u/CompetitiveCar3846

I (F) had a first visit with a pelvic floor physical therapist to try and address Pudendal Neuralgia symptoms as a conservative measure. The main symptoms I am experiencing from PN are pain on the vulva and urinary incontinence.

I loved the provider, however just the internal exam caused a huge PN flare up and I left the office with soreness near alcocks canal that got increasingly worse throughout the rest of the day sitting and laying on pillows. The pain/discomfort reached 4/10 in the evening, and I experienced numbness over the buttock and pain in the lower back.

This was my first time at PT. To be honest, the provider did not do much. She barely pushed around internally and was not aggressive with it.

I was told by my PN specialist (who referred me to PT) that “no pain no gain” is not the strategy you should take with PN. So, I’m not sure how PT can be successful when the diagnostic exam alone caused a huge flare up. I’d love to hear more thoughts.

Has anyone gone to a pelvic floor physical therapist for urinary incontinence related to pudendal neuralgia? Bonus points if you’re female. Please share your story.

I (22F) was recently diagnosed pudendal neuralgia from cycling for sport. My pudendal neuralgia presents as pain on the outer vulva, labia majora, and minora on one side only. Around the same time I started feeling vulgar pain (5-6 years ago), I started having mixed urinary incontinence. At this point the incontinence is severe- I can’t hold blatter and I have the urge to pee when I’m not full.

I’m going to see a PFFT soon. What should I ask? Is a pelvic wand a good option? What approach should a well trained PFFT take to address the vulvar pain from pudendal neuralgia as well as the incontinence caused my neuropathy from my pudendal nerve injury?

I’ve been misled on this diagnosis for years and trying to avoid seeing a mediocre PFFT that will not provide the correct approach to this complex issue.

Need answers!! How is pudendal neuralgia connected to urinary incontinence, if at all? Please share your stories. Here's mine:

I am 22F with diagnosed pudendal neuralgia from intense cycling as a high schooler; have had symptoms for 5-6 years. I haven't cycled since high school, but I never fully recovered.

Around the time my PN symptoms started, I started having urinary incontinence which has gotten worse with time.

Details:

- Pain from PN is a 2/10 all day every day on one side of vulva, labia majora, and labia minora (totally normal sensation on the other side)
- Hypersensitivity or allodynia from stimulus that should not cause pain like friction with underwear or sitting cross-legged
- No burning or shooting pain
- Mild pain on insertion with sex 2/10
- Deep internal pain when I press the pelvis area where the pudendal nerve is (feels like a bruise on the inside of my body)
- As soon as I get the signal it's time to pee, it amplifies 10x and I need to pee in the next minute
- Have peed my pants many times (can't hold blatter)
- hypertonic pelvic floor

I just started getting seen for this medical issue after years of being misled by healthcare providers. I was just recommended pelvic floor PT, a nerve block, and medicine for the PN. However they had no answers for the urinary incontinence. They could not tell me how much of the incontinence is related to the PN, and what the combined treatment plan would be for both issues. Please help.