levator ani injection

[Faith]

The next thing they are talking aobut is something with radio frequency ablation of the Prudendal. Anyone have any information on this??

Sue, sorry your PGAD is back. There have been mixed results with radio frequency on the board. Are you talking about pulsed radio frequency? Here is a link to a thread about a success with PRF, http://tinyurl.com/7l8fxcd but some say it makes their pain worse. have you had success with PN blocks? It seems to me those who have success with nerve blocks have better success with PRF. Maybe the kenalog will help. I know one person who got some trigger point injections with kenalog and they helped some. Unfortunately they made me worse.

Lernica, sorry you have to wait so long for the hip surgery. Sorry for the misunderstanding about the PT/trigger point. If you get a trigger point injection with kenalog or a steroid it's possible it might help you with the post PT flares, but it will take around a week for the steroid to kick in.

[quiltlady]

http://tinyurl.com/7l8fxcd
thanks for the link to the radio frequncy treatment. It sounds promising.

I am wondering about what you said about the possiblity that the kenalog may kick in later on. I would love to hold onto that hope.

sue

[Faith]

I am wondering about what you said about the possiblity that the kenalog may kick in later on. I would love to hold onto that hope.

sue

Kenalog is a steroid and it often takes 7-10 days after the injection for the steroid to kick in. If your nerve is not truly entrapped the steroid might decrease the nerve inflammation and muscle spasm. Does that help?

[quiltlady]

Yes Faith that helps. I am having some discomfort but feel it may be just the injection site itself. Thank you for the answer.

Sue

[nyt]

Lernica, I have a pelvic floor that is full of trigger points. The left side is quite bad and they refer to the ischial tuberosity. The right side, I have absolutely no sensation. I can not tell where the PT palpitates but occasionally I get the referral to the ischial tuberosity. She has to be real careful working on the obturator internus as that always flares my adductors in my legs. That has been a problem for me for 4 years now when I try to do PT. I still get alot of spasms when I stand. I think in my case, this is going to be an ongoing battle because of the multiple nerves in my pelvis that are damaged. For me, the botox has helped with the pain in my butt. In my case much of my butt ache that can get very painful is from my pelvic floor. Some is piriformis syndrome and some is from my pelvic floor. Trigger points can be incredibly difficult to get rid and takes alot of time and work.

[Lernica]

Thanks, NYT, for the warning about being patient with the pelvic floor trigger point. (Sigh.) Just when you think you've solved the pelvic pain puzzle, another piece of the puzzle pops up.

[White Falcon]

Here is a link to an excellent article about trigger points, pelvic pain, and treatment. The authors are gynecologists in Alberta. Their treatment includes dry needling (not injecting anything, just poking) as well as xylocaine or botox injections. Incidentally, the article also mentions that one patient whose trigger points did not resolve with treatment probably had a hernia contributing to her pelvic pain.

http://www.stacommunications.com/journa ... icpain.pdf

Here is an exerpt from the article that discusses the levator ani.

A 32-year-old woman presented with severe pelvic pain such that sitting was not possible. She avoided voiding and defecation whenever possible, and was not sexually active because of the pain. The patient was found clinically to have several severe trigger points in the lower abdominal wall and a significant tense band in the levator ani, pyramidalis, and obturator internus muscles. With extensive physiotherapy and the self-management program of the Calgary Chronic Pain Centre, significant benefit was achieved. The patient required several injections into the left pyramidalis. Additional injections of tight bands were undertaken into the levator muscles and obturator internus muscles with 5 cc to 10 cc of 1% xylocaine. These were most noticeable on the left side. The patient demonstrated significant improvement in the degree of disability; she was able to sit and walk with substantially improved ability.
This case demonstrates that, in the pelvis, severe spasm is not isolated to the abdominal wall, but often extends to the intra-pelvic musculature. Muscles that are commonly involved include the levator ani and obturator internus. The involvement of such muscles commonly causes severe pelvic spasm that results in urinary pain post-voiding, avoidance of micturition, and defecation, leading to marked alterations in the physiologic functions of the pelvic viscera.

[Lernica]

Excellent article, WF! Thanks for posting. Describes my remaining pelvic pain symptoms exactly. I have my first appointment with a renown pelvic PT tomorrow and hope that her treatment will resolve my remaining pelvic pain.

[Patience]

Sue (quiltlady) -
I'm wondering how you are doing now after the kenelog/botox injection?

Two years ago my husband had PPH surgery (the newer stapled hemmorhoidectomy procedure). 2 weeks after the procedure, he started having severe pain and it has not let up. He can not work any longer and he is feeling quite hopeless. We have seen about 5 doctors regarding this. Three colorectal specialists have said he has levator ani spasms. He has tried every cream and ointment out there. He's tried nerve blocks, biofeedback, trigger point massage and electro-galvanic stimulation. He's also tried diazepam, etc. It's very disturbing that the medical community considers this syndrome as "rare" when I see forums all over the internet about this problem.

In an effort to try and bring him some hope, I searched the internet for the top colorectal surgeons. So far, I have only found one colorectal surgeon that seems to be able to state that she has treated this condition successfully. Apparently she injects kenelog/botox which is what I believe you had done Sue. Since it's about 10 days since your injection, I'm wondering how you are doing? I saw that you went to Cleveland Clinic and wondered who your doctor is?

Thanks so much,
Nancy

[helenlegs 11]

I hope you do get a reply from Sue, Patience although I noticed that her post was almost a year ago. You could try and PM her or ask the question again on the forum (both in fact)
Someone else may have details about who in the Cleveland clinic now too, you never know. Sorry I can't help with that one.
There are a few people here who have had post surgical pelvic nerve problems on this site so I feel sure there will be answers to all sorts of questions you may have about your husbands condition. It's so lovely that you are not giving up and still searching for answers on his behalf and on Valentines day well I saw it on Valentines anyway
Welcome to you both. you will find support and help here I hope it will make the difference and get you the answers you seek.
Take care,
Helen