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Sayer world-leading Pudendal Neuralgia and Pelvic Pain Clinics in London

Musculoskeletal disorders which can cause pelvic pain include sacroiliac, symphysis pubis and sacrococcygeal joint dysfunction. Coccyx injury, dislocation and nerve irritation as well as compression in the lower thoracic, lumbar and sacral plexi may be involved in pelvic pain. Longterm pain-avoidance 'antalgic' postures and lack of mobility also need to be considered as potential causes of pelvic pain.

Pudendal Nerve Entrapment – PNE

The Pudendal nerve can become compressed or inflamed as it passes from the sacral and coccygeal nerve branches within self-perpetuating, deep muscle spasms close to the ischium or “sitting bones” area of the pelvis. Chronic referred pain or neuralgia may be felt in the perineum, genitals, abdomen and buttocks. Most patients have increased pain on sitting which is usually one-sided but both sides can be involved.

Symptoms may include pain, burning, numbness and parasthesia in the pelvis near the sacrum and coccyx which can radiate throughout the pelvic floor, inner thigh, lower abdomen and groin.

After a thorough evaluation to confirm your diagnosis we use specific connective tissue techniques, acupuncture or myofascial release to reduce muscle spasm and nerve compression and, therefore, inflammation. Specific physical therapy techniques called ‘nerve tissue tension releases’ and neural mobilisation or acupuncture can help decrease and regain reduced coccygeal range of motion by internal mobilisation to reduce coccyx/spinal cord meningeal tension. Misalignment or fixation of the pelvis, sacro-iliac joints, facet or sacro-coccygeal joints and muscular spasms are usually interrelated factors. We may use acupuncture, manipulative techniques and exercises prescribed with instruction.

It is very important to previously exclude, in consultation with your GP, urological and other potential medical causes of your pain.

Pudendal neuralgia, Pudendal Canal Syndrome, Alcock Canal Syndrome or Pudendal Nerve Entrapment (PNE) is essentially nerve pain, neuralgia or neuritis with pain in the pelvis, pelvic floor or perineum.

PN or PNE pelvic pain is aggravated by sitting with burning, stabbing or pricking parasthesia, numbness with a sense of a foreign body in the vagina or rectum and in some cases sexual dysfunction, impotence and incontinence.

The three pudendal nerves branches are the Inferior anal branch with burning, itching or tingling pain, Perineal branch with referred pain to pelvic floor skin and muscles with impaired erectile function of the clitoris or penis and Dorsal nerve of the clitoris or penis controlling sensation and erectile function.

 

Causes of Pelvic Pain

Childbirth or Obstetric Neuropathy is pelvic nerve injury during delivery or by forceps or ventouse affecting the pudendal, obturator to inner thigh and sciatic nerves to the back of the thigh, calf and foot.

Pudendal Neuralgia is injury to pudendal nerves in the pelvis caused by excessive sitting - especially to one side to avoid painful coccyx - cycling with a narrow saddle, horse riding, pelvic surgery, pelvic fractures and falls with direct blunt trauma to the pelvic floor.

 

Diagnosis

Signs and symptoms of pudendal neuralgia: Tingling, numbness and altered sensation to vibration and temperature usually on one side of pelvis or perineum with loss of pin-prick sensation.

 

Pudendal Neuralgia Differential Diagnosis

  •  Coccyx pain / dislocation
  •  Piriformis syndrome
  •  Interstitial cystitis
  •  Myofascial trigger points (pelvic floor)
  •  Sacro-iliac joint pain, neuralgia, dysfunction
  •  Sciatica, lumbar spine prolapsed disc or bulge

Investigations 

Standing or sit/stand x-rays can show coccyx subluxation or dislocation, pelvic obliquity, disc degeneration / narrowing.

MRI can show prolapsed lumbar discs and pelvic tumours but is unable to show pudendal entrapment. Diagnostic ultrasound scans at Kensington are often helpful in pelvic pain and Pudendal Neuralgia diagnosis

 

Treatment

Avoid excess sitting, cycling, horseriding. Pain medication covers and dulls perception of pain but is not curative. Cortisone and Pudendal nerve block injections can be diagnostic but are not a safe treatment solution - it allows you to continue to cause yourself further injury to the area whilst not being aware of the damage you're doing.

 

Manual Pelvic manipulation and mobilisation alongside Physiotherapy/ Physical Therapy is the optimal treatment in most cases of nerve compression.

 

Our expert London Pelvic Pain and Pudendal HCPC registered Physical Therapists Marta Dias de Oliveira, Karolina Krzaczek and Adele Telenta Practice in W8, W1 and EC2 and liaise very closely at our Kensington clinic with Musculoskeletal Chiropractor and radiologist Dr Michael Durtnall the internationally renowned expert on joint, muscle, fascia and ligament manipulation for musculoskeletal pelvic, Pudendal neuralgia (PNE) and coccyx pain.  Michael is listed as a specialist for the International pelvic pain society [IPPS],  www.pelvicpartnership.org.uk and www.coccyx.org 

Book first to see Dr Michael Durtnall for your initial consultation and standing, weight bearing digital X-Ray's to assess for pelvic torsion, disc narrowing and pelvic joint imbalances and to start your treatment pathway to a pain-free and healthy future.


Sayer Clinics Pelvic Physical Therapists use their brilliantly sensitive hands-on experience and practical knowledge treating many patients with pudendal neuropathy (PNE) with expert internal and external manual treatment to break down painful myofascial "trigger points" in skeletal muscle and fascia which can be felt as thickening or lumpiness in the muscle. Fascia is a three-dimensional web of connective tissue throughout the body which surrounds muscles, bones, organs, nerves and blood vessels, maintaining structural integrity and providing support and protection. Myofascial trigger point sites include quadratus lumborum, rectus abdominus, thigh adductors, gluteus maximus, medius and minimus, obturator internus and piriformis.

Our pelvic physiotherapy team are world renowned for effectively treating trigger points and using deep muscle massage, manual therapy or trigger point (dry needling) acupuncture into trigger points to release tight muscles. Manual therapy aims to lengthen the pelvic floor - PN and PNE patients generally have extremely tight, shorter pelvic floor muscles. Manual treatment lengthens the constantly contracted superficial and deep pelvic muscles which compress the pudendal nerve. Physical therapy uses internal vaginal or rectal manual therapy and trigger point and myofascial release to help lengthen the pelvic floor. Sacroiliac joint pain causes increased tension in the ligaments between which the pudendal nerve passes so that the tightened ligaments compress or shear the nerve, leading to inflammation and pelvic pain.

Connective tissue thickening, restriction and loss of function decreases blood flow with muscle atrophy of subcutaneous tissue. We use 'connective tissue manipulation' with gentle pressure to subcutaneous tissues to restore connective tissue integrity and improve circulation. Effective manual treatment frees neural tension when a nerve is compressed in tight muscle or stretched around a bone.

Sayer Clinics expert, hands-on pelvic physical therapists in London Marta, Karolina and Adele use manual therapy "neural mobilisation" or "nerve flossing" to free restricted spaces and restore mobility to peripheral nerves. Ultrasound and laser also decreases scar tissue, increases blood flow and reduces pain, whilst acupuncture stimulates healing, reduces pain and improves function.

Mobilisation of restricted connective tissues in the lower abdomen, diaphragm, hips, low back, lower extremities and gluteal muscles is critical in pudendal neuralgia physical therapy to release the muscular tension in these regions.

We understand how to efficiently treat structural musculoskeletal Sacroiliac Joint dysfunction, straighten pelvic twists or obliquity, rebuild core strength, muscular control and hip biomechanics. The Sacroiliac joints connecting the sacrum to the pelvis are tough, shock-absorbing structures transmitting the weight and forces of the upper body to the pelvis and legs.

Pelvic obliquity where the pelvis is dislocated, subluxated or twisted needs expert chiropractic or osteopathic manipulation with an exercise program to strengthen and re-educate muscles to maintain proper joint position and stability.

PELVIC PAIN? call Alexandra or Lucie on 020 7937 8978 - We’re here to help you - in London W8, W1 and City, EC2.