doggicam wrote:I was severely injured by a vaginal pudendal nerve block unguided. The injection caused a very large hematoma in my pelvis that took two years to resolve. I was unable to work for 6 months. Dr McDonald did the procedure (ucla). I have contacted other drs and pelvic pain centers that considers this to be experimental at best. Hope this helps
Hi.
I originated this thread and did go on to have the pudendal nerve block with cortisone.
Fortunately,things didn't get worse, except for a big two week flare .Oh,and mine was guided, too(fluoroscopy and nerve stimulator). Somewhere in the region of the sacrospinous and sacrotuberous ligaments (gluteal approach)-not at the Alcocks canal.
Cheers and thanks for your contribution.
Last edited by Jackson on Fri Apr 19, 2013 8:01 am, edited 1 time in total.
Yes, thanks Bathsheba for reporting back. I am wondering if the physician who did your nerve blocks informed you of the possible risks prior to the blocks. I know people who have gotten worse long-term from nerve blocks and I just wonder if patients are being informed of the risks better than they used to be.
Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
Dear Violet:
I was in this forum few years back becuase of my PNE symptoms since 2007. I had one fluroscopy guided block with Dr. Antalok, which gave relief for 2 hours. Then I went to see Dr. Filler after few years he did MRI guided injection on various areas (obturator internus muscles, priformis) muscles which relieve my pain on third day (again for few hours). Later I had MRN which suggested split priformis/split sciatic nerve and some image intensity for both sciatic nerve and distal end also shows some hyperintensity of pudendal nerve.
I do not know but do you recall when you had your PNE surgery in france did they cut any of the ligament (e.g., sacrospinus ligament) to free the pudendal nerve.
I am in a delima (even after 5 years) to decide if my PNE is caused by priformis sydrome or vice versa. Dr. Filler wants me to do the surgery for both but I am little worried about cutting the sacrospinal ligament which may create more pain and SI joint instability.
Please let me know if you remember anyone had both pudendal and priformis surgery at the same time.
It seems like you are doing well.
My conditions regarding walking and daily activity have deteriorated in the last 5 years though I admit that with some PT my pudendal pain is improved but I always have pain in the gluteus medius and feet burning.
I am not sure what cause my feet burnign PS or PNE? Hence, anyone who has PNE please comment if they got better with feet burning after PNE surgery.
Best
Shawn
Shawn, I had the sacrospinous ligaments cut but not the sacrotuberous. I don't think it significantly affected my pelvic stability.
I had piriformis syndrome on the right side before PNE surgery. I had numbness in my right leg and foot (not burning). That is completely relieved since PNE surgery. I did not have surgery on the piriformis muscle. I think that after the PNE pain was relieved the piriformis muscle was able to relax and the sciatic nerve was no longer irritated.
Best,
Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
Thanks Violet for your quick answer. In my case, if I recall I did had my PNE and priformis pain came at the same time. I say this because PNE pain feels more on the sit bone at the ischial tuberosity and deep. I notice that my pain between the priformis and pudendal area alternates. Sometime I feel more pain one area than the other. I used to have some pain in the groin area, but that has decreased somewhat with stretches which I did for SI joint dysfunction. I had considerable session dry needling in the deep area around prerectal area, which relieves my pudendal pain but the pain which is more toward the middle of my leg where the buttocks ends and hamstring starts is I believe the obturator and priformis area.
My MRN showed split priformis and split sciatic nerve (congenetically). This means that part of my nerve is going through the priformis muscles and part underneath the muscles. The MRN suggested that "There is hypersintensity within the sciatic nerve, which commences at the sciatic notch, and persists as it descends to the level of obturator internus tendon and resolves as it proceeds distally into the upper thigh."
The pudendal nerve elements demonstrates significant increase in caliber and intensity, just at the level of ischial spine and proceeding distally.
Hence, it is difficult to decide, which surgery (pudendal or priformis surgery) will relieve my pain or I should proceed with both.
Interestingly my PMLT was negative but provocative EMG shows SI nerve denervation, which means there is some sciatic irritation.
I will visit Dr. Hibner to see what he has to say.
Thanks once again for your quick reply.
Shawn
Ahhh, well that is a hard decision. I wonder how many people have split piriformis congenitally without any pain. Does a split piriformis = sciatic pain? We see a lot of Filler reports with them. Maybe you want to choose the surgery for the pain that is the worst -- is it the pudendal or the sciatic? I don't know -- just a thought. Wishing you the best whatever you decide.
Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
Violet :
Thanks for your input. Yes, I feel like walking on egg shells for the past one year while thinking to make this decision. When my PT does internal work I do not jump as much as I used to be, but could be due to better pain tolerance. You mention whichever pain is worst do that first. The question is how would clearly distinguish between the two pains if sciatiic nerve is so close to pudendal.
Do you potter MRI could confirm spit muscles/spli priformis or Dr. Filler is the only doctor who can tell this.?
Thanks
Shawn
Shawn, I'm pretty sure Dr. Potter could tell if you had a split piriformis. I've seen a report where she states the sciatic nerves do not pierce the piriformis so it sounds like she does look for that type of anomaly.
For me, sciatic pain was more like a dull ache/numbness halfway between the sacrum and hip bone that radiated down the back of my leg into my foot. PNE pain was more like a deep knife-like pain lower down near the ischial tuberosity/pelvic floor area radiating into the perineal area. For me, PNE pain was by far the worst but everyone is different and it would also depend on which branch of the PN was affected. I'm not sure how you would tell them apart but that's what mine were like.
Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
