Pelvic Neuralgias: General Info, Causes, and Treatment

In pudendal neuralgia by Stephanie PrendergastLeave a Comment

By Stephanie A. Prendergast, MPT, Cofounder, PHRC Los Angeles

When considering neuropathic pain in the pelvis most people think of the pudendal nerve, but there are several other pelvic nerves that can also contribute to pelvic pain! 

The genitofemoral nerve supplies a portion of the genitals as well as the front of the thigh. This nerve is sometimes confused with the pudendal nerve since both nerves innervate the genitals and can cause genital pain.

The posterior femoral cutaneous nerve supplies the perineum and the back of the thigh. Similar to the pudendal nerve, this nerve can contribute to pain with sitting. 

Paresthetica meralgia, or lateral femoral cutaneous neuralgia, causes pain in the outside or lateral aspect of the thigh. This is most commonly caused by positioning during vaginal childbirth.

Obturator neuralgia causes pain in the inner or medial thighs. This nerve can become compromised during some pelvic organ prolapse repairs that utilize mesh products.

Ilioinguinal neuralgia causes pain in the inguinal canal, above the pubic bone and the top of the labia or base of penis. This nerve can become compromised during a Cesarean section or inguinal hernia repair. 

 

causes of Pelvic Neuralgias

Nerves do not like to be compressed or put on too much tension. When they are compressed or overly stretched they don’t get enough oxygen and can become irritated resulting in neuralgia.

Nerves can become compressed by surrounding soft tissue such as high tone muscles, fascial restrictions, and scar tissue.

Nerves can be overstretched during constipation or during some surgical procedures.

Nerves can also undergo direct trauma during a fall or surgical procedure.

treatmentofPelvicNeuralgias

Treatment for all pelvic neuralgias typically require a multidisciplinary approach including physical therapy, nerve blocks and medications.

Physical therapy may include manual therapy such as scar mobilization and myofascial release, as well as developing an appropriate home exercise program and recommending lifestyle modifications such as improving bowel mechanics.

In some cases nerve blocks can provide a temporary relief of neuropathic pain. More so, they can help to definitively diagnose which nerve is primarily responsible for the pain. 

Medications for neuropathic pain can decrease pain but can also provide a therapeutic effect. Therefore, all medications are not just a band aid for the pain, some actually facilitate nerve and nervous system healing. Be sure to talk to your pain management specialist about which medications may be most appropriate for you.

 

 

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Are you unable to come see us in person in the Bay Area, Southern California or New England?  We offer virtual physical therapy appointments too!

 

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page

Melissa Patrick is a certified yoga instructor and meditation teacher and is also available virtually to help, for more information please visit our therapeutic yoga page

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