Pudendal neuralgia – a challenging diagnostic pathway

Abstract

We present a clinical case of a male patient with pudendal neuralgia (also known as Alcock’s canal syndrome), whose diagnostic and therapeutic path lasted more than 6 years. Although the suspicion of neuralgia was raised about 6 months after symptom onset, the failure of the treatment undertaken by the patient prompted him to seek other causes underlying the manifestations. He underwent urological treatment for suspected prostatitis, proctological treatment for perianal pain and pain on bowel movement, therapy at a number of pain management centers, and psychotherapy for suspected psychogenic nature of symptoms. None of these therapeutic approaches led to the expected improvement, which significantly reduced the patient’s quality of life. In conclusion, we emphasise that the treatment of patients with pudendal neuralgia is difficult, usually takes many years, as well as includes physiotherapy and, occasionally, surgical treatment. Pudendal neuralgia is rare and there are few centers for the diagnosis and treatment of patients with this disorder. Therefore, the affected patients often wait many years for proper diagnosis and treatment.