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 nerve compression in the lower thoracic, lumbar and sacral plexi may be involved in pelvic pain. Longterm pain-avoidant '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 coccygeal range of motion by external or internal mobilisation to reduce coccyx/spinal cord meningeal tension. Misalignment or fixation of the pelvic sacro-iliac joints, lumbo-sacral facet or sacro-coccygeal joints and associated powerful and very painful muscular spasms are usually interrelated factors. We may use acupuncture, manipulative techniques and rehabilitation exercises prescribed with instruction.

It is very important to previously exclude, in consultation with your GP, urological and other potentially more serious 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 a painful coccyx - cycling with a narrow saddle, extreme exercise, 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.

Michael Durtnall's Pelvic Pain and Pudendal Neuralgia patients are offered thorough lumbar / sacral / pelvic neurological motor, sensory and bulbocavernosus reflex examination with rectal and / or vaginal assessment of pelvic floor muscle tone, voluntary contraction strength, speed and endurance, pelvic sphincter resting tone and precise mapping of perineal / pelvic floor sensation.

Pudendal Neuralgia Differential Diagnosis (and associated dysfunction)

Coccyx pain / dislocation
Anismus and rectal Dyssynergia
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. MRN Neurography can show pudendal entrapment.
Diagnostic ultrasound scans at Kensington are often helpful in pelvic pain and Pudendal Neuralgia diagnosis

Treatment

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

Expert manual pelvic manipulation and mobilisation alongside specialist pelvic Physiotherapy/ Physical Therapy is the optimal treatment in most cases of nerve compression.

Michael Durtnall, neuro-musculoskeletal pelvic pain manipulation expert is internationally renowned as the best in the world for joint, muscle, fascia and ligament manipulation for musculoskeletal pelvic, Pudendal neuralgia (PN), pubic SPD pain and coccyx pain.

Michael is specialist listed with International Pelvic Pain Society [IPPS], SPD and pelvic pain in pregnancy, with www.coccyx.org as the leading coccyx manipulation specialist world-wide and with www.Pudendalhope.info, achieving optimal outcomes for his pudendal neuralgia and pelvic pain patients from across the world.
Michael practices with his specialist pelvic physiotherapy team at Sayer Clinic: Kensington, London, UK.

Book to see Michael for your initial consultation, history and examination and standing, weight bearing digital X-ray's to assess for pelvic torsion, disc narrowing and pelvic joint imbalances and/or diagnostic pelvic ultrasound examination to diagnose and begin your treatment aiming for a pain-free and healthier future.

Sayer Clinics Pelvic Therapists have 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 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 aims to free 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 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, pelvic twist or obliquity, rebuild core strength, muscular control and improve 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 partially dislocated, subluxated or twisted needs expert chiropractic manipulation with an exercise program to strengthen and re-educate muscles to maintain proper joint position and stability.

if you suffer PELVIC PAIN ... Email Alexandra or Lucie on mail@sayerclinics.com and we will help you!

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