How is pudendal neuralgia diagnosed?

Clinically, using the Nantes criteria: pain in the nerve’s territory that is worse with sitting, does not wake you at night, with normal sensation on examination, and that eases with a diagnostic nerve block. Scans are usually normal. A pelvic floor assessment often finds the tight muscles that are compressing the nerve.

Can physiotherapy fix a trapped nerve?

When the nerve is being compressed by tight muscles and restricted tissue, which is common, releasing them and restoring movement can relieve the irritation. When the compression is from ligaments alone, physiotherapy still reduces the muscular contribution and helps you manage load while your physician considers other options.

Should I stop cycling?

Often temporarily, while the nerve settles. We then look at saddle choice, bike fit and gradual return rather than a permanent ban.

Pudendal Nerve Irritability & Neuralgia

What is pudendal nerve irritability?

The pudendal nerve supplies sensation to the perineum and genitals and controls the anal and urethral sphincters. On its way there it threads between the sacrospinous and sacrotuberous ligaments and through Alcock’s canal, surrounded by the obturator internus and pelvic floor muscles. If those muscles are chronically tight, if the ligaments compress the nerve, or if the nerve has been stretched by childbirth, prolonged cycling or a fall, it becomes irritable.

An irritable nerve fires with normal pressure, which is why sitting is the classic aggravator and why symptoms are often one-sided. Diagnosis is clinical: the Nantes criteria describe pain in the nerve’s territory, worse with sitting, that does not wake you at night, with no loss of sensation on examination. Physiotherapy aims to create space and calm around the nerve.

Common signs and symptoms

Burning, tingling, electric or numb sensations in the perineum, anus, vulva, scrotum, clitoris or penis
Pain that is worse with sitting and better standing, lying down or sitting on a toilet seat
A sensation of a foreign object or swelling in the rectum or vagina
Pain with sex, bowel movements or urination
Symptoms often on one side, sometimes both
Urinary urgency or frequency alongside the pain

What causes it?

Chronically tight pelvic floor and obturator internus muscles compressing the nerve
Prolonged or intense cycling, rowing or sitting on hard surfaces
Childbirth, especially a long second stage or instrument delivery
Pelvic surgery, falls or repetitive strain
Entrapment between the sacrospinous and sacrotuberous ligaments or in Alcock’s canal
A sensitised nervous system that keeps the nerve firing after the original irritation

How pelvic floor physiotherapy helps

Pelvic floor physiotherapy for pudendal nerve irritability focuses on decompressing and desensitising the nerve. That means releasing the muscles it passes through, restoring pelvic and hip mobility, changing the loads that provoke it, and calming the nervous system’s response, before considering injections or surgery.

A treatment plan typically includes:

An assessment that maps your pain against the nerve’s pathway and checks the pelvic floor, obturator internus, gluteal and hip muscles
Manual therapy to release the muscles and connective tissue around the nerve, externally and, with consent, internally
Neural mobilisation and gentle movement to improve how the nerve glides
Down-training and breathing to lower resting pelvic floor tension
Sitting modifications: cushion choice, posture and pacing, plus bike-fit or activity changes where relevant
Coordination with your physician or pain specialist if nerve blocks or medication are part of the plan

What the research says

The studies below are peer-reviewed and linked to their permanent records so you can read them yourself.

The Nantes criteria define pudendal neuralgia clinically: pain in the pudendal nerve territory, worse with sitting, not waking the patient at night, without objective sensory loss, and relieved by a diagnostic nerve block.

Labat JJ, Riant T, Robert R, Amarenco G, Lefaucheur JP, Rigaud J. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourology and Urodynamics, 2008. View study

This clinical review describes the anatomy and causes of pudendal neuralgia and sets out a stepwise approach in which conservative treatment, including pelvic floor physical therapy, comes before nerve blocks and surgery.

Hibner M, Desai N, Robertson LJ, Nour M. Pudendal neuralgia. Journal of Minimally Invasive Gynecology, 2010. View study

Treatment at Corelife Wellness in Oakville

Corelife Wellness is a dedicated pelvic health clinic at 3075 Hospital Gate, Unit 312, Oakville, next to Oakville Trafalgar Memorial Hospital. Care starts with a free 15-minute consultation by phone, video or in person, followed by a full assessment with our Registered Physiotherapist. Every pelvis is unique, so your plan is built from that exam rather than a template. No referral is needed, and physiotherapy is often eligible under extended health benefits.

How assessment and treatment work, and how to book, are on our main page: Pelvic floor physiotherapy in Oakville.

Helpful reading from our team

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When to see a doctor first

Pelvic floor physiotherapy is safe and you do not need a referral, but some symptoms need a medical assessment before or alongside treatment:

Loss of sensation in the saddle area, or new bladder or bowel control problems (seek urgent care)
Pain that wakes you at night regardless of position
Fever, unexplained weight loss or a history of cancer
Progressive weakness in the legs

Written by the Corelife Wellness pelvic health team, Oakville, Ontario. Last reviewed September 29, 2026. Sources are listed under “What the research says”.

This page is general information about pudendal nerve irritability, not a diagnosis. An assessment tells you what applies to you. Contact the clinic with any questions.