Cyclist Syndrome (Pudendal Neuralgia) Treatment Options
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- เผยแพร่เมื่อ 20 มิ.ย. 2024
- Pudendal Neuralgia is a rare cause of chronic pelvic pain BUT common in longdistance cyclist due to the chronic compression of pudendal nerve!
Video talks about causes of this and regenerative techniques help repair the nerve and resolve symptoms!
Link to full article: centenoschultz.com/cyclist-sy...
Great information, and well presented!
Do you offer pudendal nerve decompression?
There are various kinds of diagnostic pudendal nerve blocks, and I know that, in theory, only more distal parts of the nerve are numbed by a block. I also know that even the blocks at the ischial spine aren't easy to do. Ive had 4 and 2 missed. Knowing the various locations on the nerve where blocks can be done would REALLY help PN patients to isolate exactly where the nerve is being irritated. Knowing that would be of tremendous help in deciding on treatment options - especially for surgical approach selection for decompression surgery.
Can you please list the different potential locations for blocks and what each block is called, so we know what to ask for?
Thanks for a very informative video, I developed PN years ago from a bad fall while backcountry skiing and I was lucky that it went away after awhile (it was misdiagnosed as peripheral neuropathy). I recently developed PN again while taking Cipro for a bout of UTI. When I first felt the sensation of pain in the right side of my groin I went online to research side effects of Cipro and found lots of reliable sites that simply said "do not take Cipro if you have ever had nerve issues. I'm wondering if you're familiar with this side effect and also if nerve damage from Cipro presents a different challenge for treatment.
Wow! Never heard that!
Hi Dr. Markle, Can I see you through Video consultation? Currently I live in outside of USA for work. I would appreciate your help and guidance. Mine one happened due to inappropriate Kegel combined with prolonged siting and lower abdomen exercise (sit up).
I'm a massage therapist and encounter this problem regularly, and would love some advice on some good techniques that don't get to "personal." I do the supine piraformis stretch (taking the hip into flexion with knee bend and medially rotating the leg) as well as the other, usual approaches, but would greatly appreciate effective ways to address this that go beyond standard massage school training. (Hopefully still within my scope of practice!) For many nerve entrapments/impingements, my main go-to is cupping (use of vacuum rather than compression), but the fascia and nerves involved here are either too deep or shielded by a lot of tendonous tissue, not to mention glute max being massive. Are there any areas where this approach might apply?
I also have a relative who suffers greatly from a doctor's malfeasance; he nicked her pudendal nerve during a surgery. I think she'd be a good candidate for the regenerative type of therapy. She's tried just about everything and is at her wit's end. (Being a relative, I don't treat her, but do try to lend as much guidance and support as I can.) Please drop a line if you've got a moment. Thanks!
@Stu Chisholm - cupping is too superficial to release pudendal - getting training in pelvic floor release techniques can be helpful here
thanks
Thanks so much for such an informative video. I guess my question is.. Which is the best to see for such an issue : an osteopath, a physio, an orthopaedic or a neurologist? I definitely have PN is a question of weather the cause is S1 S2 S3, or L4, L5? Or both? Finally an upright/ standing MRI scan or a scan while lying down, for better capture of inflammation? Once again thanks for the excellent video!
Chase - appreciate the watch and would recommend seeing a physiatrist (Physical Medicine and Rehab - PM&R) whom has spine / interventional spine fellowship...they should be able to evaluate to attempt to ID location and cause of symptoms.....MRI lumbar spine and MR neurography of pudendal can also be helpful ...end of the day - could be coming from multiple locations -- hence treatment should be targeted at multiple location... thanks!
@@dr.markleregenerativeortho9552 thank you so much for your advice. I'll keep watching. Keep up the good work!
Is it okay do massage the perineum/pudendal nerve area? If so, for how long should you massage it? Or will it just agitate it? Thank you.
Everyone responds a little different, some yes and some no - working with a pelvic floor PT specialist can help in deep muscle release - but can exacerbate symptom
when you saturate the nerve through the glute does it only regenerate that particular area? For example if there was damage to the dorsal branch of the pudendal nerve would that also start regenerating? I ask because I experience a loss of sensation (no pain no tingling) in my shaft and glans but no where else
Great video. You look like me. It’s kind of strange looking at you lol. I can’t believe a bicycle seat hurt me. My urologist seems convinced it was the cycling. But I read so many different ways can affect the nerve itself. It’s tiring. I have to have faith in his diagnosis!
Hey bud same situation I would like to hear more of your story
Yup
What are your symptoms?
Hi Dr. thank you for your video because I been having pain and burning in vagina and uthera after pee I have disc bulge problems L4-5 and seen specialist for urethra and vagina and tests that are normal and emergency room doctors telling me I have atrophy vaginal and IC but know that the case can this be a nerve that cause pain and burning vagina and uthera after pee . I call my Neurologist to exam me for this nerve . Started from there again.
Neurontin is also good forTrigeminal neuralgia which I used for three months and when I stop using it my Trigeminal neuralgia flared up only about once a year and it was not as bad..
I have been dealing with pn since my daughter was 12 weeks old my pain comes and goes but 24mobths of pt and still not cured. do you have any locations in texas
Do have know of other clinic that does in central valley California o near by ?
not many but Dr. Patel www.fxregencenter.com/meet-dr-patel/ could be a good option depending how far he is from you....
How do you bathe the pudendal nerve in prp just from one injection site? It has such a long and tricky pathway. Using the injection site that you showed in the video, are you able to reach the front part of the pudendal nerve that is compressed when cycling?
the nerve is typically compressed at ischial tub.-->alcock canal which is visible under ultrasound
You can actually see it? Never heard that. I need decompression surgery.
Whats your thoughts on shockwave therapy for the pelvic floor? is it safe around those nerves?
yes is safe and possible help with this but structure are deep and may not be able to get focus energy that deep and specific...
I think I have this. Interestingly, when I pull in my left transverse abdominus muscle, or stretch my left torso away from my left groin, I get a benign tingling sensation in my left groin, where my inner thigh meets my pelvis. It’s my left pudendal nerve that feels kind of numb and compressed.
Is this symptom consistent with pudendal compression? (I had a slight limp for years which may have caused it to develop)
that could be several issues stemming from possible lumbar spine issue or pudendal ...spine doc could help navigate that with possible diagnostic injection of anethetics and see if helps....all the best
Is it possible that pudental nerve lies under left sitbone not over it?
I have all symptoms after sitting (especially after sitting on bicycle saddle) or stretching this areas. But in my case I can feel this nerve just under skin below left buttock.
Is there any connection between pudendal nerve problems,and pelvic pain syndrome?
Yes - many times pelvic nerve originate from the sacrum and so does the pudendal nerve which all can get irritated to create pelvic pain
Can running cause pudendal neuralgia as well? Thanks!!
potentially but is running causing symptoms then potentially something in lumbar spine or SI joint instability causing neural tension .....
@@dr.markleregenerativeortho9552 Thanks again. Have had symptoms return well after I stopped running, so running doesn’t seem to be the only cause, if a cause at all. Was told by a certain Dr. Antolak to stop running, but I would really love to return to the activity. Have no symptoms now.
@@stevenhartlaub4557 Sorry to hear - if you'd like feel free to email me jmarkle@centenoschultz.com my staff can set up a tele health evaluation and discuss what is going on if we can help -- if we can help then many patients travel to denver for treatment - single day trip and flying is just fine day of or following day...thanks
Can pudendal neuralgia go away on its own? And if so, how long do you think it would take to see improvement? I have some numbness in my penis and it hurts slightly when sitting down. The first couple of days were pretty bad and now it still hurts but not as bad. I don’t know if it’s actually getting better or if I’ve just built a tolerance for it. Thank you!
Good question - sometimes yes...example - saw a guy few weeks ago with this who was a truck driver but after examining and talking to him - he started wearing his wallet in his back pocket and started getting symptoms... so easy fix there -- take the wallet out while driving ...he did and after 2-4 weeks symptoms resolved...so if you take away the underlying issue early then yes can go away but sometimes even if you take it away there is already damage to nerve and the symptoms persist and then have to treat
@@dr.markleregenerativeortho9552 thank you so much for the quick reply. I hope it goes away soon.
@@WavyFBaby hey wavy hows u now
@@MrGinz4uuu hey. My pain was decently noticeable for a few months from the date of my original comment. But I was pretty good since august (almost no pain). But these last two weeks for me, my penis is numb and tingly again and I know for sure it was caused from sitting on too many hard surfaces for too long. The last couple of weeks I had to drive and sit more than normal and the seats I had didn’t have much cushion. So now I’m kind of dealing with the same thing. So please only sit on seats with good cushion or buy a pillow to sit on. I’m going to be messaging my physical therapist to see if he can give me more exercises to do since some of the other ones that he gave me kind of helped.
@@WavyFBaby thx dear yea its pure hell… do u have errection issues pain etc
Hi doc thx for such a knowledgeable video, doc i feel tingling in my l5s1 and strange sensation around my s1 joints.. sometimes the tingling seems to be connected to my genetials pain as it would tingle the same time.
My symptoms started two years ago after bit mastrubation.
But i started getting ed issues 4-5 years ago may b due to excessive sitting job.
I also tried pudental nerve block which did not help.
Sitting causes pain in genetials plus i get urine burning from tea etc..also low labido errection issues..( have been to urologist too scan was done but not much there )
Definitely a nerve issue dont know where..
any guidance plz
If u have been tested by doctor for STI , or UTI and have seen a urologist. And have cleared other things that could be wrong .
It sounds like you would benefit from pelvic health for men .
It is at least worth it
@@john24gold1 have tried few pelvic physio no help mate… there is some nerve entrapment or something
My penile got numb and tingling in top due to this nerve how can i treat ?
dr. I use to Musterbation excessive , after my last Musterbation i have started feeling abdominal pressure and frequently urge of urinating 😑
Sometimes feel pain in testes
Is it possible to for drosal nerve damage ?
If it is, is it’s cure able?
Sounds like you would want to discuss this with a proctologist or urologist as they would have better understanding of that but highly unlikely a pudendal issue
@@dr.markleregenerativeortho9552
That is not a very good response . Considering a large percentage of men suffer from prudential nerve issues in the pelvic floor , including muself . Yea of course a urologist or general GP would be able to do the basic tests for infection and give antibiotics.
But.. and there’s a big but . Many men presenting with various symptoms that cover a wide variety of men’s healing issue stem from injury and pelvic health .
This person , even by the comment he is overthinking , stuck in the cycle of wondering what is going wrong .. and being labels as having infected prostate , or pelvic inflammation.
And shows one red flag of excessive masturbation .
At least direct men to GP , pelvic health men specialist, and urologists.
Pain on one side of the penis only ( right side ) can this be pudendal neuralgia? I have no pain anywhere else, beside the leg sometimes... but cycling triggers it.
Yup
Sir, Can it cause to pain in the thighs and radiates to foot.....? Thanks 😊
Sagar - that sounds more of a lumbar spine issue - which can also be treated with platelet rich plasma ...likely need a Lumbar spine MRI and examination
@@dr.markleregenerativeortho9552 thanks sir, actually today went to MRI (Spin) my Doctor told me everything is normal nothing wrong in my spine, but my pain going worse day by day I don't know what is wrong in side of me 😥
Im in dopy arse Australia 🇦🇺 how can you help me???????
How are you doing now
I have loss of sensation and a throbbing pain in my right testicle, numbness around the anus, pain in my right knee, PAIN IN MY FEET, and sometimes pain after ejaculation. This problem occurred suddenly after getting up off the wrestling matt. The initial pain came and went so fast, that I'm not really sure where it was located. Somewhere in the perineum or lower back maybe? That night I noticed that I couldn't get and erection and the next morning my feet began to hurt. Ten years later and my feet still hurt. I can get an erection but there is diminished sensation. Could this be pudendal neuralgia? Thank you very much.
Matt - unlikely pudendal nerve..with the leg / foot involvement, potentially have nerve irritation / compression somewhere in the lower lumbar region -- would recommend MRI pelvis and lumbar spine and consulting with a physician ! something we can potentially treat using a similar technique discussed in video .... all the best
@@dr.markleregenerativeortho9552 Thank you Dr. Markle.
I've had two neurologist look at MRIs of the lumbar and can find nothing that would cause my symptoms.
@@mgreene011 can always set up a telel health evaluation, can review MRIs / did you get EMG/NCS as well? to discuss symptoms in detail ....
Matt hello
I have the same symptons as you
How are u going now?
Might be related to genitofemoral nerve. There's exercises for that. You still have the problem?
I injured my low back in the right side ,and I feel numbness and pain when I’m sitting down between my pennies and anus also sharp shutting pains coming from there my PT says I have several muscles that are spasm can this go away after I heal from this injury?
Yes .
But u should see a specialist for men’s pelvic Health . Or at least search the exercises on utube .
Is burning sensation in the rectum is also due to pudendal nerve injury ?
Burning sensation is a symptom of nerve irritation - rectum is supplied by sacral nerve roots but not the pudendal N.... can be from another nerve or also some local pathologies to teh rectum ie fissures or Hemorrhoids
@@dr.markleregenerativeortho9552 so pain in the Anus means it’s not PN but sacral nerve? Thank you
Can pudendal neuralgia cause a feeling of urine trapped in the urethra or a pressure in and right above your bladder?
you might want to see a urologist for that one, thanks
I am. Theyre not finding anything wrong
Yes .I get that symptom.. massage between your testicular area after u urinate .. that can help .
Also the exercises for PN can help a lot
Hello, i have that problem too. Sometimes when i am done urinating it moves by itself and it wets my boxers it’s been happening for 2 weeks
You look young but u know your stuff
What about fkd up bowel movements??????
Hello doctor . Is there anyway I can speak to you ? I’m 25 and I recently started getting a buzz in my area between my penis and Anus. The pain has traveled to my lower back and my anus. It constantly buzzes, bladder frequency, pins and needles in my feet and the buzz is bad especially when I drive . I’ve been cleared for a bladder infection and I’m very concerned . Would this be PN? And is there anyway to cure this Thanks so much
Evening Jaime, would recommend connecting with my clinic centenoschultz.com/ our education team can set you up with a tele health evaluation ..all the best
I’ve been feeling numbness on my penis, rectum, and in between and it hasn’t gone away. It’s not painful, I just get tingly on my legs. I’m 22 and I might be infertile now. This video was helpful and I think it explained what I have too. I have also had sciatica problems since I was 14 too and I do have lower back pain .
Thanks for watching. Many issues in lumbar spine and sacrum can something cause both pudendal symptoms and leg symptoms - best to be evaluated by doc and likely need an MRI of L-spine and sacrum to see where the problem is!
I have a slipped disc L2 and L3 pressing against my spinal nerve. My symptoms however are pain and numbness in my testicles and penis, constipation and bladder issues. I do cycling but and not sure if these symptoms are my back or pudendal nerves? I'm 53 years of age and have been cycling on and of 30 years.
@@equinoxeparabellum6776 - for this we treat the spine in addition to the pudendal N with platelet lysate (PL) but all depends on the exam and other things but we treat spine conditions often with PL with excellent success
@@dr.markleregenerativeortho9552 thank you for the reply. I live outer Belfast so it's very difficult to get anyone to help. I've been in so many hospitals and explained my symptoms but get nowhere, frustrating to say the least, Doctors tell me it's everything from a slipped disc to a autoimmune issue, the last doctor just said , We are only a hospital and this sounds very complex.
@@dr.markleregenerativeortho9552 can I please ask one question as I'm in a lot of pain. My pain appears to be where the base of the penis meets the scrotum, the underside of the penis. This is very painful to touch. Is this part of the condition and what is the pain as no one can tell me. Thank you.
One day.Because that's psychosomatic problem.seek psychetric help.
I recomended psychetric drug but doc. guidence important.
1.Nortipan-M(pregabalin75mg,nortryptiline10mg,mecobalamin vit.b-12 1500mcg)
2.mirtazapine 15mg
3.duloxitine 30mg-30mg(60mg) gastroresitant sustain release
4.stalopram(esitalopram10mg+clonazapine5mg)
After pain go away reduce the dose.
Meditation+excercise eliminated that problem(Mentally not physically remember)
I know one thing I’ll never ride a bike again
There's better ways to do the surgery to decompress. This is the old way to do it. Micro surgery with a camera is the new way. We live in the strongest country in the world but won't do the studies and use the technology from Belgium. This is sad to hear the old surgeries are still being used in America. Our system is broken!
I agree
Hey Rafael, can you tell me more about this or where I can find more info on this? Thank you brother.
@@JoshR-pb9tt i didn't do any surgery. It's all mineral deficiencies, bacteria and parasites. Or even pelvic floor dysfunction.
Good info. But please please please STOP the wandering window of you speaking. It blocks your diagrams.
yes...sorry -- first time video editor here :( ... dont know how to correct that !
if a man gets numb when riding a bike; here's some help - STOP RIDING THE FREAKIN BIKE!
All this treatment is excessive. PN is TMS and should be addressed using a mind-body approach. PN surgery is butchery.