Abdominal and Pelvic Pain Treatment in delhi

Pudendal Neuralgia/ Neuropathy (PN)rnPudendal nerve is one of the main nerves of the pelvis, with one nerve on each side. It runs from the lower back, along the pelvic floor to supply the genitals, lower part of rectum, and perineum (area between the sit bones). This nerve is closely involved with urinary and bowel functions. Pudendal neuralgia is a condition related to irritation or damage of pudendal nerve, which presents as pain or altered sensation in the genital, rectal region or deep inside the pelvis. It is more common in women and is also addressed as cyclist syndrome, Alcock’s canal syndrome and pudendal nerve entrapment. Despite the significant advances in the evaluation and management of chronic pelvic pain, it often goes unrecognised. It can be associated with other conditions such as Chronic Pelvic Pain Syndrome, dysfunctional voiding, painful bladder syndrome, chronic prostatitis etc. rnPudendal Neuralgia - Patient Information Leaflet rnSigns and symptoms of Pudendal NeuralgiarnBurning, shooting, electric shock like, crushing, aching, prickling or itching sensation in the areas of pelvis supplied by the pudendal nerve.rnPain worse on sitting or exercising and resolves when lying flat (as during the night) or standingrnBetter when sitting on the toilet seatrnIntermittent initially but can change to a constant pain with time It can radiate (travel) to buttocks (around ischial spines) and legs (inner thigh), feetrnOther symptom which may be present includernUrge to go to the toilet often (urinary frequency) or a feeling of a bladder infection,rnPain on passing urinernIncreased sensitivity in pelvic arearnNumbness, pins and needles sensation in pelvisrnPain during sex or sexual arousal or orgasm/ ejaculation. It sometimes presents as persistent sexual arousalrnForeign body/fullness sensation in rectum, vagina or perineum (like a tennis ball)rnRectal pain with an urgent need to open the bowelsrnCauses of Pudendal Neuralgia (PN)rnCompression or entrapment of pudendal nerve (cycling, prolonged sitting, pelvic floor muscle spasm, any growth pressing on the nerve)rnStretching of the nerve as during childbirth or surgeryrnDirect Injury to pudendal nerve as during pelvic trauma, falls on the buttock or even with severe constipationrnCompression at the level of spinal cord or nerve rootsrnBiochemical injury from infections and diseases (diabetes, multiple sclerosis, viral infection- herpes zoster, HIV)rnPN ManagementrnManagement of this condition requires active patient participation and use of a combination of lifestyle changes, medical interventions. Treatment includes Lifestyle changes are aimed at reducing the irritation of the nerve. These include avoiding activities which increase pain such as cycling, prolonged sitting, constipation etc, using a special cushion while sitting.rnNeuropathic pain killers- these can help in reducing the painrnInjections such as pudendal nerve block, pelvic flood muscle or tender point injections Often a series of injections are performed for maximal benefit. Pudendal Nerve Block:rnThe injection is performed for treatment of pelvic and genital pain. Resolution of pain a diagnostic nerve block, even if temporary, supports the diagnosis of pudendal neuralgia. These blocks also serve an important therapeutic role. As discussed previously the compression of nerve can occur anywhere along the path and hence sometimes a series of injections may be required. These blocks are performed as a day care procedure under local anaesthesia. Using image guidance (ultrasound, fluoroscopy or CT guidance) helps to improve safety and chances of success. If required your doctor may recommend pulsed radio frequency treatment of pudendal nerve for a more sustained response in future. Pulsed radio-frequency treatment of the pudendal nerve, sacral nerve rootsrnSupervised Physiotherapy aimed at the pelvic floor muscles. This can help with muscle spasms, imbalances and in correcting other dysfunctionsrnPsychological support including cognitive behavior therapy, meditation, mindfulness, self management and relaxation exercises