出典: CUS-DemoWiki

What could possibly be worse than experiencing an unpleasant condition and feeling ashamed to discuss the problem because of its intimate nature? Such is the situation for a lot of suffering with pudendal neuralgia, just a little known disease that affects probably the most sensitive areas of the body. This area is innervated through the pudendal nerve, named after the Latin word for shame. Because of the location from the discomfort combined with inadequate knowledge, some physicians reference the pain as psychological. But nothing could be further from the truth. Unfortunately, discussing the problem with gynecologists, urologists and neurologists often proves fruitless because most have no knowledge about the condition and for that reason cannot diagnose it.

what is pudendal neuralgia

Pudendal neuralgia is a chronic and painful condition occurring in both men and women, although studies reveal that about two-thirds of these using the disease are women. The primary symptom is pain within the genitals or the anal-rectal area and the immense discomfort is generally worse when sitting. The pain sensation tends to move around in the pelvic area and may occur on a single or each side of the body. Sufferers describe the pain sensation as burning, knife-like or aching, stabbing, pinching, twisting as well as numbness. These symptoms are often accompanied by urinary problems, bowel problems and erectile dysfunction. Since the pudendal nerve accounts for sexual satisfaction and it is one of the primary nerves related to orgasm, intercourse is incredibly painful, otherwise impossible for many pudendalites. When this nerve becomes damaged, irritated, or entrapped, and pudendal neuralgia sets in, life loses the majority of its pleasure.

So, where exactly may be the pudendal nerve? It lies deep in the pelvis and follows a path that comes from the sacral area and later separates into three branches, one visiting the anal-rectal area, someone to the perineum, and one towards the penis or clitoris. Since there are slight anatomic variations with each person, a patient�s symptoms depends which from the branches may take a hit, although often all three branches are participating. The fact that the pudendal nerve carries sensory, motor, and autonomic signals adds to the variety of symptoms that may be exhibited.

Because pudendal neuralgia is uncommon and can be similar to other diseases, it is usually misdiagnosed, leading some to have inappropriate and unnecessary surgery. At the start of the diagnosis process, it's crucially vital that you undergo an MRI of the lumbar-sacral and pelvic regions to determine that no tumors or cysts are pressing around the nerve. Additionally, the individual ought to be screened for possible infections or immune diseases, as well as an evaluation with a pelvic floor physical therapist to determine the health of the pelvic floor muscles and also to uncover whether skeletal alignment abnormalities exist. An accurate patient history is required to assess whether there's been a trauma or perhaps an problems for the nerve from surgery, childbirth, or exercise. Tests that provide additional diagnostic clues include sensory testing, the pudendal nerve motor latency test, and electromyography. A nerve block that gives hrs of relief is another tool that can help to determine if the pudendal nerve may be the source of pain.

Probably the most common symptoms that accompanies pudendal neuralgia is severe depression. Many people using the disease have committed suicide because of the intractable pain. For that reason, it is important to consider antidepressants, as they can help lessen the hypersensitivity from the genital area along with relieving bladder problems. Certain anti-seizure drugs reportedly assistance to alleviate neuropathic pain while anti-anxiety drugs provide substantial relief of muscle spasms and assist with sleeping. Uninformed physicians are reluctant to prescribe opiates for an illness that shows no visible abnormality, the desperate nature of genital nerve pain mandates that opiates be prescribed for these patients. While medications aren't always satisfactory, they are doing help go ahead and take edge from the pain for many people. Before the correct treatment methods are determined, it's imperative that patients with pudendal neuralgia receive adequate pain management since the pain associated with this illness could be intense.

Treatment depends on the reason for distress towards the nerve. When the cause isn't obvious patients are advised to test the least invasive and least risky therapies initially.

   Physical therapy that includes myofascial release and trigger point therapy internally with the vagina or rectum assists with relaxing of the pelvic floor, particularly if pelvic floor dysfunction may be the reason for nerve irritation. If no improvement is located red carpet to twelve sessions, nerve damage or nerve entrapment are.

   Botox has become used in medical settings to relax muscles and shows promise when injected into pelvic floor muscles; though finding a physician skilled at this treatment is difficult.

   Pudendal nerve blocks utilizing a long-acting analgesic and a steroid can help to eliminate the nerve inflammation and therefore are usually given in a number of three injections 4 to 6 weeks apart. 

   If physical rehabilitation, Botox, and nerve injections neglect to provide adequate relief, some patients opt for pudendal nerve decompression surgery. 

There are three published approaches to pudendal nerve decompression surgery but there is debate among members of the pudendal nerve entrapment community as to which approach is the best. Because there are advantages and disadvantages to each approach, patients face considerable confusion when deciding which kind of surgery to select. Because there are merely a handful of surgeons in the world who perform these surgeries, most sufferers need to travel long distances for help. Moreover, the recovery period is often painful and takes anywhere from six months to several years since nerves heal very slowly. Unfortunately, early statistics indicate that only Sixty to eighty percent of surgeries are successful in offering a minimum of a 50 percent improvement. Patients whose surgeries aren't successful or who do not wish to pursue surgery have the choice of trying an intrathecal pain pump which delivers pain medication locally and helps to prevent a few of the negative effects of medications. Others pursue the option of a neurostimulator with the idea to the sacral area or directly to the pudendal nerves. They are relatively recent therapies for pudendal neuralgia so it's difficult to predict success rates. Some pudendalites have devised ingenious contraptions for pain relief ranging from u-shaped cushions cut from garden pads up to balloons full of water, frozen, and inserted into the vagina. They have a popular cushion for sitting and lots of have particular computer set-ups for office and home use in order to avoid sitting. In most cases, jeans are a no-no, so patients revise their wardrobes to incorporate baggy pants and baggy underwear - if they are able to tolerate wearing underwear.

Clearly more research is required to find effective methods to better manage the pain and debilitation of pudendal neuralgia. On the other hand, family and friends close to those who have this devastating illness play a huge role in assisting patients cope, thereby maintaining the highest quality of life possible. Support, love and understanding are of primary importance for all those suffering with this affliction.