Pudendal Neuralgia Tests & Procedures

It is important to note that pudendal neuralgia is largely a “rule out” condition. In other words, because its symptoms can indicate a number of other problems, extensive testing is required to ensure that a different condition is not the source. Common conditions, infections and disorders which are evaluated include:

Coccygodynia (pain in or around the coccyx)
Piriformis syndrome (spasms and pain in the buttock)
Interstitial cystitis (bladder pressure or pain, pelvic pain)
Chronic or non-bacterial prostatitis (long term pain and urinary problems)
Prostatodynia (inflammation of the prostate)
Vulvodynia (pain, burning in vulval area)
Vestibulitis (pain in area surrounding entrance to the vagina)
Chronic pelvic pain syndrome
Anorectal neuralgia (pain in the ano-rectal region)
Pelvic contracture syndrome/pelvic congestion
Proctalgia (severe pain of pelvic floor muscle)
Anorectal pain syndromes such as:
- Proctalgia fugax
- Levator ani syndrome.
Urinary tract infection
Prostate infection
Vaginal infection
Sexually transmitted diseases (STDs)
Lyme’s disease
Multiple sclerosis
All colorectal cancers

Diagnosing Pudendal Neuralgia

In addition to eliminating other conditions, it is important to determine if the pudendal pain is caused by a true nerve entrapment or other dysfunctions related to compression/tension. Some tests can be used to help diagnose pudendal neuropathy; however, a large part of diagnosis also relies on a methodical study of the symptoms and personal medical history.

Very often there are other painful areas in the surrounding region such as the piriformis muscle or tailbone pain. Most of the time, this is a reaction to the nerve pain. However, in some cases, the piriformis muscle could pinch the nerve, becoming the main cause of pain. Since we are also experts in piriformis nerve entrapment, we are able to determine if this is the cause of the neuropathy, as well.

In addition to a physical exam, testing may be used, such as electromyography to measure the electrical activity of muscle tissue surrounding the pudendal nerve and magnetic resonance neurography (MRN) to image the relevant nerves. Image-guided pudendal nerve block, an injection with a local anesthetic performed by our experts, is the most important diagnostic test to determine if the condition is present.

The final diagnosis of pudendal neuralgia is based on a person having several or all of these criteria:

Typical PN symptoms (see above)
An abnormal electrophysiological test (MRN, MRI)
Pain elicited upon pressing along the anatomy of the nerve
Elimination of other diseases or conditions as the cause
A positive response to the pudendal nerve block

Pudendal Neuralgia Decompression Surgery

The Institute offers a specialized, minimally invasive procedure called pudendal nerve decompression. This procedure aims to carefully release compression points along the pudendal nerve pathway, relieving patients suffering from chronic pudendal nerve pain.

During the procedure, surgeons address areas where the nerve may be compressed or irritated by surrounding tissues, ligaments, or anatomical structures. By surgically decompressing these points of pressure, particularly in areas such as Alcock's canal or between the sacrotuberous and sacrospinous ligaments, pudendal neuralgia decompression helps restore normal nerve function and reduce the patient’s pain signals in that area.

After a pudendal neuralgia decompression surgery, patients typically stay in the hospital overnight, followed by 4-6 weeks of limited activity. Most patients can resume light daily activities within 3-4 weeks, gradually returning to normal activities over 8-12 weeks. Full recovery and continued improvement may extend up to six months.

Pudendal Pre-Op

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Pudendal Neuralgia Tests & Procedures