My main symptoms are
1) Pain with sitting
2) Lingering rectal pain after a Bowel movement (seems more like deep aching muscle pain - but could be a combination of muscle and nerve)
3) Burning after intercourse
If anyone has any thoughts would love to hear feedback...
MRI of the pelvis
MRI of the pelvis was performed utilizing coronal and oblique axial inversion recovery followed by coronal, sagittal and oblique axial fast spin echo techniques. Clinical concern is pudendal nerve entrapment, with particular concern of perirectal and perianal branches. The patient reports bilateral symptoms.
At the inferior margin, the coccyx is deviated anteriorly but there is no medial or lateral deviation. There is mild scarring of the anococcygeal ligament noted on series 8 image 33. The sacrotuberous and sacrospinous ligaments appear symmetric. No scar encasement of the pudendal nerves through Alcock's canal is seen. The inferior margin of the pubic symphysis ligaments are unremarkable. There is no abnormal signal appreciated the suspensory ligament of the penis. Of note, however, are pelvic floor varices consolidated the posterior margin of the pubic symphysis and in the anteroinferior margin of Alcock's canal, compressing the inferior perineal branches of the pudendal nerves to the anus, as well as abutting the dorsal nerves to the penis bilaterally. These are fairly symmetric but slightly more prominent on the right. No varicoceles are seen. There is no compression of the visualized portion of the ilioinguinal or genitofemoral nerves. There is a focal varix noted in the left obturator canal without extensive compression of the obturator nerves.
No regional adenopathy is seen. There are features of femoroacetabular impingement syndrome bilaterally with insufficient offset at the neck-head junction, intraosseous ganglion cyst formation and proliferative bone formation. The extent of labral or cartilage pathology can be confirmed with use of formal MR imaging of the hips, as clinically warranted.
Hamstring tendinosis is seen without acute tear. Disc degeneration is noted.
Impression:
MRI of the pelvis demonstrates pelvic floor varices, prominent around the inferior perineal branches of the pudendal nerves bilaterally to the anus, as well as this abutting the dorsal nerves to the penis bilaterally, and consolidated posterior to the inferior margin of the pubic symphysis. No perineural scarring is appreciated although there is scarring of the anococcygeal ligament without deviation of the coccyx .