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8 Signs Your Pelvic Pain May Be Nerve Damage

By February 24, 2021May 12th, 2021Educational Articles, Pelvic Pain
Woman holding her pelvis wondering if it's nerve damage.

Your pelvic pain symptoms may seem strange, but they can be correlated—especially to #8 

Your pelvis is one of the most important headquarters of your body. It does much of the heavy lifting for your mobility and positioning. When it’s functioning properly, you can easily take on your daily tasks of sitting, standing, walking, and relieving yourself. 

So when one of your pelvis’ core nerves gets damaged or compressed, discomfort can show up in any or all of your day-to-day actions. 

The main nerve of the perineum is the pudendal nerve. It controls motor functions for your urination and defecation. It’s also involved in the sensations you experience in your pelvis and genitals.1 It runs through a canal and between muscles and ligaments. 

Unfortunately, the nerve’s path has several opportunities to become pinched or stretched. If the pudendal nerve gets trapped in between a muscle, ligaments, or the canal, your pelvic functions can become seriously impaired.

Many pelvic nerve damage symptoms aren’t obvious

Women are no strangers to regular pelvic pain. Periods frequently bring on consistent discomfort, and menopause can come with its painful symptoms. Not to mention pregnancy and childbirth! And it’s not uncommon for bowel and bladder issues, like frequency and constipation, to show up with any of these.

Unfortunately, this makes it easy for women to overlook pelvic pain symptoms that need medical intervention. Pudendal nerve problems can look similar to pain from menstruation, menopause, and more, but there are some differences.

Do you have any of these pudendal nerve entrapment signs? 2

If you’re experiencing pain that’s coming from a crushed pudendal nerve, you’ll usually experience it with other symptoms. Do you find that…

  1. Your pelvic pain is worse when you’re in a sitting position. People with pudendal nerve pain often can’t tolerate sitting for more than a few minutes. Laying down and standing are much more comfortable.
  2. Your pain may have increased, but your pelvis’ sensation hasn’t gotten worse. In this frustrating paradox, people suffering pudendal nerve damage may report the worsened sensation that doesn’t lessen the pain.
  3. The pelvic pain gets worse with sexual activity, even hours after. Engaging these pelvic muscles, even with non-penetrative sexual activities, can exacerbate the pinched pudendal nerve. This can also keep you from reaching orgasm. Some women even report a feeling of genital arousal, even when they’re not interested in sex. 
  4. You have pain in the buttocks, pelvis, and/or thighs. Even though the pain generates in the pelvis, it can radiate farther down where the nerve travels. This pain can be one-sided or bilateral. Additionally, pudendal pelvic pain won’t wake you up at night, but the pain can keep you from trying to fall asleep. 
  5. You struggle with relieving yourself. The pudendal nerve plays a role in your urination and bowel movements. Damage to the nerve relaxes some of the pelvic muscles. This can make you feel like you suddenly need to urinate or defecate. In serious cases, the damage can give you partial or total incontinence.
  6. It feels like there’s an object or heaviness in the vagina or rectum. A nerve compressed by a foreign object or muscle inflammation will have a similar sensation. It may feel like swelling or even an internal golf ball.
  7. You’ve dealt with small but constant pelvic injuries. Chronic constipation can pinch the nerve, leading to damage and pain even when you’re not constipated. Years of biking can damage the nerve in the same way. That’s why pudendal nerve pain is sometimes called “cyclist syndrome.”
  8. You’ve had pelvic surgery. Nerve injury from pelvic surgery is a significant problem. Injury can come from the surgical incision, your positioning during your surgery, scar tissue from the healing, and more. We’ll explore this more in the next section, as pelvic nerve pain from surgery is more common than you’d think. 

Nerve injury associated with pelvic surgery

Nerve injury associated with pelvic and gynecological surgery is a common complication. It occurs at about a 2% rate.3     

Some surgeries in that area can be done laparoscopically, without needing to open you up very much. However, many require a more open surgery, which puts you at risk for things that give you pudendal nerve entrapment.

Some of these pelvic and gynecological surgeries include:4

  • Bladder or vaginal suspension
  • Pelvic floor reconstruction
  • Vaginal prolapse surgery
  • Hysterectomy

Most postoperative neuropathies aren’t caused by injury during the operation, like ligation to control bleeding. They often come from the surgical team positioning you incorrectly during the surgery. Another common problem is when the surgical retractors (the tool that holds an incision open during surgery) aren’t placed correctly.5 It’s less common, but an injury to the nerve during surgery is also possible. A suture or inflammation can also cause pressure.

Most nerve injuries from surgery resolve themselves. Inflammation goes down, sutures dissolve, and hematomas get absorbed. But if you’re having these symptoms long after your surgery, it’s time to get help. 

What can be done?

Your doctor will probably not start you with surgery. They can get diagnostic tests done to better assess your problem. Nerve studies, an MRI, and a rectal or vaginal exam are common starts. You may also receive a nerve block injection to the pudendal nerve. If your pain is relieved, it’s a strong indicator that your pudendal nerve is the culprit.6

If your doctor can confirm that pudendal nerve entrapment is what’s causing your pain, surgical decompression is the preferred treatment.7

Pudendal nerve specialist near me

Pudendal nerve entrapment is a debilitating condition. If you’re having pelvic nerve pain that started with surgery or injury, we recommend getting it assessed by a nerve expert. If you’re looking for a pelvic nerve specialist in southern Nevada, Dr. Tollestrup’s practice is close by.

If you’re not sure if your pain is from pudendal entrapment, the Tollestrup team still prioritizes getting you the care you need. Dr. Tollestrup specializes in nerve problems. We’d be happy to assess your nerve pain and refer you to the appropriate professional. Our phone number is 702-505-8655.

References:

  1. https://teachmeanatomy.info/pelvis/other/pudendal-nerve/ 
  2. https://www.ncbi.nlm.nih.gov/books/NBK544272/ 
  3. https://somepomed.org/articulos/contents/mobipreview.htm?29/43/30384/abstract/1,2
  4. https://somepomed.org/articulos/contents/mobipreview.htm?29/43/30384?source=HISTORY
  5. https://pubmed.ncbi.nlm.nih.gov/20674786/ 
  6. https://www.nhs.uk/conditions/pudendal-neuralgia/#:~:text=Pudendal%20neuralgia%20is%20long%2Dterm,the%20buttocks%20and%20genitals%20(perineum)
  7. https://www.researchgate.net/publication/8017360_Decompression_and_Transposition_of_the_Pudendal_Nerve_in_Pudendal_Neuralgia_A_Randomized_Controlled_Trial_and_Long-Term_Evaluation 
[This article isn’t medical advice or diagnostic material. Nerve issues are complex, and we recommend that you talk with a doctor about your health questions and needs.]