A pudendal nerve block is an injection in your pelvic region that can provide temporary pain relief. Healthcare providers use them for chronic pelvic pain and as regional anesthesia for certain procedures. The results can vary from person to person. Some people experience pain relief, while others don’t.
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A pudendal nerve block has three main purposes:
You usually don’t have to do anything special to prepare for a pudendal nerve block.
In some cases, your healthcare provider may recommend sedation for the procedure. If you’re receiving sedation, you’ll need to fast for six to eight hours before it. You’ll also need someone else to drive you home after the procedure.
In any case, your healthcare provider will let you know what to do. Be sure to follow their instructions. Don’t hesitate to ask questions.
Healthcare providers use three main approaches to deliver a pudendal nerve block injection:
Providers choose the best method based on your anatomy and the purpose of the block. Your provider may inject only one side of your body or both.
The process for a pudendal nerve block varies depending on where your healthcare provider is injecting it and the purpose for it.
The transvaginal approach is common for obstetric and gynecological procedures.
You can expect the following during a transvaginal pudendal nerve block injection:
Providers use the transperineal approach for anorectal and urological procedures, as well as for pudendal neuralgia in men and people assigned male at birth.
You can expect the following during a transperineal pudendal nerve block injection:
Providers most commonly use the perirectal approach for anorectal procedures and pudendal neuralgia.
You can expect the following during a perirectal pudendal nerve block injection:
Fluoroscopy is a medical imaging procedure that uses several pulses (brief bursts) of an X-ray beam to show internal organs and tissues moving in real time on a computer screen. Pain management providers most commonly use this imaging technology for pudendal neuralgia management.
You can expect the following during a fluoroscopic-guided perirectal pudendal nerve block injection:
After the injection, you’ll rest for 15 to 30 minutes to let the medication take effect. A nurse will also observe you during this time to make sure you don’t have any unexpected side effects. If you’re getting the injection to manage or diagnose chronic pelvic pain, you’ll then be able to go home.
Potential benefits of a pudendal nerve block include:
Some people may feel relief within an hour, if they received local anesthetic. If you received an injection of a corticosteroid, it may take a couple of days for it to take effect. It’s important to note that not everyone experiences pain relief from pudendal nerve blocks. You may need to try other treatment options if this is the case.
The success rate of pudendal nerve blocks varies from person to person depending on the underlying cause of the pain and other factors that can contribute to the pain.
Compared to general anesthesia, studies show that pudendal nerve blocks (as regional anesthesia) achieve a high level of pain control. In addition, people require fewer systemic analgesics, like opioids, to manage pain.
However, up to 50% of all pudendal nerve blocks may fail on at least one side of your body in the case of bilateral blocks. But the average failure rate is about 20%.
Long-term use of pudendal nerve blocks (typically monthly or as needed) can successfully relieve pudendal neuralgia. But studies show that they may not be as effective after two years of use.
The most common side effect of a pudendal nerve block is discomfort at the injection site. This often fades within a couple of days. Bleeding and infection at the site are also possible but are less common. Because your sciatic nerve is close to your pudendal nerve, you may have temporary leg numbness and weakness after the procedure.
Serious complications are rare but can include:
Pain relief from a pudendal nerve block for those who have chronic pelvic pain can vary significantly. It may last a few days, several weeks, months or even years. Each person responds differently. Some people don’t experience any pain relief.
Contact your healthcare provider immediately if you experience any new symptoms or complications from the pudendal nerve block, such as an infection or nerve issues like burning pain, tingling or prolonged weakness.
A note from Cleveland Clinic
Pudendal nerve blocks can help treat chronic pelvic pain. But the results can vary considerably from person to person. They’re also effective as regional anesthesia for certain procedures in your pelvic region. If you’re feeling anxious about receiving a pudendal nerve block injection, don’t hesitate to ask your healthcare provider about it and the procedure. They can answer any questions you may have.
Last reviewed by a Cleveland Clinic medical professional on 04/19/2023.
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