Post-operative guide
Recovery after pudendal nerve decompression.
Pudendal nerve decompression relieves the mechanical entrapment, but the nerve itself heals slowly. This is the honest, week-by-week timeline we give our own patients — from the hospital stay to returning to work, driving and sport.
The first 48 hours
Surgery is performed under general anaesthesia through a small transgluteal incision. You will be up and walking the same evening. Most patients are discharged the next day with anti-inflammatories, paracetamol and a short course of neuropathic pain medication.
You will leave with a wedge cushion, walking instructions and a written recovery plan.
Weeks 1–6: expect a temporary flare
Surgical inflammation often causes a temporary increase in nerve pain between weeks 2 and 6. This is expected and does not indicate failed surgery — it reflects the nerve reacting to being freed and to local swelling.
Walking daily, sleeping on your side with a pillow between the knees, and avoiding prolonged sitting are the three most important things during this phase.
Months 3–12: the real recovery window
Nerves regenerate at roughly 1 mm per day. Meaningful, sustained improvement is typically felt between month 3 and month 12, and can continue for up to 24 months.
We review patients at 6 weeks, 3 months, 6 months and 12 months to track nerve recovery, adjust medication and clear activities.
What patients ask about most
Common milestones, though every recovery is individual and clearance is always given by your surgeon:
- Sitting on a cushion: from week 2–3
- Driving short trips: from week 2–3
- Desk work: from week 2–4
- Swimming: from week 4
- Running and gym: from month 3, graded
- Cycling and horse riding: only after specialist clearance, usually 6+ months
- Sexual activity: from week 4–6, guided by comfort
Common questions
How long is the hospital stay after pudendal nerve decompression?
Most patients are discharged 24–48 hours after transgluteal pudendal nerve decompression. Pain is managed with a combination of anti-inflammatories, paracetamol and neuropathic medication; opioids are rarely required beyond the first 48 hours.
When does the nerve pain actually improve?
Nerve recovery is slow. Many patients notice a transient worsening in the first 2–6 weeks (surgical inflammation), then gradual improvement from month 3 onwards. Meaningful relief is typically reported between 6 and 12 months, and the nerve can continue to improve for up to 18–24 months.
When can I sit normally again?
Short sitting on a proper cushion is usually possible from week 2–3. Prolonged sitting without a cushion should be avoided for at least 3 months. Most patients return to a normal desk routine (with a cushion and standing breaks) between weeks 4 and 8.
When can I drive again?
Short local trips are typically resumed at 2–3 weeks with a cushion. Long-distance driving should wait 6–8 weeks. Do not drive while taking sedating pain medication.
When can I go back to work?
Desk-based work: 2–4 weeks. Work involving prolonged sitting or driving: 6–8 weeks. Physically demanding work (lifting, standing all day): 8–12 weeks, discussed individually with your surgeon.
When can I exercise again?
Walking is encouraged from day 1. Swimming and light stationary work from week 4. Running, gym and heavy lifting from month 3, gradually. Cycling and horse riding: only after specialist clearance, usually not before 6 months.
What is the success rate of pudendal nerve decompression?
Published series report meaningful improvement in 60–80% of properly selected patients. Selection is decisive: patients with a clear pudendal pattern, positive diagnostic block and imaging correlation do best. Realistic expectation-setting is part of every pre-operative consultation.
Speak with a pudendal nerve specialist.
Dr Renaud Bollens leads a specialist practice dedicated to chronic pelvic pain, with centers in Dubai and Belgium.