Really wondering what the procedure is and if it works

[dlb]

I posted here a few months ago with my story ...and as you all know the saga continues. Since my last post I have been to the orthopedic Dr., been sent to integrated health for yoga, massage therapy, acupuncture and therapy. Been sent to a second pain specialist who did an injection in my lower spine where I have a torn disc and then back to the first pain specialist who had her PT specialist look at me (I have already done PT before). Now I am back in PT.

To sum up my problem it started in July...lower abdominal pain that radiated across my crotch. They removed my right ovary initially and no luck...then I began all of the doctors, MRIs, CT scans, pain meds etc.

The pain specialist dr. sent me back to my original PT for STM/MFR medial hamstring and iliaaslpsral , clear SI. Not even sure what that all meant...(side note, I have added to my original pelvic pains with pain in my knee and arch of my foot).

My PT said she is finding that my obturator muscle is just hard as a rock and that my levator ani muscle feels clamped (which is exactly as I would describe the pain across there). She is going to suggest that they do a trigger point injection in my obturator muscle instead of the obturator nerve which is what they thought they may need to do (they have already done the pudendal nerve block with no success)

I have tons of questions...could this be it? could it work? how does it work...it is internal? external? (the injection)...would it help the levator pain? would it help the knee pain which they said was the hamstring....I am just tired of trying things that don't work and cost money....but mostly the disapointment. The pain dr. I saw today put me on welbutrin for depressoin (75mg) and to try to help me quit smoking which he said makes pain worse. He also told me to take benadryl to help me sleep because I can't and he said that makes pain worse.
any advice would be appreciated!
Thank you

[Lernica]

Is it Botox that they are thinking of injecting? That is usually what they use in the obturator muscle. If so, you should do some research into the possible risks of the injection. Just type "Botox" into the box at the upper right hand corner of this page and read the posts that come up. Unfortunately our members seem to have had more failures than successes with this procedure.

Your symptoms sound very similar to my remaining symptoms after my pudendal neuralgia was cured. I have a very tight obturator on the left, which is the same side as my lower abdominal pain and groin pain. I seem to be making some progress with internal PT so I elected not to go for the Botox injection which was offered to me. I was scheduled to have it today but I cancelled.

Is your pain making it difficult to walk? This is an ongoing challenge for me. However, as with any tight muscle it is important to keep the obturator supple with exercise, stretching and lots of warm- hot baths. Strong jets on a hot tub are also very soothing, as is lying on the floor with a tennis ball under the sore glute.

Like you, my obturator pain sometimes radiates down the leg and into the foot. I think that the spasming obturator muscle could also be affecting the piriformis muscle through which the sciatic nerve travels. So some piriformis stretches would be helpful too. There are many examples of piriformis stretches on YouTube.

Good luck and keep in touch!

BTW, the procedure is done internally with lots of needles poking into your vag!

[nyt]

There are some excellent pictures on the main page you might want to look at so you can get a better understand of the anatomy. It is easy to get confused over the word obturator because there are two obturator muscles (obturator internus and obturator externus) and the obturator nerve. The obturator nerve does NOT control the obturator internus. The obturator nerve controls the muscles and the sensations we feel of the adductor muscles which includes the obturator externus. The adductor muscles are the muscles on the insides of our legs and allow us to close are legs. The obturator nerve runs through the obturator internus muscle so if that muscles is tight and clamps down it will cause the problems with the obturator nerve and thus problems with our adductor muscles. The obturator internus muscle is controlled by nerves that come directly from the back (L5-S1). It could be possible that your problems are from your lower back. Did you MRI show any bulging discs as L5-S1?

So as you can see this can become complicated to figure out. One problem starts and then leads to another. To treat the muscles one can do trigger point injections and massage therapy. Some dr.'s use marcaine which is related to Lidocaine that you get when you have a cavity filled at the dentist office. Some dr.'s use marcaine mixe with a steriod for trigger points. Some dr.'s use botox for trigger points. Many insurance companies won't initially pay for botox so some dr.'s do marcaine first so they can go back and petition the insurance company. How trigger points are treated depends on the dr.'s philosophy.

To treat the nerve one does nerve blocks. They inject marcaine or a mixture of marcaine and steriod to block the transmission of the nerve as close to the nerve of interest as possible.

Lernica's suggesting of doing a search on botox within this forum is a good suggestion so you can see the breathe of everyone's experience. Personally, for me I have found botox extremely helpful. I've had botox injections to the pelvic floor muscles (levator ani and obturator internus) 3 times and will have it done for a 4th time in April. I have mine done by Dr. Hibner under anesthesia and he is quite aggressive with the amount of botox he uses. I have found that with the 3rd try as the botox started to wear off the pain did not return to the same level. For me there appears to be a cumulative effect. I was unable to do any pelvic floor PT before the botox because my muscles were so hyperexcitable that any internal work just made them spasm worse and crippled me. Even with the botox I have to be extremely careful with pelvic floor PT because it will make me worse if we just over do just a little.

Good luck and keep us posted on your progress. Prayers are sent your way as you figure out the next steps.

[dlb]

Thank you so much for your advice and information. They have not said what they would inject...I believe my PT thinks that it is the obturator internus...that is the one she mentions. although she talks about the nerve too and piriformus muscle. I did have an injection for the pudendal nerve months ago with no help. I don't have a bulging disc, just a torn disc at the spot you mentioned L5 S1. That is where they gave the last injection, but it did not help either.
After the internal PT I usually feel worse for a few days and then it goes back to the same. Sometimes I have a hard time understanding everything they are talking about and where they all are and how they connect.
I really wish I knew what had started it all...I feel like they do not really know for sure the start ...I hear a lot of what came first the chicken or the egg.
Walking can hurt, but not the main problem...sitting is awful and most relief comes from laying down, but when I lay on my side it hurts and feels like something is moving around if that makes sense. Like there is something hard that pushes down??
My Dr. left a message yesterday that she wants to change my pain med to something more long term...I don't know what that means. I take 7.5 hydrocodone now...6 pills a day, sometimes 7 if it is really bad. Do you know what she could be talking about?
I also take tiazadine and gabapentin.
they just started me on .75mg of bupoprin for anxiety.

[Lernica]

My Dr. left a message yesterday that she wants to change my pain med to something more long term...I don't know what that means. I take 7.5 hydrocodone now...6 pills a day, sometimes 7 if it is really bad. Do you know what she could be talking about?

She's probably talking about a long-acting opiate like oxycontin. It lasts 8 - 12 hours and has fewer side effects like sleepiness and dizziness. If constipation is an issue for you, you could ask for Targin which is a combination of oxycodone (10 mg.) and naloxene (5 mg.). It's supposed to have anti-constipation properties although I still get constipated when I use it. But I'm super prone to constipation.