What can be done to alleviate constipation likely caused by pudendal neuralgia, given that prune juice, coffee, and fiber supplements have had a limited impact?

From the Guidelines

For patients with constipation likely caused by pudendal neuralgia who have not responded to prune juice, coffee, and fiber supplements, taking 17 grams of polyethylene glycol (PEG) mixed in 8 ounces of water once daily is a recommended treatment approach. This is based on the most recent and highest quality study available, which demonstrated the efficacy of PEG in increasing bowel movements and improving symptoms of constipation 1. The use of PEG has been shown to be effective for up to 6 months, with a durable response and minimal side effects, making it a reasonable option for patients with chronic constipation 1.

Some key points to consider when using PEG include:

• Starting with a dose of 17 grams once daily, mixed in 8 ounces of water
• Continuing the regimen for up to 7 days, or as directed by a healthcare provider
• Increasing water intake to at least 8 glasses per day to help soften stool and promote bowel movements
• Considering gentle pelvic floor exercises or relaxation techniques to help manage symptoms of pudendal neuralgia
• Monitoring for side effects, such as abdominal distension, loose stool, flatulence, and nausea, and adjusting the dose or discontinuing use as needed

It's also important to note that while PEG can provide relief from constipation, it may not address the underlying cause of pudendal neuralgia. Therefore, patients should consult a healthcare provider for a comprehensive evaluation and tailored treatment plan, which may include prescription medications, physical therapy, or other interventions specific to pudendal neuralgia and chronic constipation 1.

From the FDA Drug Label

USE • relieves occasional constipation (irregularity) • generally produces a bowel movement in 1 to 3 days ASK A DOCTOR BEFORE USE IF YOU HAVE • nausea, vomiting or abdominal pain • a sudden change in bowel habits that lasts over 2 weeks • irritable bowel syndrome

Considering the limited impact of prune juice, coffee, and fiber supplements, polyethylene glycol (PO) may be an option to alleviate constipation likely caused by pudendal neuralgia.

• It is intended to relieve occasional constipation and can produce a bowel movement in 1 to 3 days 2. However, it is essential to consult a doctor before use, especially if there are underlying conditions such as nausea, vomiting, abdominal pain, or irritable bowel syndrome 2.

From the Research

Treatment Options for Pudendal Neuralgia

To alleviate constipation likely caused by pudendal neuralgia, several treatment options can be considered, as prune juice, coffee, and fiber supplements have had a limited impact.

• Pelvic physical therapy, lifestyle modification, and medications can be used as conservative measures 3
• More invasive treatments such as nerve blocks, radiofrequency ablation, cryoablation, neuromodulation, and neurectomy/neurolysis can be considered if conservative treatments are ineffective 3
• Laparoscopic pudendal nerve decompression and omental flap wrapping operation can be a treatment option for pudendal neuralgia, especially in cases of failed conservative treatment and mesh removal surgery 4
• Pudendal neuromodulation is feasible and effective, even after prior pudendal nerve entrapment surgery, and can provide pain relief for patients with intractable pain in the pudendal nerve distribution 5
• Resection of the perineal branches of the pudendal nerve with implantation of the nerve into the obturator internus muscle can significantly reduce pain and improve sexual function in women who sustained injury to the perineal branches 6

Considerations for Treatment

When considering treatment options, it's essential to take into account the individual's specific condition, medical history, and the severity of their symptoms.

• The distribution of pain at perineal, dorsal clitoris, and inferior anal nerves can help determine the affected anatomical segment of the pudendal nerve 7
• The duration of pain and the presence of radiation of pain to the inferior members can also be indicative of the affected segment 7
• A positive Tinel sign in the third segment of the pudendal nerve can indicate nerve entrapment 7