Pudendal Nerve Block Melbourne

What is a Pudendal Nerve Block?

A pudendal nerve block is a medical procedure used to relieve pudendal neuralgia or other pain in the pelvic area by injecting medication near the pudendal nerve. The pudendal nerve is a major nerve located in the pelvic region that supplies sensation to the genitals, anus, and perineum (the area between the genitals and anus).

During a pudendal nerve block procedure, a local anaesthetic, steroid, or a combination of both is injected near the pudendal nerve to numb the area and reduce inflammation. This can provide temporary relief from conditions such as chronic pelvic pain, pudendal neuralgia (a condition characterised by pain, burning, or numbness in the pelvic area), or pain associated with certain surgical procedures in the pelvic region.

The procedure is typically performed by a pain management specialist or anesthesiologist, using ultrasound or fluoroscopy (live X-ray) or CT guidance to ensure accurate placement of the needle near the pudendal nerve.

Pudendal nerve blocks can be part of a comprehensive treatment plan for managing pelvic pain, and they may be used alone or in combination with other therapies such as physical therapy, medication, psychological therapy or nerve stimulation techniques. Like any medical procedure, there are potential risks and side effects associated with pudendal nerve blocks, which should be discussed with your doctor before undergoing the procedure.

How Does Pudendal Nerve Blocks Alleviate Chronic Pain?

Pudendal nerve blocks are a therapeutic approach aimed at alleviating chronic pain, particularly for patients with conditions like pudendal neuralgia. Here’s how they work:

• Local Anaesthetic. The primary component of a pudendal nerve block is a local anaesthetic, such as lignocaine or bupivacaine. When injected near the pudendal nerve, this anaesthetic temporarily blocks the transmission of pain signals along the nerve fibres. By numbing the area, it reduces the perception of pain.
• Anti-inflammatory Effects. In some cases, a steroid medication may be included in the injection. Steroids have anti-inflammatory properties, meaning they help reduce inflammation in the tissues surrounding the pudendal nerve. In conditions like pudendal neuralgia where inflammation may contribute to pain, this can provide additional relief beyond the numbing effect of the local anaesthetic.
• Interrupting Pain Pathways. By targeting the pudendal nerve specifically, pudendal nerve blocks disrupt the transmission of pain signals from the pelvic region to the brain. This interruption can provide temporary relief from chronic pain associated with conditions like pudendal neuralgia, allowing you to experience a reduction or cessation of their symptoms.
• Diagnostic and Therapeutic. Pudendal nerve blocks can serve both diagnostic and therapeutic purposes. When used diagnostically, they can help confirm whether the pudendal nerve is the source of your  pain. If the block provides significant relief, it suggests that the pudendal nerve is indeed involved in generating the pain. Therapeutically, repeated nerve blocks or using corticosteroid in the nerve block may offer prolonged relief from chronic pain, potentially allowing you to engage in activities they previously found difficult due to pain.
• Complementary to Other Treatments. Pudendal nerve blocks are often used as part of a more comprehensive treatment plan for chronic pelvic pain. They can complement other interventions such as physical and psychological therapy, medications, nerve stimulation techniques, and lifestyle modifications. By combining multiple approaches, doctors can tailor treatment to address the unique needs of each patient and maximise pain relief.

Pudendal nerve blocks provide a targeted and minimally invasive option for managing chronic pelvic pain. However, it’s essential to discuss the potential benefits, risks, and alternatives with your pain specialist before undergoing this procedure.

Why Would You Get a Pudendal Nerve Block for Chronic Pain?

A pudendal nerve block may be recommended for chronic pain in the pelvic region, particularly if the pain is suspected or confirmed to be originating from the pudendal nerve. 

Here are several reasons why one might undergo a pudendal nerve block for chronic pain:

• Pudendal Neuralgia. This is a condition characterised by chronic pain in the pelvic region, including the genitals, perineum, and anus, caused by irritation or compression of the pudendal nerve. Pudendal nerve blocks can help alleviate the pain associated with pudendal neuralgia by temporarily blocking the transmission of pain signals along the nerve.
• Diagnostic Purposes. Pudendal nerve blocks can be used diagnostically to confirm whether the pudendal nerve is the source of a patient’s chronic pelvic pain. If a nerve block provides significant relief, it suggests that the pudendal nerve is indeed involved in generating the pain. This diagnostic information can help guide further treatment decisions.
• Therapeutic Relief. In addition to diagnostic purposes, pudendal nerve blocks can provide therapeutic relief from chronic pelvic pain. By temporarily numbing the pudendal nerve and interrupting the transmission of pain signals, nerve blocks can offer significant pain relief, allowing you to function more comfortably in your daily routine. By using corticosteroids in the nerve block, it can help reduce inflammation around the pudendal nerve and hence reduce the pain originating from the nerve dysfunction.
• Conservative Treatment Option. Pudendal nerve blocks are a minimally invasive and conservative treatment option for chronic pelvic pain. This procedure offers targeted pain relief without the need for surgery or long-term medication use. For patients seeking non-surgical alternatives for managing their pain, pudendal nerve blocks can be a valuable option.
• Complementary to Other Treatments. Pudendal nerve blocks can be used as part of a comprehensive treatment plan for chronic pelvic pain, alongside other interventions such as physical therapy, medications, nerve stimulation techniques, and lifestyle modifications. By combining multiple approaches, healthcare providers can optimise pain management and improve patient outcomes.

Getting a pudendal nerve block may be recommended for chronic pelvic pain when other conservative treatments have been ineffective or as part of a broader pain management plan. However, it’s important for you to discuss the potential benefits, risks, and alternatives with your doctor before undergoing this procedure.

The Risks of Pudendal Nerve Blocks

Pudendal nerve blocks are generally considered safe procedures when performed by experienced pain management specialists. 

However, like any medical procedure, there are potential risks and complications associated with pudendal nerve blocks, and it is essential to discuss these risks with your doctor before undergoing the procedure. 

Here are some of the potential risks and complications:

• Injection Site Reactions. Some patients may experience temporary pain, discomfort, or bruising at the injection site.
• Flare up of pain. There may be a temporary flare up of pain which is usually a ‘pressure effect’ from the injection.
• Infection. Any invasive procedure carries a risk of infection. Though rare, infection can occur at the injection site or in the surrounding tissues, leading to complications that may require further treatment. Signs of infection include increased pain, swelling, redness, or drainage from the injection site.
• Bleeding. There is a risk of bleeding at the injection site, especially for patients taking blood-thinning medications. This can lead to hematoma (collection of blood) at the injection site.
• Allergic Reactions. Allergic reactions to the medications used in the injection, such as local anaesthetics or corticosteroids, are possible but uncommon. If a contrast dye is used during the procedure, there’s a slight risk of an allergic reaction to the dye, which may include rash, itching, or more severe reactions like anaphylaxis.
• Nerve Damage.  While the goal of the procedure is to target and block the pudendal nerve temporarily, there is a risk of inadvertent damage to the nerve during the injection process or infection or bleeding. This can lead to worsening or new-onset pain, numbness, or other neurological symptoms.
• Temporary Side Effects. You may experience temporary side effects following the procedure, such as numbness or weakness in the pelvic region, dizziness, or headache.
• Steroid related side effects. Corticosteroids used in the injection can temporarily increase blood sugar levels in patients with diabetes. There may be transient flushing, mood swings and insomnia on the day of the procedure. 
• Exposure to X-Rays and CT. Minimal doses of radiation are used to reduce the lifetime risk of long term complications (such as cancer) due to exposure to X-Ray and/ or CT scanning.
• Failure. The procedure may not provide the expected result or benefit.

Your doctor will assess your individual risk factors, discuss the potential risks with you, and take precautions to minimise these risks and ensure optimal recovery.

It’s essential to follow all pre-procedure and post-procedure instructions provided by your doctor and inform them immediately if you experience any unusual symptoms or complications following the injection. Regular communication is key to ensuring a safe and effective pudendal nerve block procedure.

The Process of Getting a Pudendal Nerve Block

The process of getting a pudendal nerve block typically involves several steps and is performed by a trained pain management specialist or similar healthcare professional. 

Here’s an overview of what to expect when getting a pudendal nerve block:

1. Preparation. Before the procedure, you will have a consultation with your healthcare provider to discuss your medical history, current symptoms, and any previous treatments you’ve tried for your pelvic pain. This is also an opportunity to ask any questions you may have about the procedure.
2. Informed Consent. Your healthcare provider will explain the procedure to you in detail, including its purpose, potential risks and benefits, and any alternatives. You will be asked to sign a consent form indicating that you understand and agree to undergo the procedure.
3. Pre-Procedure Instructions. You may receive specific instructions to follow before the procedure. This may include stopping certain medications that could increase the risk of bleeding. Dr Mittal performs this procedure under CT guidance in specific radiology clinics in Melbourne. The procedure is performed under local anaesthesia. 
4. Procedure Day. On the day of the procedure, you are provided with an opportunity to discuss any concerns or issues prior to commencement of the procedure.
5. Positioning. You will then be positioned comfortably on your front or side on the CT table, depending on the preferences of your healthcare provider and the specific technique being used for the nerve block.
6. Sterilisation. The area where the injection will be performed will be cleaned and sterilised to reduce the risk of infection.
7. Anaesthesia. Your healthcare provider will administer a local anaesthetic to numb the skin and tissues around the injection site. This can help minimise discomfort during the procedure.
8. Guidance. Your healthcare provider will use CT guidance to accurately locate the pudendal nerve and ensure precise placement of the needle for the injection.
9. Injection. Once the pudendal nerve is located, your doctor will insert a thin needle through the skin and deliver the medication (usually a combination of local anaesthetic and steroid) near the nerve. You may feel a brief sensation of pressure or discomfort during this part of the procedure.
10. Post-Procedure Monitoring. After the injection is completed, you may be monitored for a short period of time to ensure there are no immediate complications or adverse reactions to the medication.
11. Recovery. You will be able to return home shortly after the procedure. It is important to have someone available to drive you home, as you may experience temporary numbness or weakness in the pelvic region that could affect your ability to drive.
12. Follow-up. Your doctor will schedule a follow-up appointment to monitor your response to the nerve block and adjust your treatment plan as needed. You will be provided with a Pain chart to log your pain data over the following 2 week period. You are requested to bring the pain chart for further analysis and discussion during your follow up appointment, generally made at 2 weeks post procedure. 

Overall, the process of getting a pudendal nerve block is relatively straightforward and typically takes less than an hour to complete. While you may experience some temporary discomfort or side effects, many patients find that the relief from pelvic pain provided by the nerve block outweighs these minor inconveniences.

Preparing for Pudendal Nerve Block

Preparing for a pudendal nerve block at the Persistent Pain Solutions clinic will require close communication with Dr Mittal and her team. 

Be sure to disclose all medications you may be taking and note that you may have to discontinue some or all of them immediately prior to the procedure.

Prior to your appointment, please inform us if:

• You are currently taking antibiotics.
• You have a pacemaker or defibrillator.
• You have any allergies.
• You have diabetes.
• You are taking any blood thinning medications.
• You are feeling unwell, as we may need to reschedule your procedure.

For your safety, we recommend arranging transportation to and from your appointment, as driving yourself is not advised within the 24-hour period following the procedure.

We generally recommend you take leave from work on the day of the procedure AND one day after the procedure, to rest and recover from the procedure. 

If you are receiving pudendal nerve blocks, we advise you to refrain from undergoing any additional medical procedures, such as dental treatments or colonoscopies, within 48 hours before or after receiving a facet joint block. 

Dr Meena Mittal and her team will provide specific guidance tailored to your situation. It’s important to adhere to your instructions diligently. If you have any concerns or queries, don’t hesitate to ask—we’re here to support you throughout the process.

After Getting Pudendal Nerve Blocks (Follow-Up)

Following the nerve block injection, you’ll undergo a brief resting period for observation and to allow the medication to work its effect. During this time, a member of the pain management team will closely monitor you to ensure there are no unexpected side effects. 

Once the pudendal nerve block has been administered for the management or diagnosis of chronic pelvic pain, you’ll be cleared to return home. A follow-up appointment will be scheduled to determine the next steps in your treatment plan.

There are no specific restrictions on your day-to-day activities. However, it’s advisable to prioritise rest and engage in gentle activities during the initial 24 hours after your procedure.

Occasionally, you may experience some discomfort or bruising at the injection sites. Occasionally there is a temporary flare up of the pain.

You may commence physiotherapy one week after the procedure. You may return to hydrotherapy or a swimming pool/ spa two weeks after the procedure. 

We do not recommend any long distance or overseas travel for at least two weeks after the procedure. This is such that any issues or complications can be monitored and addressed in a timely manner. 

A follow-up appointment will be scheduled at 2 weeks post procedure to assess your response to the pudendal nerve block. You will be requested to bring the post procedure Pain Chart such that the results can be analysed by Dr Mittal and next steps in your treatment plan can be discussed with you. 

After obtaining a diagnostic pudendal nerve block, a positive test block is considered if there is a significant reduction in pain over the first 4-6 hours after the procedure. Once the local anaesthetic wears off, it is normal for pain to increase to its pre-procedure levels. 

If the pain is not originating from pudendal nerve dysfunction, there will be no change to the levels of pain after the pudendal nerve block. This would be considered as a negative diagnostic block. 

After obtaining a therapeutic pudendal nerve block, the steroid medication may take effect within a few days or sometimes within 1-2 weeks after the procedure. The expected pain relief is anywhere between 50-80% reduction in pain levels.  

The effectiveness of a pudendal nerve block can last anywhere from one to six months following the procedure. Please feel free to reach out to us with any questions or concerns during your recovery period.

Finding a Doctor Who Performs Pudendal Nerve Blocks Near You

If you are suffering from chronic pelvic pain, then a pain specialist in Melbourne who can perform a pudendal nerve block may be able to provide some short term relief, potentially followed by a pudendal nerve ablation or denervation for more long term pain management. 

Asking your general practitioner for a referral to a pain specialist who offers pudendal nerve blocks and pudendal nerve radiofrequency denervation and similar treatments is a good start; you can also speak to family members, friends, or support groups (both online and in real life) for recommendations from those who have dealt with similar health issues.

Pudendal Nerve Blocks at Persistent Pain Solutions

Persistent Pain Solutions provides pudendal nerve blocks and pudendal nerve radiofrequency ablations, two procedures designed to alleviate chronic pelvic pain. 

These methods target the pudendal nerves in your pelvic and genital area. Pudendal nerve blocks provide temporary relief and serve as a diagnostic tool for pudendal nerve denervation, which is also known as radiofrequency ablation (RFA) or pulsed radiofrequency (PRF). By utilising ablation, a technique where a small portion of nerve tissue is incapacitated, we effectively interrupt pain signals to your brain, resulting in long term pelvic pain relief.