Pudendal Nerve Symptoms ?

[Barre]

Hello all,

I am new here and got here after googling my symptoms and I have a few questions about this condition.

2 Months ago I had anal sex (receiving) for the first time, followed by a period of a couple of weeks of high anxiety and stress and some constipation, I had to strain to get bowel movement and the urge to go certainly felt somewhat or even greatly diminished, this has improved a bit but not like it was before .

A week after the anal sex I started to have mild symptoms around and in my anus, mainly itching, my GP did take some blood samples and an anal swap and everything was fine, the visual exam was fine also but he noticed some small inflammation and prescribed my Trianal ointment wich helped abit.

However, we are now now 2 months later and my symptoms have only gotten worse, burning sensation and sometimes itching around my anus , sensitive perineum , these symptoms come and go and sometimes are worse or very mild/non existent.

Been to the doctor twice and she thinks it's hemorroids or typical constipation issues from strainig although she did not see any external hemorroids, one vey small one that should not give these complaints, after googling my symotms seem to relate to the Pudendal Nerve , but my doctor is not convinced.

What do you guys think ?

Thanks in advance !

[Violet M]

Hi,

Since your symptoms are in the distribution area of the inferior rectal branch of the pudendal nerve you have to be suspicious of some possible involvement with that nerve but whether it's a main branch that's affected or just some irritation of local nerve fibers it's hard to say for sure. One option is to have an evaluation by an experienced pelvic floor physical therapist and see what they think. That's how I was diagnosed originally when the doctors didn't know what was going on. They can also evaluate your pelvic floor muscles and see if there is some tension in them. You can find a list of PT's from the left menu of the homepage at www.pudendalhope.org.

Violet

[Barre]

Hi,

Since your symptoms are in the distribution area of the inferior rectal branch of the pudendal nerve you have to be suspicious of some possible involvement with that nerve but whether it's a main branch that's affected or just some irritation of local nerve fibers it's hard to say for sure. One option is to have an evaluation by an experienced pelvic floor physical therapist and see what they think. That's how I was diagnosed originally when the doctors didn't know what was going on. They can also evaluate your pelvic floor muscles and see if there is some tension in them. You can find a list of PT's from the left menu of the homepage at http://www.pudendalhope.org.

Violet

Thank you Violet,

What should I expect with pudendal nerve pain ? Is this serious pain that can get unbearable at times because my complaints are most pretty mild but can get worse when sitting, I can get a burning sensation or the touch of clothes is sensitive but when I touch it with my hand I don't feel anything, it's hard to describe this sensations but it's mostly pretty mild, it also seem to move, sometimes it's the perineum, lower back, buttock or hip, a burning sensation like a sun burn but mild overall. Nonetheless it can be very annoying and worrisome.

My doctor has no explanation for it and it could be psychosomatic as I am prone to hypochondria and these symptoms only appeared after googling this condition, the burning and itching on my anus are mostly helped by Trianal ointment. My doctor said that nerve pain should give more complaints and can be unbearable at times.

How would you prescribe the pain from Pudendal Neuralgia ? I suspect it might be psychosomatic or a problem with the pelvic floor muscles.

Thanks !

[Violet M]

Pain from pudendal neuralgia can be anywhere from mild to severe. If it is pudendal nerve irritation it could slowly fade if you avoid the activity that triggered it in the first place.

Lots of PN patients have been told to go see a psychiatrist. I was one of them. It turned out my problems had nothing to do with my mind but instead were due to nerve injury. Since your problems occurred right after an activity that precipitated the symptoms, it makes more sense to me that it’s possible nerve irritation but I could be wrong.

You could try some alternating hot/cold sitz baths using a donut cushion and see if that helps.

Violet

[Barre]

Pain from pudendal neuralgia can be anywhere from mild to severe. If it is pudendal nerve irritation it could slowly fade if you avoid the activity that triggered it in the first place.

Lots of PN patients have been told to go see a psychiatrist. I was one of them. It turned out my problems had nothing to do with my mind but instead were due to nerve injury. Since your problems occurred right after an activity that precipitated the symptoms, it makes more sense to me that it’s possible nerve irritation but I could be wrong.

You could try some alternating hot/cold sitz baths using a donut cushion and see if that helps.

Violet

Violet,

I just got back from another doctors visit, she referred me to a proctologist and in two weeks they will do a proctology to see if there might be some internal damage or hemorroids that are giving me discomfort.

She did not think it was nerve damage because anal sex is not known to cause this condition and I should have more symptoms. There where no alarm signs at this moment and I should wait the results of the proctology and problems with this nerve are extremely rare and not from anal sex alone.

I do however have some weird symptoms that seem like nerve pain, a very uncomfortable burning sensation of the skin but it's in the lower back on the left side, just above the pelvic bone, this has been pretty persistent for the last 2 or 3 days, the sensation seems to migrate, my perineum is fine now though, no sensitivty anymore but my side and lower back just above the pelvic bone have a feeling of irritation and burning, the doctor said this could be due to some minor nerve endings that are irritated and it should resolve, this is a known psychosomatic symptom as well, she was unsure.

Could this be related to the pudendal nerve? From my understanding symptoms should be more around the genitals , perineum and anus, but these are the spots where I do not have any symptoms anymore. I do feel some dull pain however when I press left of my sphincter muscle, that is why the doc send me to the proctologist.

I have a bad case of hypochondria though and this is starting to obsess me, the burning sensation is verty uncomfortable for me and only recent, as I said it migrated from my perineum, to my tigh and now my lower back/tigh , all on the left side.

Sorry for my grammar but English is not my first language.

Any advise would be welcome,
Thanks.

[Violet M]

Barre,

When your doctor tells you anal sex doesn't cause this condition, you can tell him/her that many people with pudendal neuralgia get pain after having sex. That doesn't mean sex caused the condition. It means they have an underlying condition that causes them to have pain when they have sex. Your doctor needs to find out what the underlying condition is. So hopefully your visit with the proctologist goes well and you will get some answers.

Many people with pudendal neuralgia symptoms have more than one thing going on. So while having discomfort after anal sex may not be typical, if you have any musculoskeletal abnormalities, those can contribute to causing you to have pain from an activity that doesn't normally cause pain. There are many musculoskeletal abnormalities that can cause PN pain -- for example SI joint dysfunction, pelvic instability, one leg longer than the other, etc. Since you are having burning pain in other areas, it would make sense to have an MRI of the lumbosacral spine and lumbosacral plexus, and an evaluation by a physical therapist to make sure there isn't something obvious that is contributing to your burning pain.

One thing that can cause pain in your thigh is if your pelvic floor muscles tense up due to the original pain you had. A good pelvic floor physical therapist should be able to assess your pelvic floor and determine if your muscles are overly tense in that area. My personal experience was that my obturator internus muscle was very tight and it caused burning pain down the back and inner thigh. A tight muscle can irritate nerves and cause burning pain.

You know, it's impossible not to obsess about it when you are having burning pain. So please don't blame yourself. It's important for you to get the care you need.

Violet

[Barre]

After another visit to another doc I got a referral to a neurologist, she suspects it might be sciatica, and this can cause irritation of other nerves close by such as the pn, she did not think it was anything serious though and that anxiety and stress are certainly not helping me as this alone can multiply your pain sensation by a factor of 10 to 20, the dreaded hyperfocus.

But at least she took it more serious because the symptoms don't go away.

The burning pain luckily is alot better but it seems to go up and down, problems and discomfort around the perineum and anus are back though, it's very weird and it seems to migrate and symptoms vary .

Anyway tomorrow I'll go to the neurologist and see what he thinks, I also found a PT therapist that is specialized in nerve rehabilitation and the pelvic muscles but he advised to await the diagnosis of the neurologist.

Thanks Violet, I'll keep you updated.

[Barre]

I would like to add that she prescribed Diclofenac twice daily for 5 days and this seems to help, unfortunately I get annoying side effects from this drug and ibuprofen does not seem to be very helpful.

The back and side pain started after I took very bad positioning on my chair because of the discomfort on my anus, I put alot of pressure on that side so this can explain the nerve/ muscle irritation.

[Violet M]

What side effects are you getting from the drug? Maybe you can report it to the physician and they can prescribe something else.

Hope all goes well with the neurologist.

Violet

[Barre]

What side effects are you getting from the drug? Maybe you can report it to the physician and they can prescribe something else.

Hope all goes well with the neurologist.

Violet

Some stomach and bowel issues.

And I have tinnitus and this seems remake it much louder and pelvic pain is annoying but loud tinnitus is right up there as well !