Pudendal Neuralgia: What Is It and Can Pelvic Physiotherapy Help?

If you’ve been diagnosed with pudendal neuralgia, you may have been experiencing persistent pelvic pain, burning, tingling or discomfort for months—or even years.

Many people arrive at our clinic feeling frustrated because they finally have a diagnosis but still don’t fully understand what’s causing their symptoms or what they can do about them.

The good news is that pelvic physiotherapy may play an important role in helping manage pudendal neuralgia and identifying factors that may be contributing to ongoing symptoms.

What Is Pudendal Neuralgia?

Pudendal neuralgia refers to pain involving the pudendal nerve.

The term itself simply means “pain in the pudendal nerve distribution.”

One challenge with this diagnosis is that it describes where the pain is occurring, but not necessarily why the pain is occurring.

In many cases, the diagnosis is only the starting point.

A thorough assessment is needed to determine what may be irritating or sensitising the nerve.

Where Is the Pudendal Nerve?

The pudendal nerve travels through the pelvis and supplies sensation to several areas including:

• The anus and anal canal

• The perineum

• The vulva, penis and surrounding genital structures

Because the nerve follows a complex path through the pelvis, there are several locations where it can become irritated.

Common Symptoms of Pudendal Neuralgia

Symptoms vary from person to person but may include:

• Burning pain

• Electric shock sensations

• Tingling or prickling

• Pelvic aching

• Rectal pain

• Perineal pain

• Genital pain

• Pain when sitting

• Pain during sexual activity

• Increased symptoms after bowel motions

  
  

What Causes Pudendal Neuralgia?

There is rarely one single cause.

Contributing factors may include:

• Falls onto the tailbone or buttocks

• Childbirth-related injuries

• Pelvic surgery

• Cycling or prolonged sitting

• Chronic constipation and straining

• Pelvic floor muscle overactivity

• Hip or lower back dysfunction

• Persistent pelvic pain conditions

Often several contributing factors are present at the same time.

The Importance of the Pelvic Floor

When a nerve becomes irritated, the body often responds by increasing muscle tension around the area.

In the pelvis, this commonly involves the pelvic floor muscles.

Tight or overactive pelvic floor muscles may contribute to ongoing symptoms by reducing space and movement around the nerve.

Nerves function best when they have adequate blood flow, mobility and room to move.

How Pelvic Physiotherapy May Help

Pelvic physiotherapy aims to identify and address the factors contributing to symptoms.

Treatment may include:

• Education about pain and the nervous system

• Pelvic floor muscle assessment and rehabilitation

• Movement and exercise prescription

• Bowel management strategies

• Activity modification

• Relaxation and down-training techniques

• Collaboration with your GP and specialist team

  
  

Every treatment plan is tailored to the individual.

What If I’ve Had Symptoms for Years?

Many people with pudendal neuralgia have been living with symptoms for years before finding appropriate care.

When pain has been present for longer than three months, changes can occur within the nervous system that may contribute to ongoing sensitivity.

This does not mean recovery is impossible.

It simply means treatment often needs to address more than the nerve itself.

A comprehensive approach is often the most effective.

Do I Need a Referral?

No.

You can book directly with a pelvic health physiotherapist.

If you’re waiting for specialist appointments or investigations, physiotherapy may still be appropriate and can often be started while you wait.

What Happens at the First Appointment?

Your initial consultation will include:

• A detailed history

• Discussion of bladder, bowel and pelvic symptoms

• Review of previous investigations and treatments

• Physical assessment where appropriate

  
  

Internal examinations are never mandatory and will only be performed with your informed consent.

Seeking Help

If you’re experiencing persistent pelvic pain, burning, tingling or symptoms consistent with pudendal neuralgia, early assessment can be beneficial.

A comprehensive pelvic health assessment can help identify contributing factors and determine whether pelvic physiotherapy may be an appropriate part of your treatment plan.