What shouldn't be done in case of pudendal neuralgia?
The disease restricts us in simple actions that every person is accustomed to doing daily. Each patient has individual characteristics, and there is no single list of prohibitions, but the main recommendations are the same for everyone. The problem is that while it's possible to never swim breaststroke in your life, the recommendation "never sit down" is absurd. Fortunately, there are special devices that, according to patients' feedback, greatly improve life with pudendal neuropathy.
Sitting Position
The main advice is to avoid sitting as much as possible where possible because excessive sitting exacerbates damage to the pudendal nerve and makes the pain significantly sharper. Many patients find salvation in special work desks like Air Desk, chairs, and cushions designed to prevent compression of the affected area. These can be:
● regular donut-shaped cushion;
● U-shaped cushion with a cutout at the back under the coccyx, straight or tilted;
● chair cushion with a depression in the middle;
● backpack cushion for those who find it inconvenient to carry a regular one everywhere.
● backpack chair - a special cushion for working at a computer while lying on the stomach.
Some show ingenuity and come up with their own options - for example, you can take a nursing pillow or a car cushion, or cut out a comfortable one from any material. This approach has two advantages: an individual solution to the problem and saving money.
Bending
When bending the torso, the inflamed pudendal nerve will not slide normally, leading to its stretching. For illustration, take a rubber band in your hands and try to stretch it as much as possible. You will notice that during stretching, cracks form on it, and when it exceeds the permissible limits, the material tears.
While there haven't been cases of such strong impact causing the pudendal nerve to tear during bends, in any case, frequently and heavily bending, the patient causes irreparable damage to it. With nerve compression, only the portion below the site of compression stretches, which exacerbates the negative impact.
The way out of the situation is to use a special grabber for objects, thanks to which you can pick up things from the floor without bending over. It is inexpensive, and you can buy it in almost every pharmacy. There are similar devices for putting on shoes, etc.
Constipation
Frequent
constipation, accompanied by the need to strain, is one of the causes of
pudendal nerve neuropathy. If the disease has already been diagnosed, they can
cause unbearable pain. It is worth consulting a doctor about changing the diet
and taking additional medications to avoid such difficulties.
Experienced patients offer many simple solutions that have become salvation for them, for example, adding to the daily diet:
● flaxseed oil or seeds;
● prunes or prune juice;
● fiber in addition to other foods.
Some patients use microclysters or laxative drugs. The main thing is to consult a doctor if you plan to start using medical procedures on a permanent basis.
Some Exercises and Practices
In the list of not recommended physical activity for pudendal neuropathy are:
● squats and step aerobics;
● elliptical trainer;
● yoga and abdominal twists;
● skiing;
● brisk walking.
The common feature of these exercises and complexes is that they involve stretching, particularly in the area of the pudendal nerve. This is not an exhaustive list. You can make your list based on personal experience, following a simple principle: if it hurts - stop moving immediately.
Bicycling
Pudendal neuralgia is particularly prevalent among cyclists, including professional athletes. For many of them, the thought of giving up their favorite means of transportation is terrible. Fortunately, there are now seats that allow, with some restrictions, to use a bicycle even with compression. They are adjustable and prevent neuropathic pain by means of indentations and holes. Also, the seat can be ordered to suit individual needs.
Patients
with pudendal neuralgia often try not to sit at appointments. Those who have
recently fallen ill are afraid of exacerbating symptoms, and experienced
patients have long known that it's better to stand an extra time. This patient
is a novice, but it's not the first time for me:
— Hello, doctor. I've started the prescribed therapy, and it seems like I'm feeling a bit better... but I'm not sure what to do about work.
— Is the problem that you need to sit a lot?
— Yes. I'm a programmer, and I spend long hours at the computer. For now, I'm dealing with it by not having a chair at all. I'm lucky that I work remotely, and no one sees me, so I work at home at the bar counter, taking occasional breaks to lie down. But I wouldn't say it's ideal.
— Does the pain improve with therapy?
— Yes, it's getting better, no acute flare-ups. But sitting constantly is still hard, and as far as I know, it's harmful... last time, you recommended that I always choose positions where there's no pressure on the nerve whenever possible.
— Yes, that's one of the main principles. Most of my patients use special cushions, they come in various shapes. Moreover, there are chairs designed for seated work.
— So far, I haven't been able to find a comfortable seat. And there's one problem — in a month, I'm flying for an internship to Canada. Fourteen hours sitting in one position plus waiting. Usually, I took melatonin to avoid jet lag and slept almost the entire flight, but I'm afraid it won't work this time. I'm inclined to cancel the trip.
— You shouldn't cancel, let's try to figure something out. What's wrong with the cushions?
— My pain is localized on the right side, and all the cushions are symmetrical. I've tried round ones and ones with a cutout at the back, but it's uncomfortable to sit — I have to lean to the side and tense my muscles. In general, it's not very helpful. Maybe there are other options?
Actually, there are many options here. You can make a cushion yourself, and among those available for sale (there are many varieties too), you can combine various options. The only inconvenience is the lack of a configuration that would suit every patient. Pain with pudendal neuralgia manifests very individually depending on where exactly the nerve is compressed, personal anatomical features, and many other factors.
I advised my patient not to try to find the perfect cushion for sale but to turn to forums of people living with a similar diagnosis and see how his "colleagues" solve the problem, especially those who complain of unilateral pain localization. The man nodded thoughtfully and left.
Our next meeting took place after his return, and it turned out that my advice helped.
— Doctor, after trial and error, the issue was resolved. Actually, I was lucky — on an international forum, I found someone whose symptoms were very similar to mine. I couldn't find anything similar to what he described here, but my engineering mindset saved the day.
The forum user recommended using not one but two wedge-shaped cushions about 15 cm deep. One should be placed in the center of the buttocks, opposite the painful area, and the second one — slightly lower, on the other side. It turned out to be an asymmetrical construction that freed up the necessary space and completely relieved the pressure from the pudendal nerve.
— The option with two cushions was just a lifesaver for me, but it wasn't very convenient technically. Two cushions are not ergonomic. I had to buy polyurethane foam and tinker a bit... — the patient unfastened a small cover from his backpack and unfolded it. — Well, now I have a portable folding device that allows me to fly on an airplane even around the world. And such a device cost me five times cheaper than a branded cushion.
In proof of his words, the patient unfastened
some strap and demonstrated a fairly compact asymmetrical seat, on which he
confidently sat, evidently not feeling discomfort.
Sometimes it's enough to come up with a solution once, and it will save you from complications for the rest of your life. Many patients invent devices to alleviate the manifestations of neuralgia on their own, and it works.
Make it a rule to consult with your treating doctor in any contentious situation, but don't forget to rely on your own feelings. Only with such a comprehensive approach can you develop lifestyle changes that bring minimal discomfort.
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