Lifestyle changes for pudendal nerve neuropathy

The patient is clearly on edge. The diagnosis was literally just made, and she is shocked, seemingly overwhelmed by all the manifestations of the disease at once. She has already read enough information about pudendal nerve compression and the restrictions she will have to live with, possibly for the rest of her life. But she hasn't read about ways to solve the difficulties yet:

— Doctor, I just don't understand what to do. I'll have to rebuild my entire life. I'm in pain. I'll have to give up fitness and yoga, stop leading an active lifestyle, and stay at home... well, no, I can't even sit at home! All these recommendations seem like mockery.

— Let's calm down a bit. I understand that accepting the diagnosis immediately is difficult, but many people lead a full life with it, and in some cases, surgery helps to eliminate all restrictions and radically get rid of the disease. I assure you, once you start figuring out what you can and can't do, you will feel better.

— Right now, it feels like I can't do anything. For example, I regularly went to fitness, and now any bend or attempt to squat is accompanied by excruciating pain.

— This happens with the tension of certain muscles, not all of them. We're talking about the muscles of the pelvic floor and those adjacent to them. Movement in this area needs to be restricted because it can lead to stretching of the nerve that hurts. But all other exercises are available to you, and giving up fitness is not necessary.

— I had to interrupt my session with the instructor because more than half of the exercises are simply painful to do. Or I know I can't do them.

Indeed, this can be discouraging at first. A patient accustomed to a certain rhythm of life is forced to abruptly change their habits, which may have been formed over years and without which they cannot imagine their existence.

— Instructors rarely encounter circumstances like yours. But you can set a task to find a set of exercises that you can do without harm. Primarily, these are any movements that only affect the upper half of the body.

— Okay... but what about the rest?

— It is necessary to exclude those exercises that are always detrimental to the nerve, such as bends and squats. But then there is some freedom of action. In many cases, the pain changes and may decrease depending on the body's position. Together with the trainer, you can try such a scheme: they show exercises that are not absolutely contraindicated, and you try to perform them. If you feel pain, stop immediately. This way, by process of elimination, you can find a complex that you can apply specifically to yourself.

— This probably will take a lot of time.

— I think just a few sessions. Don't strain yourself too much — the pain might be delayed, so try to be careful. But it's important that you modify your routine once — then it's just a matter of following it, which doesn't require much effort.

— But what would you recommend specifically that is definitely safe?

— Leg lifts from a standing position, back arches, leg abduction while lying on your side, and similar exercises — they relax the pudendal nerve and can temporarily alleviate pain. From strength training, you can focus on arms and back.

— What about abs?

— Very cautiously. Some of my patients do abdominal exercises, slightly modifying them and redistributing the load. You can try that too, with a trainer. And walking is absolutely fine for you — it can partially replace lower body exercises. You won't become a bodybuilder, but you'll maintain a nice figure.

— Is that all?

— Those are the basic principles. Pain is individual for each patient, so I would recommend getting help from a trainer. Together, you'll choose the movements that don't cause discomfort, and they as a specialist will balance the routine to be maximally beneficial. But the main condition is very simple: if it doesn't hurt, you can do it; if it hurts, you shouldn't.

— Doctor, this seems terribly complicated, and honestly, I feel like life is over and I've turned into a helpless invalid.

— That's normal. Any negative changes in lifestyle can provoke such feelings. You should consider seeing a therapist; I can recommend a specialist who deals with this issue. Acceptance of the diagnosis doesn't happen immediately; you need to go through all stages, including the stage of depression. But with a therapist, it's easier to do.