Which doctor treats pudendal neuralgia?
If pudendal neuralgia is suspected, a general practitioner should always be consulted first, as he or she can already rule out simpler differential diagnoses such as hemorrhoids. In most cases, a referral is made to the proctologist, who can carry out a more detailed examination and generally treat this neuralgia. The diagnostic procedures described above, such as imaging procedures and others, are usually initiated by the proctologist. It is not uncommon for the opinion of a neurologist to be consulted in the treatment of the disease, as they are specialized in the treatment of neuralgia. Thus, the diagnosis and treatment of pudendal neuralgia requires the interdisciplinary involvement of different disciplines.
By which symptoms can one recognize a pudendal neuralgia?
The drug treatment of pudendal neuralgia, like most nerve pain, is complicated because it does not respond to conventional painkillers such as ibuprofen or ASA. For this reason, drugs are used that are normally used as antidepressants or antiepileptic drugs. The antidepressant that is most frequently used in this context is amitryptyline.
Antiepileptics or anticonvulsants that are used A combination of active ingredients from these two substance classes is possible and often shows a good effect. However, complete freedom from symptoms can rarely be achieved. Thus, in addition to drug therapy, treatment by surgical intervention has also become established.
These always aim to decompress the nerve and show response rates of over 70%. In most cases, however, the effect of the interventions only becomes apparent within the following months. Canular infiltration is another therapeutic option.
In this procedure, a mixture of cortisone and long-term local anesthetics is injected into the compression site of the pudendal nerve. While this therapy shows a good effect in almost all patients until complete freedom from pain, this effect is only limited to a few weeks. Therefore, drug therapy or surgical decompression of the nerve are still the leading options in the long-term treatment of pudendal neuralgia.
- Carbamazepine,
- Gabapentin,
- Lamotrigine
- Pregabalin
As described above, surgery is a possible treatment option for pudendal neuralgia. The aim of the procedure is to decompress the nerve, i.e. to remove structures that pinch the nerve in its course. Surgical access is usually via the muscles of the rear (gluteal muscles).
The nerve is often transferred to the small pelvis, and disorders of the ligament structures that can cause the nerve to become trapped are removed. As the pain often increases after the release of the pudendal nerve, it is usually anesthetized with local anesthetics at the end of the operation. In most cases, the pain-relieving effect of the procedure only becomes apparent after a few weeks to months.
There are numerous homeopathic remedies that promise to improve or cure the pain in pudendal neuralgia. Which remedy is used depends largely on the cause of the nerve pain. For example, if the pain is caused by an injury or trauma, the use of Arnica is recommended. However, the quality of the pain is also taken into account when deciding on the appropriate remedy. If the pain is described as pressing, throbbing, Belladona is often prescribed, while Bryonia is used for stabbing pain.
