What is Pudendal Neuralgia? Signs, Causes, and Proven Treatment Options

Physical Therapy: Treatment for Pudendal Neuralgia

Living with persistent pelvic pain can be frustrating, confusing, and sometimes even life-altering. For some people, the source of this discomfort isn’t well known or often misunderstood. One such condition is pudendal neuralgia—a type of nerve-related pelvic pain that’s frequently underdiagnosed yet has a major impact on quality of life.

Pain is the main symptom of pudendal neuralgia. The good news? Pudendal neuralgia is treatable. With approaches like physical therapy, pain management strategies, nerve blocks, and lifestyle changes, many people can reduce their symptoms and regain control of their lives.

This comprehensive guide will walk you through everything you need to know: what pudendal neuralgia is, why it happens, how to recognize it, and how specialists like the team at Pelvis NYC can help.

What is Pudendal Neuralgia?

The pudendal nerve is one of the most important nerves in your pelvic region. It runs through the pelvic floor and carries both sensation and motor function to areas including the anus, perineum, genitals, clitoris, and penis. The perineal branch of the pudendal nerve provides sensory innervation to the perineal region. It plays a vital role in urinary control, bowel function, and sexual health. The pudendal nerve also controls the sphincter muscles responsible for opening and closing the urethra and anus.

Pudendal neuralgia occurs when this nerve becomes irritated, compressed, or damaged. This can lead to nerve pain described as burning, stabbing, tingling, or shooting sensations. Because the nerve supplies such sensitive areas, including the rectum as part of its sensory distribution, the pain can be intense and disruptive.

Unlike muscle pain, pudendal neuralgia often worsens with sitting and may improve when standing or lying down. Many patients report that the discomfort feels worse throughout the day, especially after long periods of sitting.

Unfortunately, pudendal neuralgia is often misdiagnosed as a bladder problem, prostatitis, or gynecological condition, which delays proper treatment. That’s why awareness is crucial.

Pelvic Floor Muscles and Pudendal Neuralgia

The pelvic floor muscles form a supportive sling across the base of your pelvis. They hold your bladder, bowel, and reproductive organs in place. The pudendal nerve runs directly through this muscular region, making it vulnerable to compression.

When these muscles are too tight, weak, or imbalanced, they can place extra pressure on the pudendal nerve. This is why pelvic floor dysfunction and pudendal neuralgia often go hand in hand.

For example:

  • Overly tight pelvic floor muscles may trap or irritate the nerve.
  • Weak or imbalanced muscles may cause structural shifts that increase nerve compression.
  • Scar tissue from surgery or childbirth can also contribute to pudendal nerve entrapment.

The obturator internus muscle, which is located on the lateral wall of the pelvis, can also contribute to pelvic and perineal pain when it is tight or in spasm. Entrapment or spasms of this muscle may cause tenderness and should be considered during physical examination to help differentiate pelvic pain syndromes.

Understanding the relationship between muscles and nerves is key to finding the right treatment—especially since many people assume pelvic pain is purely muscular when in fact the nerve is involved.

Recognizing Nerve Pain and Chronic Pain

Not all pain feels the same. Muscle soreness after a workout is very different from nerve pain. With pudendal neuralgia, people often describe sensations like:

  • Burning or stinging
  • Electric shock–like jolts
  • Numbness or tingling
  • Stabbing pain deep in the pelvis

These are typical symptoms of pudendal neuralgia, which may affect the sensory distribution of the pudendal nerve and significantly impact quality of life.

Pudendal neuralgia is a form of neuropathic pain, and if untreated, this pain can become chronic neuropathic pain, meaning it lasts for months or even years. Chronic pudendal neuralgia can interfere with sitting at work, driving, using the restroom, and sexual activity. Patients suffering from chronic neuropathic pain may also experience emotional distress, such as depression and frustration, especially when earlier interventions have failed to provide relief.

The longer nerve pain persists, the harder it can be to treat, which is why early pain management strategies are so important.

Pelvic Pain Symptoms

Pudendal neuralgia symptoms can vary, but some of the most common include:

  • Pain in the genitals, anus, or perineum
  • Perineal pain, often chronic and neuropathic in nature
  • Discomfort that worsens when in the sitting position but improves when standing or lying down
  • Burning or tingling sensations in the pelvic region
  • Changes in skin sensation, such as numbness or sensitivity, in the pelvic area between the genitals and anus
  • Numbness or sensitivity in the buttocks or thighs
  • Sexual dysfunction and sexual problems, including pain during sex, erectile dysfunction, or difficulty reaching orgasm
  • Frequent urge to urinate or discomfort with bowel movements

Both men and women can experience pudendal neuralgia, though the triggers may differ. For example, men may notice symptoms after cycling or prolonged sitting, while women may develop it after childbirth or pelvic surgery.

Why is Pudendal Neuralgia Underdiagnosed?

One of the biggest challenges with pudendal neuralgia is that it’s often mistaken for other conditions. Because the symptoms overlap with urinary tract infections, prostatitis, gynecological problems, or even lower back issues, many patients see multiple doctors before receiving a proper diagnosis. Clinicians must consider other causes of pelvic pain and review all possible diagnoses to ensure accurate assessment and treatment.

The lack of awareness among healthcare providers contributes to delays in treatment. The diagnostic process involves ruling out other diagnoses and applying specific diagnostic criteria, such as the Nantes criteria, to confirm pudendal neuralgia. Patients often feel frustrated, unheard, or dismissed, which can worsen their overall mental health. Raising awareness about pudendal neuralgia helps ensure that more people get the care they deserve.

Physical Examination for Pudendal Neuralgia

Diagnosing pudendal neuralgia usually involves a thorough physical examination and medical history review. A pelvic health specialist may check for:

  • Tenderness along the pudendal nerve pathway
  • Muscle tension in the pelvic floor
  • Postural or structural issues contributing to nerve irritation
  • Rectal and vaginal examinations to assess for nerve involvement and exclude other diagnoses

During the anatomical assessment, the examiner may trace the path where the pudendal nerve travels through the pelvis, noting areas where the nerve travels through tight anatomical spaces that could lead to irritation or compression.

In some cases, imaging tests (like MRI) or a diagnostic nerve block are used to confirm the diagnosis. Early and accurate diagnosis can make treatment more effective and prevent chronic pain from worsening.

How Can Physical Therapy Help Pudendal Neuralgia?

One of the most effective conservative approaches to treating pudendal neuralgia is physical therapy. At Pelvis NYC, we specialize in pelvic floor physical therapy, which focuses on restoring balance, mobility, and function to the pelvic region.

Here’s how physical therapy can help:

  1. Pelvic Floor Muscle Release
    Tight pelvic floor muscles can compress the pudendal nerve. Through manual therapy and targeted relaxation techniques, a therapist can release tension and reduce nerve pressure.
  2. Posture and Alignment Correction
    Poor posture, especially when sitting, can worsen pudendal nerve pain. Physical therapy includes strategies to improve spinal and pelvic alignment, which reduces daily stress on the nerve.
  3. Tailored Exercises
    Gentle strengthening and stretching exercises help rebalance the pelvic floor and surrounding muscles. Over time, this improves circulation, reduces inflammation, and prevents recurring pain.
  4. Nerve Mobilization Techniques
    Some therapists use techniques designed to “free up” nerves that may be restricted by tight tissues. This helps restore natural nerve mobility.
  5. Education and Self-Management
    Patients learn strategies for sitting more comfortably, modifying activities like cycling, and avoiding positions that trigger pain.

The beauty of physical therapy is that it’s non-invasive and focuses on long-term healing rather than temporary fixes. Many patients find significant relief within weeks of starting treatment.


Nerve Block for Pudendal Neuralgia

When pain is severe or persistent, a pudendal nerve block may be recommended. This is a specific type of injection used for both diagnosis and treatment of pudendal neuralgia. The procedure involves injecting an anesthetic (sometimes combined with steroids) around the pudendal nerve, often using image-guided techniques. Injections are frequently performed in anatomical areas such as Alcock’s canal to accurately target the nerve.

Benefits of a pudendal nerve block include:

  • Immediate pain relief in many cases
  • Diagnostic value (if the pain disappears temporarily, pudendal neuralgia is confirmed)
  • Breaking the cycle of chronic pain, making physical therapy more effective
  • Potential for repeated pudendal nerve blocks to provide ongoing pain relief

While pudendal nerve blocks aren’t a cure, they can provide a window of relief that allows other treatments to work better.

Pain Management Options

Managing pudendal neuralgia often requires a multifaceted approach. Beyond physical therapy and nerve blocks, other pain management strategies may include:

  • Medications such as nerve pain drugs (gabapentin or pregabalin), muscle relaxants to help relax pelvic floor muscles, and topical creams for localized relief and to calm nervous system sensitivity
  • Nerve stimulation (such as TENS or neuromodulation) as a non-invasive treatment option
  • Acupuncture or biofeedback for relaxation and pain reduction
  • Counseling or therapy to address the emotional toll of chronic pain

The goal is to reduce pain to a manageable level while improving quality of life.

Management of Pudendal Neuralgia

The best management of pudendal neuralgia is a personalized, step-by-step plan. Treatment usually begins with conservative approaches like physical therapy and lifestyle changes. If these don’t fully relieve symptoms, nerve blocks or medications may be added.

For the small percentage of people who don’t improve with non-invasive methods, surgical decompression of the pudendal nerve may be considered—but this is rare and reserved for severe cases. In such situations, decompression surgery, specifically pudendal nerve decompression, is an important option. Various surgeries may be considered to relieve nerve compression, especially when scarring, congenital issues, or trauma are involved.

Lifestyle Changes

Certain lifestyle changes can make daily life easier and reduce flare-ups:

  • Use cushions designed to reduce pressure on the perineum when sitting.
  • Take breaks from sitting to stand, stretch, or walk.
  • Modify activities like cycling or horseback riding that increase nerve irritation.
  • Stay hydrated and eat a fiber-rich diet to avoid constipation, which can worsen symptoms.
  • Practice relaxation techniques like yoga or meditation to reduce pelvic floor tension.

These small changes can add up to major improvements over time.


Other Conditions to Rule Out

Because pudendal neuralgia symptoms mimic other issues, it’s important to rule out other conditions, including:

  • Interstitial cystitis (bladder pain syndrome)
  • Prostatitis (inflammation of the prostate in men)
  • Endometriosis (in women)
  • Sciatica or herniated discs
  • Infections or hernias

A thorough evaluation ensures the right treatment is chosen.


Prognosis and Outlook for Pudendal Neuralgia

Living with pudendal neuralgia can be challenging, but the outlook is not the same for everyone. The prognosis largely depends on how early the condition is diagnosed, the underlying cause, and how well the treatment plan is tailored to the individual’s needs. With a proactive approach—including physical therapy, lifestyle changes, and other targeted treatments—many people experience significant pain relief and a noticeable improvement in their symptoms.

Early diagnosis is key. When pudendal neuralgia is identified and managed promptly, there’s a much better chance of reducing nerve pressure and preventing chronic pain from becoming a long-term issue. A comprehensive treatment plan that addresses all aspects of the condition—such as muscle imbalances, nerve irritation, and daily habits—can make a real difference in quality of life.

For some, symptoms may persist despite best efforts, and in rare cases, severe pain can lead to ongoing discomfort or disability. In these situations, more advanced interventions like surgical decompression of the pudendal nerve may be considered to relieve pressure and restore function.

Ultimately, working closely with your healthcare provider to develop a personalized treatment plan is essential. With the right combination of therapies and support, it’s possible to manage symptoms, regain comfort, and improve overall well-being—even with a chronic condition like pudendal neuralgia.


Deterrence and Patient Education

Education is a powerful tool in both managing and preventing pudendal neuralgia. Understanding how everyday activities and habits can affect the pudendal nerve is the first step toward reducing the risk of severe pain and long-term complications.

Patients should be aware that certain activities—like prolonged sitting, horse riding, or anything that puts direct pressure on the pelvic floor—can aggravate symptoms or even contribute to the development of pudendal neuralgia. Making simple lifestyle changes, such as taking regular breaks from sitting, using supportive cushions, and modifying exercise routines, can help protect the nerve and minimize discomfort.

Maintaining strong and flexible pelvic floor muscles is also crucial. Regular stretching and gentle exercises can reduce muscle tension, improve nerve function, and support overall pelvic health. Avoiding habits that increase pelvic pressure, such as straining during bowel movements or lifting heavy objects improperly, can further decrease the risk of nerve irritation.

Healthcare providers play a vital role in patient education by offering resources, guidance, and support. Educational materials—whether brochures, online articles, or support groups—can empower individuals to recognize symptoms early, seek timely treatment, and make informed decisions about their care.

By staying informed and proactive, patients can take control of their condition, reduce the likelihood of severe pain, and improve their quality of life. Together, patients and providers can develop effective strategies for managing symptoms, preventing flare-ups, and ensuring the best possible outcomes for those living with pudendal neuralgia.

Living with Pudendal Neuralgia: Patient Tips

Living with pudendal neuralgia can be overwhelming, but small strategies help:

  • Keep a pain journal to track triggers and flare-ups.
  • Join support groups where you can share experiences and coping tips.
  • Pace your activities—alternate sitting, standing, and lying down to avoid prolonged pressure.
  • Don’t hesitate to seek mental health support—chronic pain can affect mood and outlook.

When to Seek Medical Help

You should seek medical attention if you have:

  • Persistent pelvic pain lasting more than a few weeks
  • Pain that interferes with sitting, sex, or daily activities
  • Symptoms that worsen over time despite home care

Early treatment prevents complications and helps avoid long-term nerve damage.


Book Your Appointment at Pelvis NYC

At Pelvis NYC, we specialize in diagnosing and treating conditions like pudendal neuralgia. Our team uses advanced pelvic floor physical therapy, personalized treatment plans, and holistic pain management strategies to help patients regain control of their lives.

pudendal neuralgia

👉 Don’t let pudendal neuralgia control your day-to-day life. Book your appointment at Pelvis NYC today and get a FREE 15-minute teleconsultation to start your path toward relief.


FAQs About Pudendal Neuralgia

1. Can pudendal neuralgia go away on its own? In some cases, mild nerve irritation may improve with rest and lifestyle changes. However, persistent symptoms usually require medical intervention.

2. Is pudendal neuralgia permanent? Not necessarily. With the right treatment—including physical therapy, nerve blocks, and lifestyle modifications—many patients experience significant improvement or even full recovery.

3. How do I sit with pudendal neuralgia? Using a special cushion (such as a U-shaped or donut cushion) reduces pressure on the perineum. Taking frequent standing breaks also helps.

4. Who is at risk for pudendal neuralgia? Anyone can develop it, but risks are higher in people who cycle often, sit for long periods, or have a history of pelvic surgery, trauma, or childbirth.

5. How is pudendal neuralgia diagnosed? Diagnosis typically includes a physical examination, review of symptoms, imaging if needed, and sometimes a diagnostic nerve block.

6. Does pudendal neuralgia affect life expectancy? No, pudendal neuralgia does not impact overall life expectancy. While it can significantly affect quality of life, it is not a life-threatening condition.

Final Thoughts

Pudendal neuralgia is a challenging condition, but it doesn’t have to control your life. With early diagnosis, comprehensive management, and the right blend of physical therapy, pain management, and lifestyle changes, many people find real relief.

If you’re struggling with ongoing pelvic pain and suspect pudendal neuralgia, the team at Pelvis NYC is here to help with compassionate, expert care.

Pudendal Nerve Entrapment: How Physical Therapy Can Help?

Pudendal Nerve Entrapment: How Physical Therapy Can Help?

If you’re a man experiencing unexplained pelvic discomfort, pain during sitting, or persistent urinary or sexual issues, you might be dealing with a little-known condition called pudendal nerve entrapment (PNE). PNE occurs when an entrapped pudendal nerve leads to nerve compression, resulting in chronic pelvic pain. It’s often misunderstood, misdiagnosed, and—worst of all—left untreated.

This blog will walk you through what pudendal nerve entrapment is, what causes it, how to identify it, and most importantly, how physical therapy can play a major role in recovery.

What Is Pudendal Nerve Entrapment?

The pudendal nerve is one of the main nerves in the pelvis. It runs from the lower back through a small canal in the pelvis (called Alcock’s canal) and branches out to serve the genitals, anus, and perineum (the area between the genitals and anus).

The pudendal nerve supplies motor and sensory innervation to the perineal region. It ncludes the external genitalia and anal sphincter, playing a crucial role in continence, sensation, and sexual function. It controls sensation and some muscle movements in that region, including the pelvic floor.

“The main branches of the pudendal nerve include the perineal branch, dorsal nerve, and inferior anal nerve. The perineal branch innervates the perineal muscles and skin, the dorsal nerve provides sensation to the penis in males and the clitoris in females, and the inferior anal nerve supplies motor innervation to the external anal sphincter and sensory innervation to the anal canal.”

When this nerve becomes compressed, irritated, or entrapped—often between ligaments or by tight muscles in the pelvis—it can lead to a painful condition called pudendal neuralgia. Pudendal nerve compression is a common cause of these symptoms. The resulting nerve pain can feel like burning, stabbing, aching, or numbness in the genitals, perineum, or rectum.

After passing through Alcock’s canal, the pudendal nerve is susceptible to entrapment, which can result in pudendal canal syndrome—a specific form of nerve entrapment within the pudendal canal.

Though it’s not widely recognized, pudendal nerve entrapment can affect both men and women. Symptoms of pudendal neuralgia may include genital numbness, sexual dysfunction, and bladder or bowel issues. Men, however, often report symptoms like:

  • A dull or sharp ache in the perineum or lower pelvis
  • A feeling of “sitting on a golf ball” or lump in the groin
  • Erectile dysfunction that doesn’t respond to typical treatments
  • Urinary urgency, frequency, or incomplete emptying
  • Pain that worsens while sitting and improves when standing or lying down

Understanding Pudendal Nerve Pain (Pudendal Neuralgia)

Pudendal neuralgia is a type of chronic pain that stems from irritation or damage to the pudendal nerve. Chronic pudendal neuralgia is a long-term condition that can be associated with chronic perineal pain, pelvic and perineal pain, and other chronic pain syndromes. It may come and go—or it might persist and affect your quality of life significantly. Because symptoms vary and mimic other conditions, it’s frequently misdiagnosed as prostatitis, pelvic floor dysfunction, or even psychological distress.

The pain may be:

  • Sharp, burning, or electric-shock-like
  • Localized to the penis, scrotum, perineum, anus, or inner thighs, with pelvic and perineal pain being common manifestations
  • Made worse by activities like cycling, squatting, or even sitting

If left untreated, it can contribute to anxiety, depression, and withdrawal from physical or intimate activities. Some patients experience persistent pain despite treatment, which can significantly affect daily activities.

Symptoms of Pudendal Nerve Entrapment

Pudendal nerve entrapment can present with a wide range of symptoms, often making daily life challenging. The most common sign is persistent pelvic pain, which may feel like a burning pain or numbness in the genital and anal regions.

Many people notice that their discomfort worsens when sitting and eases when they stand or lie down. This nerve entrapment can also lead to urinary frequency, constipation, or even painful bowel movements, making routine activities uncomfortable.

Sexual dysfunction is another frequent concern, with some individuals experiencing erectile dysfunction, painful ejaculation, or a decrease in sexual sensation. Others may describe a sensation of having a foreign object in the rectum or vagina, which can be both distressing and confusing. Because these symptoms can significantly impact quality of life. It’s important to seek an accurate diagnosis and appropriate treatment for pudendal nerve entrapment as soon as possible.

Causes of Pudendal Neuralgia?

Pudendal nerve entrapment typically results from nerve compression, which occurs when the pudendal nerve is pinched or irritated along its path through the pelvis. This compression may happen between ligaments, within tight spaces like Alcock’s canal, or from overactive pelvic floor muscles.

Pudendal neuralgia caused by nerve entrapment is often due to compression of nerve fibers at specific anatomical sites, leading to neuropathic pain that can worsen with sitting. The nerve fibers transmit pain signals, and their compression results in the characteristic symptoms of pudendal nerve entrapment syndrome. Prolonged sitting—especially on hard surfaces—can lead to chronic compression of the perineal region, placing constant stress on the nerve. Activities such as cycling or horseback riding can produce similar effects through repetitive pressure and friction.

Trauma, including falls or accidents that impact the lower back or pelvis, may also lead to pudendal nerve entrapment syndrome, especially when there is bruising or misalignment in the pelvic structures. Pelvic trauma is a recognized cause, as it can damage or entrap the pudendal nerve and its fibers, resulting in pain and dysfunction.

Surgical procedures in the pelvic or perineal region can leave behind scar tissue, creating adhesions that further compress the nerve. Chronic straining due to constipation or heavy lifting may also contribute to gradual injury. In some individuals, the nerve may be compressed by benign or malignant tumors, cysts, or anatomical abnormalities, although these cases are rarer. Identifying and treating the root source of nerve compression—whether muscular, structural, or surgical—is key to relieving symptoms.

When Is Decompression Surgery Considered?

When conservative treatments like physical therapy, nerve blocks, and medication do not provide adequate relief, pudendal nerve decompression surgery may be recommended. This surgical procedure involves carefully releasing the pudendal nerve from the tissues or ligaments compressing it—most commonly between the sacrospinous and sacrotuberous ligaments or within Alcock’s canal. Surgical decompression, including minimally invasive approaches like laparoscopic pudendal nerve decompression, aims to relieve nerve compression and provide pain relief.

Decompression surgery is typically reserved for individuals who meet specific diagnostic criteria, such as a positive response to a diagnostic pudendal nerve block and persistent pain or symptoms that have not improved with non-invasive care. Persistent pain despite conservative treatment is a key reason for considering surgical intervention. Because this is a complex and delicate procedure, it should be performed by surgeons who specialize in pelvic neuropathies. While not everyone is a candidate, those who undergo successful decompression may experience significant relief from pain and a better quality of life. However, surgery is not a guaranteed solution and some patients may continue to experience persistent pain even after intervention, so it should be considered only after thorough evaluation and exploration of other options.

How Do You Diagnose Pudendal Nerve Entrapment?

The diagnosis of pudendal nerve entrapment is a structured process that involves clinical evaluation based on established criteria, neurophysiological testing, and advanced imaging techniques.

Diagnosing pudendal nerve entrapment can be tricky. It’s not something you can see on a typical X-ray or even a standard MRI. Instead, diagnosis relies on a combination of clinical symptoms, physical examination, and sometimes specialized tests. Pudendal nerve entrapment syndrome is recognized as a clinical entity with specific diagnostic criteria, including history, physical examination, nerve blocks, and imaging such as MRI or ultrasonography to confirm nerve entrapment and rule out other causes.

When considering what conditions to rule out, sacroiliac joint dysfunction and chronic pelvic pain syndrome should be included in the differential diagnosis, along with other causes of pelvic or perineal pain.

Here’s how the process typically goes:

1. Clinical Evaluation

A thorough history of your symptoms, especially their relation to sitting and whether they change with movement, gives the first clues. Pudendal neuropathy is a broader term that refers to nerve injury or damage from various causes, such as trauma, childbirth, or compression, and may or may not involve entrapment. Pudendal neuralgia caused by pudendal nerve entrapment is a specific subset, where nerve compression leads to chronic pain, and is diagnosed using established criteria. Doctors will often follow a set of diagnostic criteria, including:

  • Pain in the pudendal nerve area
  • Worsening pain when sitting
  • No pain when lying down or at night
  • No loss of sensation or motor function
  • Temporary relief from a diagnostic pudendal nerve block

2. Diagnostic Pudendal Nerve Block

A local anesthetic is injected near the pudendal nerve in a procedure known as pudendal nerve block injections, which serve as both a diagnostic and therapeutic tool. If your pain improves for a few hours or days afterward, it confirms the pudendal nerve is involved.

Pain medication, such as local anesthetics or corticosteroids, may be used in conjunction with these nerve block injections to provide temporary relief and reduce inflammation. This procedure also helps guide treatment options.

3. Imaging and Nerve Tests

High-resolution MRI, CT scans, or pelvic floor EMG may be used to rule out structural problems. These are less about seeing the nerve directly and more about excluding other conditions.

Can It Be Treated Without Surgery? Yes. Here’s How.

While decompression surgery is an option in more severe cases, non-surgical treatment is highly effective for many people—especially when started early. This is where pelvic floor physical therapy plays a central role.

Nerve Compression: How It Affects the Pudendal Nerve

Nerve compression is a key factor in the development of pudendal neuralgia and chronic pelvic pain. The pudendal nerve runs through the pelvic floor muscles and passes close to several structures, including the ischial spine, sacrospinous ligament, and the pudendal canal.

When these surrounding tissues—such as tight muscles, ligaments, or tendons—press on the nerve, it can lead to symptoms like numbness, tingling, and neuropathic pain in the pelvic area.

Prolonged or repeated compression can cause lasting nerve damage, resulting in chronic neuropathic pain that is often difficult to manage without targeted treatment. Understanding exactly where and how the pudendal nerve is being compressed is vital for choosing the right therapy. Whether that involves physical therapy to relax the pelvic floor, nerve blocks, or, in some cases, surgical intervention. By addressing nerve compression early, it’s possible to reduce pain and prevent long-term complications.

How Physical Therapy Helps Pudendal Neuralgia

pudendal nerve entrapment

In some cases, muscle relaxants may be prescribed alongside physical therapy to help reduce pelvic floor spasm and improve the effectiveness of treatment.

A specially trained pelvic health physical therapist can:

  • Teach you how to relax and lengthen the pelvic floor muscles
  • Guide you through exercises to strengthen weak muscles and improve coordination
  • Use manual therapy techniques to release tight or tender areas
  • Provide education on posture, body mechanics, and lifestyle modifications

✅ Release Pelvic Floor Tension

Overactive or tight pelvic floor muscles can compress the pudendal nerve. Therapy focuses on relaxing these muscles through manual techniques and guided exercises.

pudendal nerve entrapment

✅ Correct Postural Imbalances

Poor posture or spinal alignment may strain nerves in the pelvis. PT helps you improve posture to reduce unnecessary pressure on the nerve.

✅ Identify Aggravating Movements

A trained eye can spot which activities or movements irritate your nerve—and help you adjust or eliminate them safely.

✅ Teach Safe Stretching & Mobility

Stretches that target hip rotators, hamstrings, and the lower back can open up tight areas that may be indirectly affecting your nerve.

✅ Support Bladder and Bowel Function

Therapists can help you develop habits that prevent straining, such as healthy bathroom posture, breathing techniques, and dietary changes.

✅ Incorporate Pain Management Tools

Devices like TENS units can help block pain signals from the pudendal nerve. Therapists guide proper use for maximum benefit. In cases where pain is refractory to conservative treatments, advanced neuromodulation techniques such as sacral nerve stimulation and spinal cord stimulation may be considered. This can use for complex or persistent neuropathic pain conditions.

Physical therapy is especially helpful when nerve entrapment is caused by muscle compression, not a structural defect. It is something quite common in active men or those who sit for long periods. Persistent genital arousal disorder, which can be associated with pudendal nerve compression, may also benefit from similar pain management strategies.

Lifestyle Changes for Managing Pudendal Neuralgia

Making thoughtful lifestyle changes can have a significant impact on managing pudendal neuralgia symptoms and improving overall quality of life. One of the most effective strategies is to avoid activities that trigger or worsen pain. Examples are prolonged sitting or cycling. Using ergonomic cushions, taking frequent breaks, and adjusting your daily routine can help minimize discomfort.

Maintaining a healthy weight and engaging in regular, gentle exercise can support pelvic health. It can reduce pressure on the pudendal nerve. Practicing good posture and incorporating pelvic floor physical therapy into your routine can strengthen pelvic muscles. Additionally, it can improve bladder and bowel function. Stress management techniques, like meditation and deep breathing, are also valuable tools for coping with chronic pain and reducing symptom flare-ups.

By adopting these lifestyle changes and working closely with a physical therapist, individuals with pudendal neuralgia can take proactive steps to manage their symptoms, regain control, and enhance their quality of life.

When Is Surgery Necessary?

If conservative treatments fail to relieve symptoms over several months, pudendal nerve decompression surgery may be considered. This involves surgically releasing the nerve from surrounding tissues to reduce compression. It’s a complex procedure and should be done by a surgeon experienced in pelvic nerve disorders. Pre-surgical nerve blocks are often used to predict whether surgery will help.

Managing Chronic Pudendal Pain

Living with chronic pudendal pain can be both physically draining and emotionally overwhelming. Especially when the symptoms persist without a clear explanation or diagnosis. Fortunately, there is a range of treatment options available that can help patients manage pain and improve their quality of life.

A comprehensive approach typically includes pelvic floor physical therapy as the foundation. It aimed at releasing muscle tension, restoring mobility, and reducing nerve irritation. Alongside therapy, patients often benefit from pain management techniques. Examples are the use of TENS (transcutaneous electrical nerve stimulation) units, which deliver low-level electrical currents to disrupt pain signals.

Medications for nerve-related pain—such as gabapentin, amitriptyline, or duloxetine—can also be prescribed to help calm nerve activity and reduce discomfort. For some, pudendal nerve blocks or pulsed radiofrequency treatments may be used to target the source of the pain more directly.

Additionally, psychological support, particularly cognitive behavioral therapy (CBT), can be an important part of pain management. It helps patients develop better coping mechanisms and address the emotional strain that often accompanies chronic pain.

Lifestyle modifications are equally important in reducing symptom flare-ups. This may involve adjusting exercise routines, using ergonomic cushions when sitting, avoiding activities that aggravate the nerve, and improving bowel and bladder habits to avoid straining. With the right combination of interventions—and the support of a skilled care team—many patients are able to manage their symptoms effectively and regain a sense of normalcy in their daily lives.

Take the First Step Toward Relief

At PELIVS NYC, we understand how difficult pudendal nerve pain can be, both physically and emotionally. That’s why we offer expert evaluation and individualized pelvic floor therapy to help you regain control over your health.

We also offer a FREE 15-minute teleconsultation so you can speak to a professional, ask questions, and explore whether therapy might be right for you.

You don’t have to live in pain. Get the right diagnosis, the right treatment, and your life back.

Related Blog: Pudendal Neuralgia: PT Is Your Treatment