Pudendal Nerve Block for Perineal Pain

What is a perineum?

The perineum is the area between the thighs covering the perineal body, or the central tendon of the perineum, the external genitalia, and the anus. It corresponds to the outlet or opening of the pelvis, bound by part of the hipbone, and where a lot of muscles from the thigh and buttocks converge. It lies within close proximity of several major systems such as urogenital and gastrointestinal organs.

What is perineal pain?

Perineal pain is the relative discomfort or ill-sensations felt in the perineum affecting men and women of all ages. Due to the presence of numerous organs (such as the digestive tract, or reproductive organs) in the pelvic area prone to strain and dysfunctions, this pain can manifest in various forms such as tearing, fullness, aching, cramps, spasms, tightness, and burning. The pain can be felt with varying intensity depending on the cause, and may be short term (acute) or more persistent (chronic). It is often made worse by sitting, and may or may not be felt with many other symptoms.

Causes of Perineal Pain:

In order to evaluate the appropriate course of action, it is better to have an understanding of the possible causes for perineal pain.

• Postpartum vaginal trauma
• Episiotomy
• Ectopic pregnancies
• Urinary tract dysfunction or infection
• Dysmenorrhea
• Pelvic infections
• Colitis, Prostatis, Appendicitis
• Anal fissures
• Prostate enlargement or infections
• Interstitial cysts
• Musculoskeletal pain
• Pudendal nerve entrapment

Treating Perineal Pain

Perineal pain may be a mere symptom of a more serious condition, so seeing a doctor for complete diagnosis is highly advised. In the meantime, there are several ways to manage and treat the pain, such as the following:

• Using painkillers
• Applying warm compress on the affected area
• Perineal massage
• Taking antibiotics
• Acupuncture
• Neuromodulation
• Pudendal Nerve Block

What is Pudendal Nerve Block?

A nerve block is a procedure which involves localized liquid injections, deliberately desensitizing a particular nerve to block pain. A local anesthetic, slow-release corticosteroids, and in some cases, anti-inflammatory medicine would be injected to a precise region near the nerve for diagnostic or long-term therapeutic purposes. Pudendal nerve blocks specifically target the pudendal nerve, a nerve giving sensation to the perineum and surrounding organs such as the external genitalia and also controlling the anal and bladder sphincters. The procedure is done primarily to diagnose the participation of the pudendal nerve in the occurrence of perineal pain, testing if the symptom disappears upon numbing the nerve. Later on, corticosteroids or anti-inflammatory medicine may be used to lessen the swelling in the nerve. Response to the procedure vary among patients, as in some cases the nerve block irritates the nerve more than it lessens the inflammation, or as in others, the nerve is not involved in the perineal pain.

How is Pudendal Nerve Block done?

Physicians from a pain clinic in Los Angeles, for example, would use imaging techniques such as MRI, CT scan, or ultrasound, to locate the nerve first. It is extremely important to be able to do this correctly, as the nerve can be significantly impaired with a small mistake in needle placement, or the block rendered useless if placed too far. The next step would be to inject the liquid, commonly either at the ischial spine between two ligaments, or in Alcock’s canal. For diagnostic tests, the anesthetic, such as Marcaine is injected, and the pain monitored for a few hours. If the pain disappears, the pudendal nerve probably is the cause of pain in the perineal area, so follow up nerve blocks may be done. In such cases, the steroids or anti-inflammatory medicine like heparin would be utilized for long term pain management. After the course of treatment, mild exercise and physical therapy is advised for patients to improve the chances of completely eliminating the pain. If the nerve remains unaffected from the block, diagnostic tests for other possible causes have to be done.

Where can I get a Pudendal Nerve Block done?

Needing a pudendal nerve block? Specialist Dr. Kevin Li, MD, is an expert pain management physician based in Los Angeles. With his excellent training and years of experience in interventional therapy, he is sure to be able to give you the best treatment healthcare can offer. Get in touch with his clinic in L.A. at (626) 538 – 8950 for more information, and to set appointments. Just remember, being pain-free doesn’t have to be impossible.