Have you ever noticed that sitting for long periods makes your pelvic pain worse — yet standing or lying down brings relief? If so, your discomfort might not be just from “tight muscles” or “poor posture.” It could be something more specific: pudendal neuralgia.
This condition is often misunderstood, underdiagnosed, and surprisingly common among people who experience deep pelvic or perineal pain. Here’s what you should know — and how pelvic floor physical therapy can help.
What Is Pudendal Neuralgia?
The pudendal nerve is a key nerve that runs through your pelvis. It supplies sensation to the genitals, perineum, and anus, and also helps control muscles that support urination, bowel movements, and sexual function.
Pudendal neuralgia occurs when this nerve becomes irritated, inflamed, or compressed along its pathway. This can cause pain, burning, tingling, or numbness in the pelvic region — often made worse by sitting.
Common Symptoms
While symptoms vary, people with pudendal neuralgia often describe:
- Pain, burning, or pressure in the genitals, perineum, or rectal area
- Pain that worsens when sitting and improves when standing or lying down
- A feeling of a “foreign object” or “golf ball” in the rectum or vagina
- Discomfort with clothing pressure (like tight pants or bike seats)
- Sexual pain or numbness
- Changes in bladder or bowel habits (sometimes difficulty starting or fully emptying)
These symptoms can be frustrating and isolating — but there’s hope.
What Causes Pudendal Neuralgia?
The pudendal nerve travels through tight spaces in the pelvis, making it vulnerable to compression or strain. Common causes include:
- Prolonged sitting (especially on hard surfaces or bikes)
- Childbirth or pelvic trauma
- Pelvic surgery or injury
- Chronic constipation or straining
- Tension or dysfunction in the pelvic floor muscles
Often, muscle tightness and nerve irritation feed into each other — which is why pelvic floor physical therapy is so effective.
How Pelvic Floor Therapy Helps
A skilled pelvic floor physical therapist can identify where the pudendal nerve is being irritated and work to relieve the pressure. Treatment may include:
Manual therapy: Gentle internal and external techniques to release tight pelvic floor muscles and improve mobility of surrounding tissues.
Nerve gliding techniques: Specific stretches and movements to help the pudendal nerve move freely without irritation.
Posture and sitting modifications: Teaching you how to reduce nerve compression through sitting cushions or body positioning.
Relaxation and breathwork: Training the nervous system and muscles to relax, reducing chronic tension and pain.
Education and self-care: Understanding your pain helps reduce fear and restore confidence in your body.
While pudendal neuralgia can take time to resolve, many people experience significant improvement with a personalized pelvic floor therapy plan. Early intervention often prevents the condition from becoming chronic.
If you’ve been dealing with unexplained pain when sitting, don’t ignore it. Pelvic floor physical therapists specialize in identifying and treating these complex nerve-related conditions, helping you get back to a life that feels comfortable again.