pain near perineum

[Lara1244]

since having a total hysterectomy in 2019 for very early stage cancer which cured it I have developed nagging pain near the perineum which at times feels as if I’ve been kicked in that area. I also developed urge incontinence and changes to bowel function. Recently I saw a physiotherapist who specialised in the pelvic area and while it helped my urge incontinence temporarily it did nothing for the the pelvic pain. Is this something I will have to live with?

I would appreciate any advice from someone who has suffered similar.

Thank you

Lara

[janeneil]

did the physio see if you have tight pelvic floor muscles which would benefit from pelvic floor trigger point therapy. Have you seen a pain doctor that specialises in pelvic pain?

[Lara1244 in reply to janeneil]

Hi I did see a physiotherapist who specialises in pelvic area and she identified tightness in the pelvic area near the perineum on right side of bottom but right underneath bottom. She gave me tightening and relaxing exercises but don’t think they help much. I have intermittent pain which ranges from mild to more intense pain. What is trigger point therapy?

Thanks

Lara

[janeneil in reply to Lara1244]

I can only speak from my own experiences. I have tightness due to a neurologic injury after an operation in the pelvis. In this situation tightening exercises are a no and trigger point therapy is when a practitioner presses on certain points vaginally with the intention of relaxing and stretching the muscles that are held in tension. I imagine a pelvic physiotherapist would know if you need this technique as opposed to strengthening techniques which are the opposite. In my case any strengthening makes my situation worse.

[BlueLagoon007]

Hi Lara1244,

I too had a total hysterectomy in 2022 and have suffered with chronic pelvic pain ever since.

I was diagnosed with pudenda neuralgia l that same year. I also have changed bladder and bowel issues. In fact, the last 29 months I have done nothing but go to medical appointments. I have had several nerve blocks, botox into pelvic floor muscles and anal sphincter and a ganglion impar block plus on Lyrica for the nerve pain. As a result of the surgery I now have a rectocele and enterocele and rectal intussusception.

I am also being treated regularly by a pelvic floor physio and osteopath.

I don't know whether you have the same condition but make sure you see someone who specialises in this area, possibly a very good gynaecologist who also treats chronic pain or a urogynaecologist.

Take care and I hope you find some answers soon. I feel like I am on a continuous medical merry-go-round.

[janeneil in reply to BlueLagoon007]

Hi Blue lagoon, I too have been suggested ganglion impar block. Did it help you at all?

[BlueLagoon007 in reply to janeneil]

Hi Janeneil,

To answer you honestly, I am not sure that the ganglion impar block helped all that much. It is hard to know as I have had different procedures done from time to time. Perhaps they have each contributed in their own way, so it is hard to tell whether the ganglion block on its own really helped.

I think the botox into 2 pelvic floor muscles and botox into the anal sphincter have helped the most, but it depends on what your symptoms are. I have vaginal as well as rectal issues.

Take care

[janeneil in reply to BlueLagoon007]

Thank you for letting me know. So far I have been relying on pelvic floor trigger point therapy, TENS machine and chinese acupuncture. Although they all help to a degree, I have been getting worse over the years and now starting to think what i could do as a starting point on more invasive therapies.

[Lara1244 in reply to BlueLagoon007]

Hi

I stopped seeing my pelvic pain physiotherapist as felt I wasn’t getting much improvement. She did advise I had a strong pelvic floor. I believe from other peoples experiences that I have pudendal neuralgia. Is it worth going down the route of getting treatment to resolve or learning to live with and manage pain? Ontop of that my bowel function has changed and I get discomfort in rectum and moving bowels almost every time I wee. I also have urge incontinence. All of these problems started after a total hysterectomy for early stage cancer. But if you could advise from your experience if it’s worth the efforts trying to resolve the pudendal neuralgia?

Kind Regards

Lara

[BlueLagoon007 in reply to Lara1244]

Hi Lara,I think it is definitely worth going down the path of pudendal neuralgia.

There is no cure for pudendal neuralgia only management but there are a lot of different options to consider.

The most important thing is to be seen by a doctor who recognises and treats pn and is a pain management specialist.

I live in Sydney, NSW, Australia so I can't help you on who to see unfortunately.

Good luck with it all.

[Konagirl60]

Both of the other responders have suggested the right course of action.

I agree, can you see a physiotherapist who specializes in pelvic pain?

I had Pudendal nerve entrapment and I had successful surgery. My right pudendal nerve ( the nerve that innervates most of our pelvis along with our external genitalia and anus. ) was stuck/ entrapped and pinched in three places ) .

Where do you live? I know of the doctors who deal with pudendal neuralgia. I’d be willing to share with you if you want. Wishing you good luck.

[Lara1244 in reply to Konagirl60]

thank you for your considered reply. Do you live in uk? I live in Newport area in South Wales. Do you know of any specialists here in perineum pain?

[Konagirl60]

Dr. Gareth Greenslade is the closest pudendal nerve expert to you. He works out of Nuffield Hospital, 3 Clifton Hill, Clifton, Bristol. His mobile phone no is: 0747-991-2933. His landline number is: 0117 968 8312. His email is: [e-mail]. Good luck.

[Lara1244 in reply to Konagirl60]

Thanks for your reply

[Konagirl60]

You are so welcome. Keep me posted.