Sleeping with Pudendal Neuralgia: Tips for Comfort and Relief

By Dr. Zarina Vitebsky, DPT, MSPT, PRPC, TPS, LPF, DN on 10/16/2023

Pelvic Floor Physical Therapy Patients Experiencing Pain with Sleeping with Pudendal Neuralgia

How to Sleep with Pudendal Neuralgia


Pudendal neuralgia is a condition that affects the pudendal nerve, which runs from the lower back to the genitals. It can cause chronic pain, numbness, and discomfort in the pelvic region. This condition can greatly impact a person's quality of life, including their ability to sleep comfortably.

Impact of Pudendal Neuralgia on Sleep

The pain and discomfort caused by pudendal neuralgia can make it difficult to fall asleep and stay asleep. Many people with this condition experience increased pain at night, which can disrupt their sleep patterns. Additionally, the pressure and friction from lying down can aggravate the affected area, making it even more challenging to find a comfortable sleeping position.

Importance of Finding Ways to Sleep Comfortably with Pudendal Neuralgia

Getting enough quality sleep is crucial for overall health and well-being. Lack of sleep can lead to fatigue, irritability, and difficulty concentrating. It can also worsen pain and discomfort, making it even more challenging to manage pudendal neuralgia symptoms. Therefore, finding ways to sleep comfortably with this condition is essential for managing symptoms and improving overall quality of life.

Understanding Pudendal Neuralgia

Definition and Causes

Pudendal neuralgia is a chronic pain condition that affects the pudendal nerve, which is responsible for sensation in the pelvic area. This nerve runs from the lower back, through the buttocks, and into the genitals. Pudendal neuralgia can be caused by a variety of factors, including injury or compression of the nerve, pelvic surgery, childbirth, and chronic inflammation.

Symptoms and Diagnosis

The main symptom of pudendal neuralgia is pain in the pelvic region, which can range from mild discomfort to severe, debilitating pain. Other symptoms may include numbness, tingling, or burning sensations in the genitals, as well as urinary or bowel dysfunction. Diagnosis of pudendal neuralgia can be challenging, as it is often misdiagnosed as other conditions. A thorough medical history, physical exam, and imaging tests may be used to diagnose this condition.

Treatment Options

There are several treatment options available for managing pudendal neuralgia, including medication, physical therapy, nerve blocks, and surgery. Medications such as pain relievers, muscle relaxants, and nerve pain medications may help to alleviate symptoms. Physical therapy can also be beneficial in strengthening pelvic muscles and reducing nerve compression. Nerve blocks, which involve injecting medication near the affected nerve, can provide temporary relief. In severe cases, surgery may be necessary to decompress the nerve or remove any sources of compression.

Pelvic Floor Physical Therapy for Pudendal Neuralgia

Pelvic floor physical therapy (PFPT) has emerged as a highly effective approach to treat pudendal neuralgia. It involves a specialized form of therapy that focuses on the muscles, ligaments, and tissues of the pelvic floor. These muscles can become tight, weak, or imbalanced, contributing to nerve irritation and compression, which may exacerbate the symptoms of pudendal neuralgia. A skilled pelvic floor physical therapist will assess the condition of the pelvic muscles and customize a program to address specific issues. Through a combination of manual therapies, stretching exercises, and biofeedback, PFPT can release tight muscles, promote blood flow, and alleviate pressure on the pudendal nerve. This therapeutic intervention not only provides relief from the chronic pain associated with pudendal neuralgia but can also enhance bladder and bowel function, and improve sexual health. For those struggling with pudendal neuralgia, incorporating pelvic floor physical therapy into their treatment regimen can pave the way for a significant improvement in their quality of life.

Preparing Your Sleeping Environment

Choosing the Right Mattress and Pillows

When dealing with pudendal neuralgia, it is important to have a supportive and comfortable mattress and pillows. Look for a mattress that is medium-firm, as this will provide enough support for your body without putting too much pressure on your pelvic area. Memory foam or latex mattresses are also great options as they conform to your body's shape and provide pressure relief. Additionally, make sure to choose pillows that properly support your head and neck, as well as any other areas of your body that may need extra support.

Adjusting Room Temperature and Lighting

Creating a comfortable sleeping environment also involves adjusting the temperature and lighting in your room. It is recommended to keep your room cool, between 60-67 degrees Fahrenheit, as this can help promote better sleep. You can also use blackout curtains or an eye mask to block out any excess light that may disrupt your sleep. On the other hand, if you prefer a warmer room, make sure to keep it well-ventilated to avoid overheating.

Creating a Comfortable and Relaxing Atmosphere

Lastly, it is important to create a calming and relaxing atmosphere in your bedroom. This can help reduce any stress or tension that may contribute to your pudendal neuralgia symptoms. Consider using essential oils, such as lavender or chamomile, to promote relaxation. You can also try playing soothing music or using a white noise machine to drown out any outside noises. Keep your bedroom clutter-free and use calming colors to create a peaceful environment for sleep.

Sleeping Positions for Pudendal Neuralgia

Best Sleeping Positions for Pudendal Neuralgia

When dealing with pudendal neuralgia, finding the right sleeping position is crucial for managing pain and discomfort. The following are the best sleeping positions for pudendal neuralgia:

  • On your side with a pillow between your legs: This position helps to align your spine and reduce pressure on the affected area.

  • On your back with a pillow under your knees: This position helps to relieve pressure on the lower back and pelvic area.

  • On your stomach with a pillow under your hips: This position helps to reduce pressure on the pelvic area and can be helpful for those who experience pain while lying on their back or side.

Avoiding Pressure on the Affected Area

It is important to avoid putting pressure on the affected area while sleeping to prevent further irritation and pain. This can be achieved by using pillows or cushions to support and cushion the pelvic area. It is also recommended to avoid sleeping on hard surfaces or using hard mattresses.

Using Pillows for Support and Cushioning

Pillows can be a helpful tool for managing pudendal neuralgia while sleeping. They can provide support and cushioning to the pelvic area, reducing pressure and discomfort. Some recommended ways to use pillows for support and cushioning include:

  • Placing a pillow between your legs while sleeping on your side to keep your hips aligned.

  • Using a small pillow or cushion under your hips while sleeping on your stomach to reduce pressure on the pelvic area.

  • Using a pillow under your knees while sleeping on your back to relieve pressure on the lower back and pelvic area.

Additional Tips for Better Sleep

Using Heat or Ice Therapy Before Bed

One way to alleviate the pain and discomfort of pudendal neuralgia before going to bed is by using heat or ice therapy. This can help relax the muscles and reduce inflammation in the affected area. You can use a heating pad or a warm compress for heat therapy, or a cold pack for ice therapy. It is important to experiment and see which works best for you, as some people may find heat more soothing while others may prefer ice.

Practicing Relaxation Techniques

Stress and tension can worsen the symptoms of pudendal neuralgia, making it difficult to fall asleep. Practicing relaxation techniques before bedtime can help calm the mind and body, promoting better sleep. Some techniques you can try include deep breathing, progressive muscle relaxation, and guided imagery. You can also consider incorporating meditation or yoga into your daily routine to help manage stress and improve overall well-being.

Trying Different Sleeping Aids

For some people with pudendal neuralgia, finding a comfortable sleeping position can be a challenge. This is where using sleeping aids can be helpful. Body pillows can provide support and alleviate pressure on the affected area, while mattress toppers can help distribute body weight evenly and reduce pressure points. It may take some trial and error to find the right sleeping aid for you, but it can make a significant difference in your sleep quality.

Coping with Pudendal Neuralgia During the Night

Managing Pain and Discomfort

One of the biggest challenges of sleeping with pudendal neuralgia is managing the pain and discomfort that comes with it. This can make it difficult to fall asleep and stay asleep throughout the night. To help alleviate this, try using a heating pad or ice pack on the affected area before bed. You can also take over-the-counter pain medication or talk to your doctor about prescription options. Finding a comfortable sleeping position, such as on your side with a pillow between your legs, can also help reduce pain and discomfort.

Dealing with Frequent Bathroom Trips

Pudendal neuralgia can also cause frequent urination, which can disrupt your sleep. To minimize this, try limiting your fluid intake before bed and emptying your bladder right before you go to sleep. You can also try doing pelvic floor exercises during the day to help strengthen your muscles and improve bladder control. If necessary, talk to your doctor about medication options to help with bladder control.

Strategies for Falling Back Asleep if Woken Up by Pain

It's common for people with pudendal neuralgia to wake up in the middle of the night due to pain. To help fall back asleep, try relaxation techniques such as deep breathing or meditation. You can also try distracting yourself with a calming activity, such as listening to soothing music or reading a book. If the pain is too intense, consider getting up and moving around for a few minutes before trying to go back to sleep.

If you are experiencing pelvic floor dysfunctions associated with the issues above, please reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at

Read More: