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Overview of PN

This information is intended to be a brief introduction of pudendal neuralgia and was not written by a medical professional. Please note that this information should not be substituted for professional medical advice. Please speak with your medical care provider regarding questions or concerns about pudendal neuralgia or other medical conditions.

What Is Pudendal Neuralgia (PN)?


Pudendal neuralgia is chronic pelvic pain due to dysfunction or compression of the pudendal nerve [1]. It’s often referred to as “cyclist’s syndrome” because of its prevalence in the cycling and triathlete communities. The condition can impact cyclists of all genders.




Common Symptoms


There are a wide range of symptoms associated with pudendal neuralgia. While each person’s experience will be different, the most common symptom is pain along the pudendal nerve or one of its branches, including rectum, anus, urethra, perineum, and genital area [2]. Other symptoms may include:

  • Sensations of burning, numbness, increased sensitivity, electric shock or stabbing pain, knifelike or aching pain, feeling of a lump or foreign body in the vagina or rectum, twisting or pinching, pain and straining with bowel movements, straining or burning when urinating, painful intercourse, and sexual dysfunction [2].




Causes


Pudendal neuralgia can be caused by many different factors. It’s important for you to work with your medical care team to understand your own personal situation and what may be causing your symptoms. In some cases, it may be challenging to determine the exact cause of pain. The below list is intended to give an overview of common causes and doesn’t include all possible causes.

Common cause for cyclists*:

  • Compression or irritation of the pudendal nerve, often caused by the saddle:
    • Saddle being too narrow or too wide
    • Sitting on the saddle crooked
    • Overly aggressive riding position or general poor fit
  • Excessive hours in the saddle or frequent climbing

Oher common causes:

  • Trauma or injury caused by an accident, surgery, infection, or pregnancy
  • Hightone pelvic floor muscle dysfunction
  • Prolonged sitting
  • Inflammatory or autoimmune illness

*No widely spread clinical studies have been conducted on pudendal neuralgia and cycling. Listed causes are assumptions based off discussions with PTs, doctors and bike fitters who have extensive understanding of the pudendal nerve and anatomy of the pelvis.




Diagnosis


Diagnosing pudendal neuralgia can be challenging. The first step is to find a health care provider that’s familiar with pudendal neuralgia. Because the condition is rare, it can be difficult to find someone in the medical community that has extensive knowledge on the subject. If you have an OBGYN or primary care physician that you are comfortable with and trust, it may be helpful to get a recommendation or referral to a specialist through them. Otherwise, check out the resources section at the bottom of this page to find a health care provider.

After you find a health care provider that fits your needs, they should be able to provide you with a diagnosis. Some tests do exist to help diagnose PN such as nerve blocks or EMG, but results can be varied. It’s more typical for a diagnosis to be made based on the patient’s symptoms, history, and exclusion of other illnesses such as an infection or disease [3]. Your medical care provider can help determine the best method for a diagnosis.




Treatment


Treatment of pudendal neuralgia is multi-faceted in order to address several goals, including:

  1. Resetting the dysfunction and restoring the tissues to a homeostatic baseline [4].
  2. Addressing root causes of dysfunction in order to make any necessary changes to reduce irritation to the nerve
  3. Reducing daily pain and other symptoms

There is no singular treatment for PN. Most patients will need to utilize several different approaches during the recovery phase. You can work with your health care provider to create a treatment plan that’s customized for you.

Lifestyle changes

  • Stress and anxiety reduction/management
  • Breathing techniques - belly breathing to lengthen pelvic floor & slow down nervous system
  • Meditation
  • Prioritization of sleep
  • Postural changes

Cycling specific changes

  • Consider taking time off the bike to let your body heal
  • Once your body is ready to get back on the bike, get a professional bike fit. It’s important to find a fitter that has previous experience with pudendal neuralgia.
  • Add crosstraining into your fitness routine that doesn’t add stress to your pelvic floor (hiking, running, swimming, strength training, and yoga are a few options)

Physical therapy

  • Dry needling (with or without electrical stimulation)
  • Myofascial release
  • Nerve gliding
  • Other manual therapy

Medicinal approach

  • Pain reduction methods such as oral medications, topical medications, suppositories, botox injections
  • Diagnostic nerve blocks, which can also aid in pain reduction
  • In severe cases, nerve decompression surgery may be considered




Recovery


The recovery process will look slightly different for everyone. There is no correct or singular way to recover from pudendal neuralgia. It can be helpful to learn from other PN patients and compare recovery strategies. Check out the "Learn From Other Riders" of this website to see how other cyclists are working through the PN recovery process.

A full recovery from pudendal neuralgia is possible. That said, it’s important to understand that it doesn’t happen quickly. It may take patients several months to several years to fully recover, depending on the severity of their case and other factors. This isn’t intended to be demoralizing, but rather set expectations accordingly at the start. We live in a time where many issues can be fixed with a pill or a procedure, so we’ve been taught to expect easy fixes. If we approach pudendal neuralgia in this “quick fix” way, it’s easy to get discouraged or entirely lose hope of recovery. Switching to the mindset that recovery is a longer process that may include both progression and setbacks, it will help your mental outlook and your body’s ability to heal itself.





Additional Resources

There are some great resources written by medical professionals for more in-depth information on pudendal neuralgia. Check out these recommended resources:

Find a Pelvic Health Specialist

Finding a pelvic health specialist can feel daunting. There are several online resources to help aid in your search. The below resources were gathered by Kelly Sammis, DPT, OCS, CLT in her article Pudendal Neuralgia + Cycling Syndrome.

References

  1. “Pudendal Association.” Pudendal Neuralgia Association, 2019, pudendalassociation.org/.

  2. Harich, Jack, et al. “Pudendal Neuralgia Symptoms.” Health Organization for Pudendal Education, 3 July 2014, www.pudendalhope.info/node/9.

  3. Harich, Jack, et al. “Pudendal Neuralgia Diagnosis.” Health Organization for Pudendal Education, 9 July 2014, http://www.pudendalhope.info/node/69.

  4. Sammis, Kelly, and Aaron Castonguay. “Pudendal Neuralgia + Cycling Syndrome.” Holistic Pelvic Health, 18 Feb 2019, www.holisticpelvichealth.org/post/pudendal-neuralgia.

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