Understanding and Managing Pudendal, Ilioinguinal, and Pelvic Neuralgia

At Horizon Spine & Pain of Utah, we understand how chronic pelvic and nerve pain can deeply impact your quality of life—from sitting and walking to intimacy and daily function. Conditions such as pudendal neuralgia, ilioinguinal neuralgia, and pelvic neuralgia often go undiagnosed or misdiagnosed, leaving patients frustrated and in pain. Our team of specialists is committed to providing thorough evaluation and targeted, minimally invasive treatments to help you find relief and regain control.

These conditions involve nerve irritation or entrapment in the pelvic or lower abdominal region, often leading to sharp, burning, or aching pain:

• Pudendal neuralgia is caused by irritation or compression of the pudendal nerve, which innervates the genitals, perineum, and anus. Pain is often worsened by sitting and relieved when standing or lying down.
• Ilioinguinal neuralgia affects the ilioinguinal nerve, leading to burning or stabbing pain in the groin, upper inner thigh, or lower abdomen—commonly after surgery or trauma.
• Pelvic neuralgia is a broader term that includes chronic pelvic pain linked to nerve dysfunction, sometimes involving multiple nerves.

Though distinct, these conditions share similar features and may overlap, requiring careful evaluation for accurate diagnosis.

These nerve pain conditions often develop from irritation, compression, or trauma to the pelvic nerves. Common causes include:

• Pelvic or abdominal surgeries (hernia repair, C-section, hysterectomy)
• Childbirth or prolonged labor
• Pelvic trauma or fractures
• Repetitive hip or pelvic movements (e.g., cycling, rowing)
• Chronic constipation or straining
• Scar tissue formation or inflammation
• Prolonged sitting, especially on hard surfaces

Risk factors include:

• Prior pelvic or abdominal procedures
• Anatomical variations or nerve entrapment
• Chronic pelvic floor tension or dysfunction
• Inflammatory conditions or nerve sensitization syndromes

Identifying the source of pain early can prevent progression and improve outcomes.

Symptoms may vary based on the specific nerve involved but often include:

Pudendal Neuralgia Symptoms:

• Burning, stabbing, or numb pain in the perineum, anus, or genitals
• Pain worse when sitting, relieved by standing or lying down
• Genital sensitivity or numbness
• Pain during or after sexual activity or urination

Ilioinguinal Neuralgia Symptoms:

• Sharp or burning pain in the lower abdomen, groin, or inner thigh
• Hypersensitivity or numbness in the area
• Pain triggered by movement, pressure, or clothing

General Pelvic Neuralgia Symptoms:

• Deep pelvic aching or nerve-like zaps
• Pelvic floor tightness or spasm
• Pain that radiates into the lower back, hip, or thighs

These symptoms can be persistent or intermittent and are often worsened by specific positions or activities.

At Horizon Spine & Pain of Utah, we perform a detailed assessment using a variety of tools to confirm the diagnosis:

• Comprehensive history and symptom review
• Physical and pelvic exam to assess nerve pathways and trigger zones
• Imaging (MRI or ultrasound) to detect anatomical entrapments, scar tissue, or inflammation
• Diagnostic nerve blocks:
  • Targeted anesthetic injections can help confirm which nerve is causing pain
• Electrodiagnostic studies (in select cases) to assess nerve function

Accurate identification of the nerve involved is essential to guiding effective treatment.

Most cases of pelvic neuralgia can be managed with conservative or minimally invasive therapies:

Medications:

• Neuropathic pain agents like gabapentin, pregabalin, or amitriptyline
• Muscle relaxants and anti-inflammatory drugs

Pelvic floor physical therapy:

• Manual therapy, relaxation training, and biofeedback to address muscle tension and nerve sensitivity

Lifestyle modifications:

• Cushion support while sitting, posture improvement, stress management

Nerve blocks:

• Ultrasound- or fluoroscopy-guided pudendal or ilioinguinal nerve blocks to reduce inflammation and pain

Our multidisciplinary approach focuses on reducing symptoms, improving function, and restoring comfort with daily activity.

If symptoms persist despite conservative treatment, we offer cutting-edge, image-guided therapies such as:

• Pulsed Radiofrequency (PRF) treatment:
  • A non-destructive method that modulates nerve pain without damaging the nerve
• Peripheral nerve stimulation:
  • A small implanted device that sends mild electrical impulses to interrupt pain signals
• Botox injections:
  • Useful in reducing pelvic floor muscle spasm contributing to nerve compression

These techniques are carefully selected based on your condition, goals, and previous treatments.

Surgery is rarely the first option, but may be considered if:

• Nerve entrapment is clearly identified and resistant to conservative care
• Pain is debilitating and significantly impairs function
• Imaging and blocks confirm a surgically accessible entrapment

Procedures like pudendal nerve decompression or neurectomy are done in select cases by specialized surgeons, with guidance from your care team.

At Horizon Spine & Pain of Utah, our patients receive care that is:

• Led by board-certified pain management and nerve specialists
• Supported by state-of-the-art diagnostics and interventional tools
• Collaborative and personalized, focusing on long-term relief
• Compassionate and confidential, especially for sensitive conditions like pelvic pain

We're here to listen, diagnose, and help you return to a full and active life—without chronic pelvic pain standing in your way.