Pudendal nerve disorders, such as neuralgia or entrapment, require a multidisciplinary approach that often includes physical therapy. Pudendal nerve disorders cause numbness, pain or tingling throughout area innervated by the pudendal nerve or its branches, including the anus, rectum, perineum, urethra, genital area, pelvis and upper legs. Physical therapy performed by a therapist trained in pelvic floor disorders along with lifestyle changes may help relieve these symptoms.
Physical Therapy Evaluation
Physical therapy starts with an evaluation of your symptoms and the things that cause your symptoms. Common signs of pudendal nerve involvement include pain or numbness while sitting or riding a bike, any change in your bowel movements or your ability to urinate, pain during sex, any type of gastrointestinal upset, pain during gynecologic or rectal exams, or the use of a tampon, explains Hina Sheth, who owns Rebalance Physical Therapy in Narberth, Pennsylvania. Your evaluation continues with an inspection of biomechanical or structural causes of pudendal nerve symptoms, such as muscle imbalances and joint alignment. Upon treatment of these problems your physical therapist will look for and treat trigger points caused by the connective tissue layer.
Physical Therapy Treatment
Treatment options vary based on the causes of the pudendal nerve disorder. Common goals of treatment include diminishing trigger points -- any spot in your skeletal muscle or fascia that causes pain not related to inflammation or injury, lengthening the pelvic floor, eliminating connective tissue restrictions, decreasing tension along the path of the pudendal nerve and its branches, and reducing neural tension cause by physiological or mechanical abnormalities such as tight muscles or narrow nerve paths. These treatments may require internal vaginal or rectal manipulation, connective tissue manipulation, specialized stretches and exercises, or trigger point injections. Your therapist may even recommend that you see a psychologist, homeopath or other specialist based on your symptoms.
Home Help
Lifestyle changes and some home based exercises may also help decrease your pudendal nerve symptoms. Avoid any activities or postures that cause you pudendal nerve symptoms such as squatting, bringing your knee toward your chest, sitting for prolonged periods, riding a bike or straining to have a bowl movement, advises Sheth. She recommends those with trigger points to try placing a softball-sized, soft ball on the trigger point by sitting on it or leaning on it against a wall and rolling it over the trigger point. Sheth also suggests learning diaphragmatic breathing, which relaxes the pelvic floor to decrease the pressure placed on the pudendal nerve, and learning how to perform a reverse Kegel. Kegel exercises increase the pressure placed on your pelvic floor, but if you learn how to gently let go of your pelvic floor muscles as though you were passing urine you may relieve some tension in the pelvic floor. Practice reverse Kegel's two to three times each time you urinate.
Expert Opinion
Avoid self-treatment for possible pudendal nerve disorders. Self-treatment often results in permanent or long-term damage to the pudendal nerve complex, advises Megan Horeis, a pelvic floor physical therapist at Allied Services in Scranton, Pennsylvania. Horeis advises you to consult your doctor, and to seek treatment and advice from a pelvic floor physical therapist prior to trying any exercise or treatment option suggested for pudendal nerve disorders. The women's health section of the American Physical Therapy Association and the Health Organization for Pudendal Education both provide a list of physical therapists who specialize in pelvic floor disorders.
References
- Hina Sheth, MS, PT, OCS, MTC; Rebalance Physical Therapy; Narberth, Pennsylvania
- Megan Horeis, PT; Allied Services; Scranton, Pennsylvania
