Sports hernia surgery resolved pudendal pain

[PKgal]

I know everyone's experience is different, but I'm sharing mine in case it helps. I had burning pain in my pelvis and pain with sitting that was constant and horrible and started seemingly out of nowhere, though later I realized I had done some heavy lifting a few weeks prior and at the time felt like I'd pulled something in my lower abdomen, but no pain developed for at least a month after. I was initially diagnosed with pelvic floor dysfunction, but I was dubious because I didn't have any other symptoms (no pain with sex, no continence issues, etc) but when you're in that kind of pain, you do anything that might help! I went for PT, and in evaluation they identified pudendal nerve pain. I had PT, shots, medication - I think a lot of it made me feel worse. Though I'm still glad I did PT because my therapist was a great coach and helped me stay sane and hopeful! My MRI of the pudendal nerve was normal, but my gyno said damage doesn't always show on MRIs, but my symptoms matched and she also did diagnose me with pudendal neuralgia. But she said if I saw no progress with PT, shots and meds after a time I should go see a surgeon for evaluation for pubalgia ("sports hernia"), though she didn't think I had it. I looked it up on-line and it ALSO didn't sound like me, except for a couple of random sites that listed different symptoms than most did. But I learned that there's not a lot of good info out there about pubalgia and that it often presents differently in men vs. women and most info out there is about the presentation in men, for whatever reason (I'm a woman). Even the surgeon said I was a borderline case, but I had the surgery, and the amazing thing is that while it's not done near the pudendal nerve, in some way it restores balance to the region, and I now have 0% sitting pain!! I still have some front pelvic pain, almost 4 months post-surgery, but it's so much less than it used to be, and it's very gradually continuing to improve so far, so I'm praying and keeping fingers crossed that it might get even better. If anyone looks it up and thinks it might fit them (or if you had symptoms like mine - burning pelvic pain, rear pain that is much worse when sitting down, and even lying down, pain worse with walking much or even the motion of leg movement for driving, pain not worsened by sex - these were my symptoms, but if yours are a little different, I still wouldn't necessarily rule it out) then I'd highly recommend my surgeon, Dr. Mark Zoland, in NYC. Wonderful person and excellent surgeon. I know how exhausting it is to look into option after option, so I don't mean to stress anyone out by adding another thing to look into, but I also know how important it is to keep looking for the RIGHT diagnosis, and how hard that is, as there's not enough known yet generally in medicine about this area!

[Buttercup28]

Hi PKGal,

Thanks so much for posting. I just joined this forum a few months ago in order to try and figure out if I could gather any helpful information from others on here. I have had the PN pain for 9 years. I just recently found out last year that I have a hip issue (impingement and labral tear) that could be the cause of and/or contributing to my long-standing pain issues.

In any case, I decided just recently to look into the hernia aspect because it came up as a recommended route I should take to determine if there is any connection. I honestly didn't think I had any kind of hernia b/c I figured I would know if I had a hernia all of these years. (And of course being a woman, I though well men have hernias, and also I don't have any preceding causal event to tie it to.)

I just saw Dr. Zoland myself recently for a consult and he did diagnose me with a hernia. I think he mentioned that I have two small chronic hernias (in two different spots), but both on the same side as my PN/pelvic floor pain. I need to review his notes though to see exactly what he told me b/c I was in a bit of a daze when I was there.

He didn't necessarily recommend surgery for me just b/c of my history with PN, hip issues, etc. and he didn't want to give me false hope. I need to give this all some more thought. Thanks so much for your input on here because you are definitely helping!

I'm really happy to hear that you are feeling better already from the surgery!

Thanks,

Buttercup

[PKgal]

Thank you, Buttercup! I live in awe of people who have been managing pelvic pain for years - I feel like you deserve some kind of medal, or badge, or something! It sounds like there are multiple issues that may affect your pain, but for whatever it's worth, I will mention that my physical therapist told me that another patient of hers who had the surgery with Dr. Zoland and did well with it also had a labral tear and hip issues. That wasn't part of my situation so I don't know how that all may tie together... and if Dr. Zoland said you had 2 hernias, I don't know if that means more the traditional kind of hernia, and therefore maybe a different kind of surgery indicated (if any) than what Dr. Zoland usually does... I don't know, but I definitely DO know what you mean about leaving the office in a daze! Very good to refer to your notes, and also I found Dr. Zoland to be very accessible and patient with follow-up questions, explaining things multiple times to me as I tried to understand this injury and what his surgery is designed to do. I wish you the best of luck!!

[mary jane]

Glad you recovered. I don't know how a doctor can diagnose someone with pudendal neuralgia if their patient says the onset of symptoms was linked to heavy lifting. I'm trusting doctors less and less these days.

[heatmiser]

Hey!

I'm just discovering this thread today, and although I know it's two years old, hopefully one of you will get this response or it will continue to evolve the conversation.

PKgal, reading your post gave me some hope! I've been dealing with pain in my lower abdomen and perineum for about a year and a half, and I feel at my wit's end. It all started with a deadlift injury back in February of 2018. I was lifting really heavy, and felt a quick, sharp stabbing pain in my lower abdomen. Super painful, but passed pretty soon after it occured. Maybe an hour later, I felt a dull, pressure-like, hot pain in my perineum (originally I thought it was in my testicles, but it wasn't). I went to urgent care because I thought I had a regular hernia -- I didn't. It didn't go away, so I did more research, and I was pretty sure it was a sport's hernia. It's an ongoing, continual pain that has slight ups and downs but is never really more than a 4/10 on the pain scale. It doesn't affect my urination, defecation, or sexual performance, though sitting for long periods of time can aggravate it. I've seen a urologist, seen a hernia specialist, had steroid injections in my abdomen by the original injury location near the pubic tubercle, had an MRI, a CAT-scan, seen a sport's doctor (who said it was probably a sport's hernia), another doctor (who said he didn't think it was a sport's hernia), and then a few surgeons who said they wouldn't operate on me because nothing really showed up on my MRI or CAT-scan. Then I saw a physical therapist and a pelvic floor specialist, I even had rectal massage (which was one of the more bizarre experiences of my life), and nothing has helped. I've spent a little over $2,000 on all these visits, and I'm feeling super desperate. I'm also fairly fresh out of college so my bank account isn't booming, haha.

So that's my background. If anything it just feels good to type it all out to people who might understand. Just today I started reading about pudendal pain, pudendal neuralgia, the pudendal nerve, and it does sound pretty familiar to the pain I'm having in my perineum. So my question is, PKgal, do my symptoms seem similar to yours? How have you been since your sport's hernia surgery? Did anything show up on your scans originally (that's one of my big issues -- nothing is showing up...)?

Any suggestions or advice or even commiseration would be wonderful.

[April]

Hi heatmiser, welcome to the forum. What did the physical therapist think was going on? A pt with experience with pelvic pain can be useful for diagnosing pn. There is often a very tender spot on the ischial spine (you can look at the anatomy pics on the home page to see where that is) that is indicative of pn. So the pt could press on that to see how sensitive you are and s/he can do other things as well.

April