Treatment of Perineal Pain, Discomfort and Soreness in NYC: Experienced Urologists
Dr. Alex Shteynshlyuger is a board-certified urologist. He is a specialist in treating men and women with acute and chronic perineal pain.
Causes of Perineal Pain and Discomfort
Many men and women may occasionally feel slight discomfort or soreness in the perineum. Usually the discomfort goes away spontaneously within a few weeks to a few months. When this discomfort or soreness becomes persistent it can severely affect the quality of life. When the perineal discomfort is persistent or if the perineal pain is severe it requires treatment.
Because of differences in anatomy, the causes of perineal pain and discomfort are different in males and females.
Women most commonly experience perineal pain after childbirth, after sex or as a result of urinary tract infections.
In men the causes are different and may be related to prostatitis.
Both men and women can experience perineal or perianal pain as a result of gastrointestinal problems or anal problems. Perineal discomfort may also be an indication of urinary problems in both men and women.
Burning in the Perineum
Burning sensation in the perineum is often a sign of underlying urinary problem or neuropathic pain. A thorough evaluation is typically performed to evaluate urinary function. Treatment plan is created with the goal of addressing the most likely cause of pain in each patient. Given the complex anatomy and interplay of multiple variables, often a few treatment approaches are tried.
Physical exam is performed. Relevant laboratory studies are obtained depending on patient history. Pelvic ultrasound is performed. If necessary, CT or MRI of the pelvis is performed. Back or Spine MRI is sometimes necessary depending on patient history and symptoms. Cystoscopy and urodynamic studies are performed as needed. Additional studies may be performed as deemed necessary.
Treatment is initiated individually in each patient guided by history, physical exam and test results. The most likely causes of pain are addressed first. If there is no adequate improvement, other causes of pain are addressed sequentially.
What is the perineum?
The Perineum is the area of the human body that includes the anal opening and the external genital organs. In the male it includes the penis and the testicles. And In the female it includes the opening of vagina and urethra and also the labial folds. The area surrounding these openings is included in the perineum. It is sometimes also called the lowest part of pelvic region and includes everything that passes through or is present in the pelvic outlet.
Perineal Pain Characteristics
Pain in the perineum is felt as a penetrating ache. It can be felt in the perineum, as well as in the rectum with associated inguinal discomfort. The pain can be very agonizing; many patients may feel depressed and exasperated by the pain. The pain can be persistent or intermittent. It may recur or may go away on its own.
Common Causes of Perineal Pain:
Prostatitis is an inflammatory condition of the prostate gland (an important gland due to its role in reproduction for providing nutrition to the sperm). It produces the characteristic pain of the prostate that is usually felt in the lower pelvic region but may also be felt in the perineum. Prostatitis can be acute or chronic. Acute prostatitis is usually due to bacterial infection of the prostate gland, whereas chronic prostatitis could be due to infection, or may be non-infectious. Fever usually accompanies infective prostatitis
An important cause of pain in the perineum is the entrapment of the pudendal nerve. The Pudendal nerve is a nerve that supplies many important organs in the lower pelvis and perineum. Entrapment of this nerve results in chronic pain, which is persistent and lasts for a long period of time. The nerve is not damaged, but gets compressed due to whatever cause. It can be due to pregnancy, any surgery that may leave a scar tissue compressing on the nerve, and it can also occur due to trauma, riding or bicycling etc. It is not a very common condition, but needs expert opinion to reach a definite diagnosis. There are a number of associated symptoms with this condition, such as the pain of pudendal nerve entrapment is increased when sitting and is reduced while standing or sitting on a toilet seat. It is also reduced while lying down on a bed. It can also result in parasthesias, which are abnormal sensations, around the buttock and the perineum. It can also lead to numbness.
Another important cause of perineal pain is the delivery of a baby. It is seen in mothers in the post partum period, which is the period right after birth. It can due to damage to the organs and muscles of the perineum during difficult labor, and also due to damage to any nerve or even the pudendal nerve. The pain usually starts right after delivery, and continues for a long period of time. The pain may spread to the inguinal region and becomes a persistent penetrating ache.
An abscess in the perineum is also an important cause of perineal pain. Usually the abscess develops in the ischeorectal fossa, which is a horse-shoe shaped space in the perineum surrounding the rectum. The infection that usually develops here is secondary to some other cause. For example, the infective organism may reach this space from the rectum. It colonizes in this space and forms an abscess which is very painful and tender. Usually it is accompanied by high grade fever and can lead to fistulas, which are unnatural openings that may lead outside.
Other minor causes include perineural cysts, abscesses and tumors of the anal canal, urethra or the external genitalia.
Other Causes of Perineal Discomfort and Pain
Pain in the perineum can be confused with a number of other conditions like the discomfort of incomplete bladder emptying or urinary retention, which is also felt in the lower pelvis, but it is associated with urinary symptoms. Prostate carcinoma may also cause similar pain, but often it is associated with urinary symptoms.
Stones in the urethra may also cause pain around the tip of penis. Scrotal pain should also not be confused by perineal pain as it is usually just localized to the scrotum or the testicles.
Treatment of Pelvic Pain in New York City
Treatment depends on the cause. The pain can be alleviated by taking pain killers. The choice of pain relieving medicines depends upon the degree of pain. It can range from “over the counter” pills like acetaminophen and ibuprofen, to synthetic opioids.
For pudendal nerve entrapment, corticosteroids are prescribed to help relieve pain and injury to the nerve. Corticosteroids are also helpful in reducing inflammation. They are usually recommended in conjunction with pain killers. The pain usually subsides after adequate treatment but in difficult cases, surgery may be needed to relieve compression on the nerve.
For prostatitis, depending on the cause, antibiotics and anti inflammatory drugs are used that may relieve the pain and discomfort. Surgery is also required for tumors developing in the perineal region, and may also need chemotherapy and radiotherapy later on.