What Is Pudendal Neuralgia?

Pudendal neuralgia is pain experienced in the pelvic floor or external genitalia that is caused by microtrauma to the pudendal nerve.

Pudendal neuralgia is worse with sitting, and better with standing, laying down, or sitting on the toilet.

Why Do Some People Have Pudendal Neuralgia?

Trauma to the pudendal nerve most commonly can occur with childbirth, pelvic prolapse surgery, cycling, or excessive sitting.

If your pain has not resolved with decompression surgery or pelvic floor myofascial release, other causes of pudendal neuralgia include endometriosis, viral infections, venous congestion, diabetes, and autoimmune conditions.

How To Diagnose Pudendal Neuralgia

You will be diagnosed with pudendal neuralgia if all the following are true.

• Pain in the area of the pudendal nerve
• Pain primarily with sitting
• Pain is not worse at night
• No sensory loss
• No itching with pain
• Pain is not fleeting
• Imaging doesn’t identify a different reason for pain
• Pudendal nerve block relieves the pain

Biomedicine’s Approach to Pudendal Neuralgia

• Pain killers and muscle relaxants
• Myofascial pelvic floor therapy
• Pudendal nerve block
• Surgical decompression

My Holistic Approach to Pudendal Neuralgia

• Set up the drainage system of the body
• Optimize organ mobility (especially kidneys and uterus)
• Address fascial constraint
• Address ligamentous and joint imbalance
• Optimize posture, breathing mechanisms, and postural muscle strength/activation

What to Expect

I will not be exclusively treating the pelvic floor

I will be identifying all the structures that have a bearing on the function of the pudendal nerve and optimizing their function.

If there is an underlying process like a viral infection, diabetes, or an autoimmune condition, we will treat that, too.

• 20 hours of hands-on manual therapy
• 2 hours of exercise
• 1-4 hours internal medicine

I feel like patients get better faster if they get treatments close together in the beginning.

People usually do well with a minimum of 2 hours of care a week.

If you are coming in from out of town for care, we should be able to complete the care within 7-10 days.

When I start working with you using manual hands-on therapy, I will start by putting my hand on the sternum (breastbone) close to the clavicles (collarbones).

In my opinion this is the area of the most important transverse plane (i.e. horizontal plane) in the body because all the lymph and blood drain here. If the structures in this area are not moving properly, it will be difficult to achieve permanent change elsewhere.

The lymph drains up from the belly and lower body, left check, left arm, and left head through the thoracic duct to the left subclavian vein. The lymph drains from the right chest, right arm, and right head into the right lymphatic duct into the right subclavian vein.

The blood drains up from the lower body into the inferior vena cava, and down from the upper body into the superior vena cava to go back to the heart for recirculation.

The axilla (armpit) is part of the shoulder transverse plane and needs to be supple and open for proper lymph and blood return.

Because most of our activities involve using the arms down and in front of us, we experience tightness in the armpits.

Also, because we do not practice physiologic breathing that moves the ribs and intercostal muscles with each breath, we experience armpit tightness.

The video below will teach your how to release the fascia in your armpits.

It is important to also incorporate overhead activities (like jumping jacks, windmills, swimming etc. or even hitting the top of the door frame when you walk through) and retrain to breathe physiologically to retain an open arm pit after therapy.

The armpits must be open in order for the blood and lymph to drain properly in the chest cavity because the blood and lymph are closed circuits. If fluid is not in the channels and in the tissue instead, the fluid system will not move well.

To Release Armpit Fascia

1. Lay on your stomach on a bed or couch or floor
2. If you want to work on your left armpit, put your right arm under your chest and insert the hand into the left armpit
3. Use your fingers to feel around in the armpit looking for a sore spot
4. When you find the sore spot you can either gently rub it, or you can apply pressure to it and move your arm and shoulder around it. Either way, you can release the fascia.
5. Continue going a little deeper with each layer that you release.
6. Check both sides

What are Transverse Planes?

Transverse planes are horizontal planes.

They slice through our body and separate it into sections through which veins, arteries, nerves, and other tubes pass.

The five transverse planes that I work with predominantly are:

1. The tentorium & sphenoid in the skull about the level of your eyes separating the cerebellum from the cortex

2. The hard palate/tongue/oropharynx/jaw/base of skull separating the head from the neck

3. The thoracic inlet/outlet at the shoulder level separating the neck from the chest

4. The respiratory diaphragm separating the chest and abdomen

5. The pelvic diaphragm separating the bottom of the pelvis from the open air beneath

These transverse planes are made of, or influenced by, fascia, dura, muscles, and bone.

These planes need to be in proper alignment and function adequately in order for everything going through them to work correctly, and in order for everything in the compartments above and below them to function correctly.

Transverse planes are critical points of transition in the body. Because they are points of transition, they are more vulnerable to having problems. Because they are critical to all other function, it is imperative to address them.

I generally begin by listening to the thoracic inlet/outlet transverse plane with my hand on the breastbone (sternum).

Within my model of care, this thoracic inlet/outlet plane is pivotal for all others because all fluids in the body drain here (or through here), and if fluid is not moving properly, no intervention can create persistent change.

What is Your Visceral Body?

Viscera is the fancy name for organs. (At least we aren’t calling them offals).

The organs are all supposed to move in gross patterns like breathing and your heart beating – called mobility.

They are also supposed to move in subtle patterns called motility.

This subtle movement pattern called motility is not the motility of your gut. According to Dr. Barral (of The Barral Technique) motility is the embryologic movement pattern of the organ. It indicates how happy the organ is doing its job.

All the organs, in fact, all the bodies I speak of here, should be happy doing their jobs.

Just as we are designed to be happy in life.

If an organ is not happy doing its job there will be alteration in its motility pattern.

Why might an organ not be happy doing its job?

An organ’s happiness quotient will decrease if there is inflammation, stagnation, or restriction (like adhesions) that prevent it from its intrinsic movement patterns. An organ also will be less happy if it is not optimally positioned in relationship to its neighbors.

Organs that are not optimally positioned or optimally moving can still appear to be functioning great from a biomedical perspective on imaging and lab.

But you might not feel like you are as comfortable in your body as you would like to be.

An organ that is not experiencing proper mobility or motility often will not provoke pain, and the pain associated with an organ that is not moving properly is the pain of the fluid system being constrained because of the organ.

There are some organs that predictably are associated with pain patterns when not moving properly.

For instance, a kidney that is a grade one or grade two ptosis (falling down) will present with stereotypical flank pain.

Also, if the pericardium is not moving properly, it can pull on the lower neck and upper back and create pain that only temporarily subsides with chiropractic adjustments and massage.

What is Visceral Manipulation?

Visceral Manipulation involves listening to the organs with our hands, and determining if the organ is moving properly. An organ that is not moving properly can impact the function of the musculoskeletal system, the vascular system, the nervous system, and the lymphatic system. Basically everything. Optimizing the movement patterns of the organs helps to support and stabilize the infrastructure of the body so everything works better, and you will be less likely to experience pain.