What is a Pudendal Nerve Block?

A Pudendal Nerve Block is an injection used to diagnose and treat pelvic pain caused by
irritation or entrapment of the pudendal nerve. This nerve supplies sensation to areas such as the perineum, genitals, anus, and parts of the pelvis. The procedure involves injecting local anaesthetic, and sometimes steroid, near the pudendal nerve to reduce inflammation and interrupt pain signals.

What conditions do we offer this for?

We may offer this procedure for patients with:

  • Pudendal neuralgia (burning, stabbing, or aching pain in the pelvis or perineum)
  • Chronic pelvic pain, including pain during sitting or sexual activity
  • Post-surgical pelvic nerve pain
  • Painful bladder or rectal syndromes unresponsive to medication

Why is it done?

A pudendal nerve block aims to:

  • Trial nerve block, to ascertain if this can help relieve pain
  • Relieve pain in the pelvic and perineal regions
  • Help confirm the pudendal nerve as the source of your symptoms (diagnostic value)
  • Reduce the need for strong oral pain medications
  • Improve quality of life, bladder/bowel function, mobility, and sexual activity
  • Guide further treatment, including physiotherapy or possible nerve ablation

What does the procedure involve?

  • You will lie on your stomach or side for the injection.
  • The ‘sit bone’ area is cleaned and numbed with local anaesthetic.
  • Under ultrasound guidance, a fine needle is positioned near the pudendal nerve.
  • A small amount of local anaesthetic and/or steroid is injected.
  • The procedure usually takes 15–30 minutes and is done as a day case.
  • In some cases, pulsed radiofrequency treatment may be used for longer-lasting relief.

Benefits

  • Targeted pain relief in the pelvic or genital area
  • Reduced reliance on oral medications
  • Improved sitting tolerance, bladder/bowel control, and sexual comfort
  • Supports diagnosis and planning for further interventions

Key Information:

  • Injections may cause temporary weakness or spasm for a few days
  • Steroids used in the block can take 2 to 4 weeks to provide full relief.
  • Duration of pain relief varies for each patient.
  • Do not drive or operate heavy machinery if you feel drowsy or unsteady after the procedure.
  • The first injection is a trial to assess whether your pain may respond to any interventions targeting the pudendal nerve.

Side Effects

Very Common side effects

(may affect more than 1 in 10 patients):
  • Pain or bruising at the injection site
  • Mild temporary numbness or spasm in the buttock, perineum or leg
  • Temporary increase in pain before improvement

Common side effects

(may affect up to 1 in 100 patients):
  • Weakness of pelvic floor muscles (temporary)
  • Difficulty with urination or bowel movement (short-term)

 Uncommon side effects

(may affect up to 1 in 1,000 patients):
  • Vaginal or rectal fullness or discomfort
  • Temporary dizziness or light-headedness

 Rare side effects

(may affect up to 1 in several thousand patients):
  • Nerve injury or persistent numbness
  • Allergic reaction to anaesthetic or steroid

Aftercare Advice

  • You will be monitored briefly and can usually go home the same day.
  • Avoid driving for 24 hours.
  • You may notice numbness or tingling in the pelvic area for several hours.
  • Resume activities gradually; avoid prolonged sitting on hard surfaces for a few days.
  • A follow-up appointment will be arranged to assess your response and plan next steps.

When to Seek Medical Attention

Seek urgent help if you experience:
• Fever, chills, or signs of infection at the injection site
• Loss of bladder or bowel control
• Severe or worsening pelvic or rectal pain
• New or persistent numbness or weakness in the legs or perineum