Pudendal nerve block injection.

[EffieT]

Has anyone had a pudendal nerve block injection with cortisone? I am due to have one but no doctor/physio has given me a diagnosis of my pelvic pain, so I don't know why I have pain. I am very nervous about having the procedure in case it makes the pain worse.

[Pinky2233]

I took great care before choosing to have this done but they worked out smoothly and have had 2. I waited til I found a pelvic urogynecologist who knew the anatomy through surgery extremely well for effectiveness

I had zero problems or complications. With the anesthesia you should only feel the first needle which is a pinch over before you know it. If you don’t handle needles it might be harder but know wyou are in good hands.

In my opinion it’s helpfulness is based upon your problem and finding what is causing it exactly.

I wish someone had explained to me in the beginning to go step by step to rule out possible causes. Very valuable advise was, the most important thing to do is get a proper diagnosis. That can come in many forms.

Pelvic pain can be muscular and it is important I believe to have a professional or even yourself if you can palpate looking for spots that are more sore than others. Ultimately looking for trigger points, little muscular bundles that can carry extreme or even simply, constant very sore pain. Trigger points can cause pulling on ligaments and choke off blood flow while lessening oxygen to certain areas that give sharp pain, flulike achy soreness or even stabbing pain in my opinion.

If you can find the specific areas that hurt through a crystal wand or a pelvic therapist don’t discount looking for a great explorative practitioner to find exactly what is wrong.

Scar tissue is notorious for causing pelvic pain and being labeled “nerve pain” by a doctor when it could be a Fascial restrictions. Of course this could be a compressed nerve but it could also be other muscular and fascial tension too.

As for feeing good about having your procedure,

If you have done your own research and made sure your doctor is board certified and look into any past lawsuits and you are confident in your doctor’s credentials you should be in good hands hopefully.

As for being your own detective,

I can suggest be really clear and calm where the pain is the most sharp and ask doctors to palpate and ask what body part is that? Is it a muscle, a ligament? Don’t be afraid to ask questions to help the doctor help you no matter how unorthodox or how different this might be for the doctor.

Don’t waste time be confident and specific and if they won’t engage find another doctor.

Pain spreads so in my opinion try to stay calm and separate the emotion from the pain. If you can figure out where it is the most sharp it could lead you to the source of the pain.

Other help:

Pelvic PT

Acupuncture for the Pelvic muscles

Dry Needling for the pelvis

CBD Oil highest strength by a reputable vendor or homemade

Valium suppositories

I hope this was helpful and just know there are a lot of treatments. Sometimes one modality works but often it is several things coming together.

Good luck!

[EffieT in reply to Pinky2233]

Thank you so much for your advice. In Canada it's really difficult to get a diagnosis. I've been running around in circles and was ready to go to the USA to see Dr. Goldstein in Washington but this was put off because of Covid. I'm going to take your advice and try to find someone who can give me a diagnosis. I've been having Pelvic PT but she doesn't know what it is.

[Pinky2233 in reply to EffieT]

This is the dry needling expert globally in Bethesda MD just 35min by subway and a clean and easy train from Union Station . Jan Dommerholt at Bethesda Physiocare.

This would be for any adhesions or scarring. Treatment would be for dry needling.

...

Was there an event?

[EffieT in reply to Pinky2233]

Thank you for your help and and advice. I am so grateful. No event really. Pain came on gradually after several new fitness classes. I have had a lot of pelvic PT but they don't know what they're treating so it's hit and miss. I really need a diagnosis.

[Pinky2233 in reply to EffieT]

Pudendal type nerve pain can also be the result of bike type classes. Squeezing muscles that become gripped could easily become over use, lock down, or a whiplash type muscle response where the muscle is trying to protect the nerve possibly the sciatic nerve. Yoga poses for the piriformis muscle such as “Log” and “Pigeon Pose” done 30 second stretches 3 times a day very gently to start could help use the muscles as a whole to elongate add deep breaths and start to Re acclimate the muscles into their original relaxed state. Whether you are building muscle or relaxing muscle in my opinion it takes approximately 6 weeks to see the results. If there is any flair begin with once a day after a hot shower or hot tub. Use heat in the beginning sparingly to see how you do to avoid swelling. Avoid Any activity at least for two weeks that squeezes the muscles to help yourself relax them.

Treat The muscles, ligaments in your mind as approachable as any other body parts. It is only my suggestion but give adequate time to the current pT as it takes time. Keep a notebook of highs and lows. Should you find there is no quantitative progress find others do not hesitate. In the event you find yourself in Ny, avoid Beyond Basics. There are many quality Pelvic Pt’s, that is not one. If any pT practice, and you might want to research who owns the practice and how long Pt’s have stayed, how many offices they own and know where you stand within their business model, if it seems like a mill, charging you for every nickle and dime, ie, 45min sessions with 10-20min intakes and no human element of compassion, as they say, if it looks like a Duck and acts like a Duck, it’s a Duck. Pt’s linked to some doctors are usually giving you the least amount of bang for your buck. Read the Pt’s bio, look for years with the practice, ask if the have any advance certification from Herman and Wells and ask what in and especially any advanced certifications in trigger point release from the Institute of Physical Art or the like in Canada. Don’t be shy, ask who is the best and why. Ask your pelvic doctors who is the best pelvic pT for your problem.

In my opinion,

Healing can be about keeping your head on straight. Think positive, surround yourself with positive people and you’ll get where you need to be. Fear, frustration, depression sometimes and naturally can get in the way. Be clear, and be patient.

A great starter book is any version of “A Headache In the Pelvis” by David Wise. He is brilliant and compassionate on all fronts.

[Pinky2233 in reply to Pinky2233]

correction / typo

Not Herman and Wells,

Herman and Wallace

hermanwallace.com/

Institute of Physical Art

my.instituteofphysicalart.com/

The above comments regarding Beyond Basics is only my opinion.

[EffieT in reply to Pinky2233]

I am so grateful to you. I will try your exercise suggestions. I was feeling despondent because my pelvic PT seemed to be inferring that it was in my head and I could change my thinking but I am a scientist, I need to know why. I will also ask my gyny more questions as she, too, brushed me off. I can't tell you how much I appreciate your help.

[Konagirl60 in reply to EffieT]

I’m Canadian. I lived in British Columbia my entire adult life.

I developed PNE in early 2008 and not one of the specialists I saw believed the extent of my pain and they just dismissed me as having a mental problem. I was prescribed medications all of which caused severe side effects and did nothing for my severe neuralgia.

I was able to see a neurologist in Toronto in June 2009 who examined me and concluded I had an atypical pudendal neuropathy. He referred me to Dr. Stanley Antolak in Minnesota.

Dr. Antolak diagnosed me with pudendal neuropathy via an extensive pin prick analysis and a fluoroscopy guided nerve block. He devised a treatment plan for me. The BC doctors didn’t believe him and my pain specialist dropped me.

Eventually I lost cognitive function and the lack of sleep due to severe pain almost killed me. By divine intervention, I met a registered nurse consultant at the end of 2010. I phoned Dr. Antolak and he couldn’t believe the doctors had not followed through.

I hired the nurse and she advocated for my surgery. No doctor would help me get the life sparing surgery. It saved my life.

Where are you from?

[EffieT in reply to Konagirl60]

Thank you for responding. OMG! What an awful experience you have gone through. I can really sympathize with you about the doctors being so dismissive and uncaring! I am so glad you managed to have the surgery and are now better.

I have read about Dr. Antolak and read some of his comments about self care for pudendal neuralgia. Unfortunately he has retired so I can't see /talk to him. I was going to see Dr. Goldstein privately in Washington at the Centre for Vulvar Vaginal Disorders but had to postpone because of Covid.

I live in Toronto and am finally being followed at the Vulvar clinic at St Michael's hospital after spending a year seeing an internist, gynecologist, neurologist with no diagnosis. I have had PT for 3 months but no improvement and no diagnosis. I am due for a cortisone shot in a couple of weeks which may be diagnostic as no one has given me a diagnosis yet. I am really frustrated with the health system which is so backward in terms of pelvic health.

[Konagirl60 in reply to EffieT]

Do you have any metal clips inside your body? They can migrate.

A metal Filshie clip migrated to my rectum ten years after my tubal ligation and caused my PNE. Doctors wouldn’t remove it. They just let me suffer.

Good luck. Keep us posted. I used capsicum pain patches as my pain was rectal and perineal,

[Billykins in reply to Pinky2233]

What a really helpful response. It's people like you that make a massive difference to other sufferers in getting the right diagnosis, support and treatment x

[Pinky2233 in reply to Billykins]

Thank you

[VS1955]

I had this done, wasn't too bad. I wouldn't be worried if I had to do it again. Unfortunately never worked for me, so now doubting myself that I've even got PN, even though I have got the symptoms. I've booked to see a pelvic floor physio next week.

[EffieT in reply to VS1955]

Thank you, thank you. I feel relieved to know that others have had the procedure with no negative effect. I read so much scary stuff on Google.

[AdeleS586]

I have pudendal neuralgia. I was diagnosed a little over five years ago. About 3 years ago I had an ultrasound-guided injection of Cortisone and Lidocaine in the pudendal area. I didn't really notice a difference. That is because by that time I was no longer having any nerve pain. My issue was numbness not being able to feel.

Pelvic floor physical therapy is what has benefited me most. And actually saved me, saved my sanity.

My PF therapist works on trigger points I use a therawand every day for therapy. I'm returning to pelvic floor therapy Tuesday this week cuz I'm still not satisfied that I'm back to what I would call my "normal", even after 5 years.

[EffieT in reply to AdeleS586]

I am so grateful. I don't yet have a diagnosis nor have I found a good pelvic floor therapist who really knows what the pudendal nerve is. I'll keep looking and pushing my gyny for some further information on PTs.

[VS1955 in reply to AdeleS586]

Glad you posted that, I'm due to see Physiotherapist next week I'm hoping she can help me. She has had dealings with PN so keeping my fingers crossed

[COZNA]

I have had several. You want a physician who has performed a fair amount of them. They are generally performed under live fluoroscopy, so it’s pretty safe. It’s also necessary for confirming that the pudendal is involved in your pain. I should mention that I have also had a pudendal nerve release surgery years ago, which worked for my pudendal pain, but seems to have cause other issues over the years. I would not worry about your procedure and view it as a way to find the culprit of your pain.

[EffieT in reply to COZNA]

Thank you. I feel so relieved that it will confirm a diagnosis of pudendal nerve involvement so I can then get on with the next steps.

[Roxy000]

I will say be careful with the nerve blockFor PN. I had one done in Washington DC and had horrible pain down my left leg. Could barely lift my leg into pants to get dressed. This took 2 months to finally go away. I think the nerve block hit the wrong nerve and caused me pain for months.

Maybe an MRI guided nerve block would be safer.

This is a sad condition to be living with, I have no idea what triggered it. Very few doctors are familiar, been going to pelvic floor therapy but haven’t seen improvement. I pray I find a solution and you too ♥️

[EffieT in reply to Roxy000]

Thank you. I feel for you and sympathize. It really is a horrible condition to live with. Takes the joy out of life. I hope you get help soon.

[Borntorunstar_62]

As like Pinky2233 below , I've had 3 Pudendal nerve block injections over the last 2 years and each time it has made a massive improvement , with no pain at all afterwards .It take 2-3 weeks to kick in but then you should get 3-4 months pain free, each time and getting longer after each injection .The injection should be done under local anaesthetic (no need for general) , injections either side of your buttocks/lower back , its uncomfortable but well worth it ,,,,...... GO FOR IT !