Pelvic Pain: How Prostatitis Differs from Pudendal Neuralgia

Pelvic pain in men can have a number of different underlying causes. A rare condition called pudendal neuralgia can be misdiagnosed as prostatitis, so understanding the difference can help patients address quality of life challenges and achieve relief more quickly.

Prostatitis, a common cause of pelvic pain, is an inflammation of the prostate gland. As a result, pain occurs in the penis and testes, low back, and the perineum, or area between the scrotum and anus.

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Quite often, the exact cause of prostatitis cannot be determined. To complicate diagnosis further, classic symptoms of prostatitis can mimic those of pudendal neuralgia.

If bacterial infection in a suspected case of prostatitis has been ruled out, the symptoms may be due to pudendal neuralgia. According to a review published in the journal Urology, cited by The Prostatitis Network, found that "prostatitis-like urogenital pain and voiding and sexual dysfunction are the hallmark of pudendal neuropathy."

Pudendal neuralgia is a condition involving entrapment or compression of the pudendal nerve. The University of Rochester Medical Center says the pudendal nerve affects the external genitals, urethra, anus, and perineum. It can be caused by tumors or trauma in the area, compression and inflammation due to prolonged sitting, cycling or horseback riding, or tension from constipation or squatting with heavy weights.

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The pelvic pain symptoms of pudendal neuralgia are worse in sitting positions and tend to get better with lying down, explains the University of Rochester.

While correctly diagnosed prostatitis is often treated with antibiotics, pudendal neuralgia can often be relieved with a pudendal nerve block, according to the Society for Pudendal Neuralgia. The nerve block can also serve as a diagnostic tool to detect pudendal neuralgia.

Other treatments for pudendal neuralgia include prescription analgesics, lifestyle modifications that minimize activities that aggravate the condition like excessive sitting or cycling, physical therapy, and surgery for extreme and persistent cases.

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