32 year old male, almost permanently impotent.

[Pleasehelpmegod]

last year i did a cystoscopy and a retrograde urethrogram, after that i developed pelvic floor dysfunction. Turns out My pudendal nerve is being compressed, but my pt dosent know exactly where it's being compressed.
When it's compressed i have the following symptoms numb penis, extremely low ejaculate, loss of ejaculate power, erectile dysfunction, loss of anal sphincter contractions, loss of morning erections,scrotum numbness but here is the weird thing whenever i do PT i get a lot of that function back for a couple of days until my muscles start spazzing out and it becomes tight again. So far she said my piriformis is tight and my obterator internus is tight.
I understand that the pudendal nerve can get entrapped in the Large sciatic foremen as the piriformis muscle compresses it because the muscle is too hypertrophic, But when this all started i had pain in my sit bones and next too my anus where my obterator internus is. I want to know where this pudendal nerve compression is. Should i do a 3T mri or should i do a MR neurography? I also have pain sitting down i have sharp pains in my sit bones and around my hips. On july 7th i moved apartments and pulled a washing machine on a dolly up 3 floors, after i carried the washing machine up i had an extremely sharp pain in my butt/hips and couldn't walk normally. I couldn't move my foot forward properly. then at 3:30am that night i think my pirformis started spazzing out like crazy. Ever since then i don't get morning erections unless it's the day or two after PT. I also got into a huge car crash after the cystoscopy/rug. I rear ended someone and pushed on the brake pad extremely hard. I don't think that caused the pains that i have now since i had ejaculating problems and pain before then, but i also don't think that it helped. all signs point to my pudendal nerve being compressed or trapped by a muscle or something. I just don't know which muscle it is. I've also have this pinching burning feeling near my sciatic foremen 24/7, i feel like it's where my pudendal nerve is being compressed. I have an appointment on august 6th with my orthopedist, i think i am going to push a MRN and trigger point injections. My PT seems to think that i have a pudendal nerve compression somewhere by the muscles. Before this PT i had previous PT and all we did was internal myofascial release and dry needling which didn't help at all, I did that for 12 sessions. So now i'm pretty lost because i have all this pelvic floor pain and i know my pudendal nerve is being compressed by the obterator internus or the pirformis muscle. When the pain first started it defitely started at my sit bones then reached out to my hips, then i started limping because it was affecting my hips. I don't know if i have hypertonic pelvic floor dysfunction because my pudendal nerve is being compressed or if the hyptertonic muscles are causing my pudendal neuralgia. So what do you guys think? is it more likely that the pirformis is compressing the pudendal nerve or is it more likely that the obterator internus is compressing the pudendal nerve. Will a 3t MRI with dr. potter protocol be able to see muscle compression on the pudendal nerve? or will a MR neurography be able to see that? If it's something someone can fix under the knife should i do it? My PT says usually it just causes more damage.

So far i've had a ct scan, pelvic mri, semen analysis, retograde urinalysis, lumar mri, which all came back normal.

[April]

So you did do a pelvic MRI already? And what were they looking for in that? The Potter protocol is helpful for identifying pn compression but even with that, many times compression is not evident in the MRI. In fact, Hibner generally doesn't use MRIs for diagnosis because there are so many false negatives. If you do another one, though, I think it makes sense to use the Potter protocol. You can email her clinic and ask for it, and they will email it to you. Then you have to ask your ordering doctor to request that the tech follow the protocol. And I would get a 3T MRI. You were wondering what muscle is compressing it, but many times it's compressed in a ligament. The most common compression location is between the sacrotuberous and sacrospinous ligaments. Surgery can be helpful if the nerve is compressed in a ligament or scar tissue, but usually people try all the conservative options first. It's a good sign that pt reduces your pain at least for the short-term. Let us know what the orthopedist says. Have you had a nerve block with imaging? That can be a helpful diagnostic tool.

April

[Pleasehelpmegod]

judging from my history, my Pt and i both think i have a compression of the pudendal canal. The reason i say this is because right after the cystoscopy i had sharp pains right by my anus, the pain then moved to my sit bone and closer to my hips. I'm guessing this is the obterator internus. I know that the obterator internus is tight and i know that the obterator internus is connect to the obterator fascia and i know that the obterator fascia turns into the alcocks canal. My plan right now is to get guided ct Botox injections to the obterator internus than get inject cortisone into the pudendal canal to decrease inflammation and do PT to stretch and relax the obterator internus, then hopefully the pudendal canal will release the pudendal nerve and artery and i will be able to feel again.

is a pudendal decompression surgery the same thing as pudendal canal decompression?

https://www.ncbi.nlm.nih.gov/pubmed/8166577

my ortho said he will do some more digging and get back to me.

im also going to talk to dr. prolongo but im not sure if the practice will take my insurance.

i'm hoping to god that i wont have to do surgery. I don't even have that kind of money.

[Pleasehelpmegod]

So you did do a pelvic MRI already? And what were they looking for in that? The Potter protocol is helpful for identifying pn compression but even with that, many times compression is not evident in the MRI. In fact, Hibner generally doesn't use MRIs for diagnosis because there are so many false negatives. If you do another one, though, I think it makes sense to use the Potter protocol. You can email her clinic and ask for it, and they will email it to you. Then you have to ask your ordering doctor to request that the tech follow the protocol. And I would get a 3T MRI. You were wondering what muscle is compressing it, but many times it's compressed in a ligament. The most common compression location is between the sacrotuberous and sacrospinous ligaments. Surgery can be helpful if the nerve is compressed in a ligament or scar tissue, but usually people try all the conservative options first. It's a good sign that pt reduces your pain at least for the short-term. Let us know what the orthopedist says. Have you had a nerve block with imaging? That can be a helpful diagnostic tool.

April

[Violet M]

is a pudendal decompression surgery the same thing as pudendal canal decompression?

Pudendal canal decompression is one type of pudendal decompression surgery, specific to the Alcock's canal area. It may not address ligament entrapment at the ischial spine.

Violet

[YrkinSon]

is a pudendal decompression surgery the same thing as pudendal canal decompression?

Pudendal canal decompression is one type of pudendal decompression surgery, specific to the Alcock's canal area. It may not address ligament entrapment at the ischial spine.

Violet

Wow, I really didn’t even know about it. Thanks for the information.

[CALIhelp]

HI EVERYONE

PLEASE PLEASE PLEASE GIVE ME YOUR FEEDBACK IF I SHOULD HAVE PUDENDAL NERVE DECOMPRESSION SURGERY?????? I AM THINKING ABOUT THAT OR CRYOABLATION OF THE PUDENDAL NERVE...... I CAN NOT SIT IN A MOVIE THEATER GO ON LONG DRIVES IT DRIVES ME CRAZY... HOWEVER I DO NOT WANT TO MAKE THIS WORSE I AM LEANING TOWARDS DOING CRYOABLATION OF THE PUDENDAL NERVE

BEST WISHES TO EVERYBODY AND GOD BLESS YOU ALL AND I HOPE NOBODY HAS TO SUFFER....

[Suekarlson]

Try to get an MRI of the lumbar area. Have prolotherapy to surrounding ligament and SI Joint area. Have someone use the palm of their hand starting in lower lumbar area on Right side of spine pushing down on muscles and moving upwards then start on lower left side. See if this releases the tightness in the genital area. Start doing planks on forearms. Start on knees and tilt pelvis and squeeze belly button to spine for 10 sec. see if this helps. It should bring your hips forward as you draw upward but don’t squeeze hips or anus.( no kegal). If you are lying in bed in pain breathe in for four hold for four and release breath for four seconds. This will relax the muscles around the nerves.