Pudendal Neuralgia and Pelvic Floor Exercises

I recently had prostate surgery (HIFU) for cancer which has left me partially incontinent.I have been recommended by my urologist to undertake pelvic floor exercises. I also suffer from pudendal neuralgia for five years which has been kept under reasonable control with pregabalin and three previous nerve blocks. I have started the exercises this week after seeing a physiotherapist. Is it a coincidence that I have started a neuralgic flare up? Is there any evidence that pelvic floor exercises have a deleterious effect on pudendal neuralgia?

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  • It would depend on what type of pelvic floor exercises I guess,but then they have got to be trying to strengthen your pelvic floor for an incontinence issue. That may be working against your PN problem if it is due to a tight pelvic floor area, which can be the case.

    That sounds SO contradictory I know. Either you have a tight pelvic floor causing or attributing to the PN or you don't. Has that ever been established?

    Do you know what caused your PN at all?

    Unfortunately I don't know what to suggest as I am not a pelvic physio. Although it would be a good idea to go to a good PN aware pelvic physio who may be able to evaluate the whole problem better??

    take a look at this

    pelvicpainrehab.com/blog/20...

    pelvicpainrehab.com/blog/20...

    Are the exercises helping the continence problem?

  • I have stopped the pelvic floor exercises for a few weeks until hopefully the pain subsides.I might start them again and see what happens.

    The problem is that sitting is not good for the PN and standing is not good for the continence. One problem at a time is easier to cope with.

    Many thanks for your help.

  • This is just one possibility to explore, I am only passing on info related to my own experiences. It may just be that as those pelvic floor muscles are being worked after being dormant for so long, the body is reacting and your pud nerve is the target. The body senses something is wrong because the muscle is working when it normally doesn't. The brain sends a pain message via the pud nerve as this is direct to the same area, to let you know something is wrong, unfotrunately there is no way of telling the brain that this is ok and not to send the pain message.

    If you want to run a marathon you don't start doing 26 miles, you maybe start with a 2 mile jog to get your body used to it a d build on it over several months.

    Its the same with your pelvic floor exercises, you may need to start with smaller amounts and less frequently until your body gets used to it, then slowly increase to the full amount.

    I don't know what your regime is but try doing only 5 at a time for however many times in the day you are supposed to do. It sounds pointless but it will work in the long run. If you can manage 5 without any misshap, next day do 10, and Increase as your body tolerates. If the pain comes back then reduce the repetitions for a day or 2.

    I find it very frustrating. At the moment I am building up my stamina via walking up hills. I'm at 15 mins before I need to stop. I find it difficult to fit a 15 min slot into my day to do the walking, and some days I feel I could carry on for longer, but I have to be disciplined so my body doesn't react. I started with 5 mins and increase by 5 mins every 4th day.

    God luck and don't get disheartened if you feel there is no improvement, it will happen.

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