerves are paired, meaning there are two nerves one on each side.
Origin: Nerve roots – S2-S4
Sensory supply – innervates the external genitalia of both sexes and the skin around the anus, anal canal and perineum
Motor supply – innervates various pelvic muscles, the external urethral sphincter and the external anal sphincter.
Autonomic supply– carries sympathetic nerve fibres to the skin of the S2-S4 dermatomal region.
Depending on the level of entrapment, Pudendal neuralgia is classified as
- Type I, in the sciatic notch
- Type II, the ischial spine and Sacrosciatic ligament
- Type IIIa, the Obturator internus muscle
- Type IIIb, the Obturator internus and Piriformis muscles
- Type IV, the distal branches of the pudendal nerve
Signs and symptoms
- A burning, tingling, or numbing pain – that is worse with sitting, and less severe or absent when standing or lying down.
- Initially, pain may be present only with sitting, but with time pain becomes more constant and severely aggravated by sitting.
- Sexual dysfunction
- Difficulties with urination and/or defecation
- Psychological stress due to the constant nagging pain and sexual dysfunction.
Risk Factors
- Compression, stretch, direct trauma to the nerve due to fall on the buttocks
- Functional entrapment where pain occurs during a compression or stretch maneuver. Repetitive microtraumas lead to persistent pain
- Prolong sitting and cycling
- Chronic straining with constipation and childbirth
- Fitness exercises, machines, weight lifting with squats, leg presses or karate with kickboxing and rollerblading
- Driving over rough roads or farm fields causing vibration trauma
JEEVISHA protocol for management of Pudendal neuralgia:
- Work ergonomics correction: Changing the Ergonomics at work place to avoid long hours of sitting, making the seat of the cycle comfortable in case of cyclists play very important role in the management of this condition. Expert faculty at JEEVISHA analysis the problems and helps the patient bring changes in their daily life.
- Medications: In the initial course of the management of this condition, patients may be prescribed some Neuropathic and muscle relaxant medications. Some other medications may be prescribed depending on the condition of the patient, which is individualized from patient to patient basis.
- Physiotherapy: Physiotherapy plays a very important role in fighting this painful condition as it is often found that these patients have some pelvic dysfunctions with in-coordinated functions of pelvic floor muscles. With a team of dedicated physiotherapist, patient is further evaluated and accordingly a plan is prepared for first reducing pain with different modalities and then slowly rehabilitating shoulder for normal functioning.
Targeted treatment
- Ultrasound /Fluoroscopic guided Pudendal nerve block
- Ultrasound/ Fluoroscopic guided Pudendal nerve Pulsed radiofrequency ablation