The idea for this article came from my lovely partner Lachlan, every time he proofreads one of my assignments his first words are the same. “ Wow you managed to blame the pudendal nerve again”. Yes, I hate the pudendal nerve. In this article I will explain why and what you can do about it if your pudendal nerve is giving you trouble.
The pudendal nerve is formed by the nerves coming out of your low, low back, the bit of your back that is basically your tail bone. It exits the pelvis through these little holes in your sacrum to squeeze between two of the strongest and tightest muscles of the body (the glutes), loops around a super strong pelvic ligament and then heads back into the pelvis through another little hole in the sacrum. And if that wasn’t confusing enough it then does a loopdy loop through the pelvic floor muscles where it finally connects to the pelvic floor muscles and the skin around the vulva and the vagina.
Unsurprisingly this nerve sometimes gets compressed and stretched. This nerve really needs to have a good hard look in the mirror and consider its life choices!
Symptoms
People with pudendal nerve pain often describe their pain as feeling like burning, stabbing, or electric shocks in the pelvic area. The discomfort may be constant or come and go. It often worsens when sitting or riding a bike and may ease when standing or lying down. Other symptoms can include a feeling of a lump or pressure in the vagina.
Causes and Risk Factors
Cycling athletes, especially if your seat isn’t fitted right are more likely to irritate the pudendal nerve, pelvic surgery and child birth are also risk factors. In some cases, the exact cause isn’t clear. Both men and women can be affected, though it is more common in women. Because the pudendal nerve is one of the ways your brain can turn on your pelvic floor, especially around the bladder opening, compression to the pudendal nerve can increase the risk of urine leakage.
How we can help!
Never fear pelvic health physio can help! Your treatment will look different depending on your symptoms and whether your nerve is stretched or compressed.
One of the things we might suggest is releasing, stretching and relaxing the muscle that might be compressing it, your glutes and your pelvic floor muscles. We might try to teach you to glide the nerve. Even mild symptoms may get worse over time so it is important that you book an appointment as soon as you notice something isn’t quite right.
Here are a few ideas of things you should try in the lead up to your pelvic health physio appointment:
- Avoid tight pants and underwear
- Minimise seated bike riding and time sitting, try sitting on a donut cushion, moving the hole in the donut around until it is the most comfortable.
- Try stretching your glutes and your hips.
References
Abrams, P., Cardozo, L., Fall, M., Griffiths, D., Rosier, P., Ulmsten, U., . . . Wein, A. (2003). The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology (Ridgewood, N.J.), 61(1), 37-49. https://doi.org/10.1016/S0090-4295(02)02243-4
Bo, K., Frawley, H. C., Haylen, B. T., Abramov, Y., Almeida, F. G., Berghmans, B., . . . Wells, A. (2017). An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. INTERNATIONAL UROGYNECOLOGY JOURNAL, 28(2), 191-213. https://doi.org/10.1007/s00192-016-3123-4
Smith AR, Hosker GL, Warrell DW. The role of pudendal nerve damage in the aetiology of genuine stress incontinence in women. Br J Obstet Gynaecol. 1989 Jan;96(1):29-32. doi: 10.1111/j.1471-0528.1989.tb01572.x. PMID: 2923841.
