Pudendal nerve block scheduled for the first time

[matthewroots77]

Matthew, that's hopeful that your symptoms have been better. I hope you gain some valuable info from PT. I think it can be valuable to get a PT evaluation because sometimes they can give you important information that doctors can't give you. However, since your symptoms have been a little calmer lately it might be wise to be careful about doing a lot of PT exercises that could kick up your pain more. I have had several experiences with PT where the exercises/treatment they gave me were actually making me worse. I have had other experiences where the exercises/treatments they gave me were really helpful. So, proceed with caution, and I think if PT flares you up, back off on it.

Hi Violet

I went to see the physio and he done an ultrasound of my pelvic floor muscles and from that and my varied symptoms,he believes that I have chronic pelvic pain and believes my pelvic floor muscles are to tight, which can cause penis pain ect
He doesn't believe I've got PN as he feels thst my symptoms are not severe enough and consistent with pn.
So there we have it,I'm still a bit confused with it all if I'm honest,he's giving me some pelvic floor breathing exercises and I'm going back in 3 weeks

[Violet M]

Hi Matthew,

That would be great if you don't have pudendal neuralgia. But, like you, I am confused too.

I went back and read your initial post. In that post, you describe many of the hallmark symptoms of pudendal neuralgia -- pain in the perineum, pain in the penis, difficulty sitting, pain triggered by sex, etc. My question to your PT would be - which of those symptoms does your PT think are not consistent with pudendal neuralgia? Looks like all of those symptoms are listed on our website's symptom page. https://www.pudendalhope.info/category/symptoms/

How severe does PN have to be? Seems to me it is really messing up your life.

I guess whether or not you have pudendal neuralgia might depend on what the definition of pudendal neuralgia is. After reading your post, I went and looked up a bunch of websites and articles on the topic and it seems like most of them do not agree exactly on what the definition of pudendal neuralgia is. There seems to be a fine line between neuralgia, neuritis, and neuropathy with some websites saying neuralgia has to be severe and shocking, but others saying it can be pain or irritation/burning. So rather than try to sift through all of the websites and different definitions, I can tell you from my own experience what pudendal neuralgia felt like. Mine started out with very mild symptoms. I never had severe shooting pain like some websites describe neuralgia. Originally it felt more like a bit of an annoying itch and some urinary irritation/burning. Eventually I developed a lot of burning pain in the perineum, and then it later it felt like I had been hit in the crotch with a baseball bat. It became difficult to sit. Sex was difficult. Urinary frequency/urge/burning were difficult. As I healed after surgery the symptoms slowly became mild again.

If your pelvic floor muscles are tight, that leads you to the question, what is causing the muscles to be tight? - which leads you to the chicken and egg discussion which we have had numerous times on this forum over the years. Which came first, the chicken or the egg? Or you could ask - which came first, the pudendal nerve pain or the muscles tightness. Which is causing which? When it comes to the pudendal nerve, can it be the cause of the pelvic floor muscles being tight? Yes, because it innervates some of those muscles. Just the pain of pudendal neuralgia can cause you to tense up your muscles. So, my question to your physical therapist would be -- what is causing my pelvic floor muscles to be tight? Is it possible there was damage to the pudendal nerve in your accident, and that the damaged pudendal nerve is causing the pelvic floor muscles to become tight? Or did the accident damage the muscles causing the muscles to spasm and impinge on the pudendal nerve? I'm not sure anyone can answer those questions with 100% certainty.

Next my question to him would be -- what nerve innervates the penis? If he answers "the pudendal nerve", then ask him why your symptoms aren't consistent with pudendal neuralgia when your pain is in the distribution area of the pudendal nerve. What other nerve would it be?

My 4th question would be -- is there tenderness along the course of your pudendal nerve, particularly at the ischial spine or Alcock's canal when the nerve is pressed on via the rectum? Did he check you internally for pain? When my PT did an internal check she knew immediately that it was the pudendal nerve. So did Dr. Bautrant. So, I think it is important for the PT to check that.

Sorry, I went on too long. Just trying to figure out my own confusion. Good luck figuring this out.

Violet

[matthewroots77]

Hi Matthew,

That would be great if you don't have pudendal neuralgia. But, like you, I am confused too.

I went back and read your initial post. In that post, you describe many of the hallmark symptoms of pudendal neuralgia -- pain in the perineum, pain in the penis, difficulty sitting, pain triggered by sex, etc. My question to your PT would be - which of those symptoms does your PT think are not consistent with pudendal neuralgia? Looks like all of those symptoms are listed on our website's symptom page. https://www.pudendalhope.info/category/symptoms/

How severe does PN have to be? Seems to me it is really messing up your life.

I guess whether or not you have pudendal neuralgia might depend on what the definition of pudendal neuralgia is. After reading your post, I went and looked up a bunch of websites and articles on the topic and it seems like most of them do not agree exactly on what the definition of pudendal neuralgia is. There seems to be a fine line between neuralgia, neuritis, and neuropathy with some websites saying neuralgia has to be severe and shocking, but others saying it can be pain or irritation/burning. So rather than try to sift through all of the websites and different definitions, I can tell you from my own experience what pudendal neuralgia felt like. Mine started out with very mild symptoms. I never had severe shooting pain like some websites describe neuralgia. Originally it felt more like a bit of an annoying itch and some urinary irritation/burning. Eventually I developed a lot of burning pain in the perineum, and then it later it felt like I had been hit in the crotch with a baseball bat. It became difficult to sit. Sex was difficult. Urinary frequency/urge/burning were difficult. As I healed after surgery the symptoms slowly became mild again.

If your pelvic floor muscles are tight, that leads you to the question, what is causing the muscles to be tight? - which leads you to the chicken and egg discussion which we have had numerous times on this forum over the years. Which came first, the chicken or the egg? Or you could ask - which came first, the pudendal nerve pain or the muscles tightness. Which is causing which? When it comes to the pudendal nerve, can it be the cause of the pelvic floor muscles being tight? Yes, because it innervates some of those muscles. Just the pain of pudendal neuralgia can cause you to tense up your muscles. So, my question to your physical therapist would be -- what is causing my pelvic floor muscles to be tight? Is it possible there was damage to the pudendal nerve in your accident, and that the damaged pudendal nerve is causing the pelvic floor muscles to become tight? Or did the accident damage the muscles causing the muscles to spasm and impinge on the pudendal nerve? I'm not sure anyone can answer those questions with 100% certainty.

Next my question to him would be -- what nerve innervates the penis? If he answers "the pudendal nerve", then ask him why your symptoms aren't consistent with pudendal neuralgia when your pain is in the distribution area of the pudendal nerve. What other nerve would it be?

My 4th question would be -- is there tenderness along the course of your pudendal nerve, particularly at the ischial spine or Alcock's canal when the nerve is pressed on via the rectum? Did he check you internally for pain? When my PT did an internal check she knew immediately that it was the pudendal nerve. So did Dr. Bautrant. So, I think it is important for the PT to check that.

Sorry, I went on too long. Just trying to figure out my own confusion. Good luck figuring this out.

Violet

Hi violet
Thanks for your reply for a long time now I've not had any symptoms at night and it seems like it's almost gone in the morning. I have been trying to work out what causes the symptoms and where its coming from. I have a very manual job as a heating engineer and I find during the week when I'm working that's when it's worse and at weekends is less.
At the beginning I has an MRI which shows I have a small bulge on my L5 S1 lower back disc but it's not causing any compression to nerves,and the doctor who went through it with me said it's possible been there years due to my manual work and that we have only found it because of the testing. Any what I've found is that my symptoms are very much linked to the position of my lower back and seem to get worse as I bend and move. So I'm wandering if the MRIs missed something as when I fell I landed on my lower back/top of bum although I did not feel any pain this seems to be when my symptoms started.
I've see a few specialist now and it seems they all have there own ideas what I need is some to start ruling stuff out,I didn't have a pn nerve block as the pain management specialist wasn't convinced it was th pn and tbh it was very expensive as they do it with ct scan.

[matthewroots77]

Hi Matthew,

That would be great if you don't have pudendal neuralgia. But, like you, I am confused too.

I went back and read your initial post. In that post, you describe many of the hallmark symptoms of pudendal neuralgia -- pain in the perineum, pain in the penis, difficulty sitting, pain triggered by sex, etc. My question to your PT would be - which of those symptoms does your PT think are not consistent with pudendal neuralgia? Looks like all of those symptoms are listed on our website's symptom page. https://www.pudendalhope.info/category/symptoms/

How severe does PN have to be? Seems to me it is really messing up your life.

I guess whether or not you have pudendal neuralgia might depend on what the definition of pudendal neuralgia is. After reading your post, I went and looked up a bunch of websites and articles on the topic and it seems like most of them do not agree exactly on what the definition of pudendal neuralgia is. There seems to be a fine line between neuralgia, neuritis, and neuropathy with some websites saying neuralgia has to be severe and shocking, but others saying it can be pain or irritation/burning. So rather than try to sift through all of the websites and different definitions, I can tell you from my own experience what pudendal neuralgia felt like. Mine started out with very mild symptoms. I never had severe shooting pain like some websites describe neuralgia. Originally it felt more like a bit of an annoying itch and some urinary irritation/burning. Eventually I developed a lot of burning pain in the perineum, and then it later it felt like I had been hit in the crotch with a baseball bat. It became difficult to sit. Sex was difficult. Urinary frequency/urge/burning were difficult. As I healed after surgery the symptoms slowly became mild again.

If your pelvic floor muscles are tight, that leads you to the question, what is causing the muscles to be tight? - which leads you to the chicken and egg discussion which we have had numerous times on this forum over the years. Which came first, the chicken or the egg? Or you could ask - which came first, the pudendal nerve pain or the muscles tightness. Which is causing which? When it comes to the pudendal nerve, can it be the cause of the pelvic floor muscles being tight? Yes, because it innervates some of those muscles. Just the pain of pudendal neuralgia can cause you to tense up your muscles. So, my question to your physical therapist would be -- what is causing my pelvic floor muscles to be tight? Is it possible there was damage to the pudendal nerve in your accident, and that the damaged pudendal nerve is causing the pelvic floor muscles to become tight? Or did the accident damage the muscles causing the muscles to spasm and impinge on the pudendal nerve? I'm not sure anyone can answer those questions with 100% certainty.

Next my question to him would be -- what nerve innervates the penis? If he answers "the pudendal nerve", then ask him why your symptoms aren't consistent with pudendal neuralgia when your pain is in the distribution area of the pudendal nerve. What other nerve would it be?

My 4th question would be -- is there tenderness along the course of your pudendal nerve, particularly at the ischial spine or Alcock's canal when the nerve is pressed on via the rectum? Did he check you internally for pain? When my PT did an internal check she knew immediately that it was the pudendal nerve. So did Dr. Bautrant. So, I think it is important for the PT to check that.

Sorry, I went on too long. Just trying to figure out my own confusion. Good luck figuring this out.

Violet

Hi violet
Thanks for your reply for a long time now I've not had any symptoms at night and it seems like it's almost gone in the morning. I have been trying to work out what causes the symptoms and where its coming from. I have a very manual job as a heating engineer and I find during the week when I'm working that's when it's worse and at weekends is less.
At the beginning I has an MRI which shows I have a small bulge on my L5 S1 lower back disc but it's not causing any compression to nerves,and the doctor who went through it with me said it's possible been there years due to my manual work and that we have only found it because of the testing. Any what I've found is that my symptoms are very much linked to the position of my lower back and seem to get worse as I bend and move. So I'm wandering if the MRIs missed something as when I fell I landed on my lower back/top of bum although I did not feel any pain this seems to be when my symptoms started.
I've see a few specialist now and it seems they all have there own ideas what I need is some to start ruling stuff out,I didn't have a pn nerve block as the pain management specialist wasn't convinced it was th pn and tbh it was very expensive as they do it with ct scan.

I forgot to say as my bladder fills I find the tip of my penis becomes very cold and I almost get a stinging feeling also when I go to the toilet it either reduces the pain or increase is so found example when wake up and don't have any symptoms it's sometimes the first wee that sets it off or is it the fact I've gone from laying to moving my body.
One more thing if you remember after 3 weeks of having the initial symptoms they completely vanished for a whole week,so why did they come back if what was causing the issue had gone why come back??

[matthewroots77]

Hi Matthew,

That would be great if you don't have pudendal neuralgia. But, like you, I am confused too.

I went back and read your initial post. In that post, you describe many of the hallmark symptoms of pudendal neuralgia -- pain in the perineum, pain in the penis, difficulty sitting, pain triggered by sex, etc. My question to your PT would be - which of those symptoms does your PT think are not consistent with pudendal neuralgia? Looks like all of those symptoms are listed on our website's symptom page. https://www.pudendalhope.info/category/symptoms/

How severe does PN have to be? Seems to me it is really messing up your life.

I guess whether or not you have pudendal neuralgia might depend on what the definition of pudendal neuralgia is. After reading your post, I went and looked up a bunch of websites and articles on the topic and it seems like most of them do not agree exactly on what the definition of pudendal neuralgia is. There seems to be a fine line between neuralgia, neuritis, and neuropathy with some websites saying neuralgia has to be severe and shocking, but others saying it can be pain or irritation/burning. So rather than try to sift through all of the websites and different definitions, I can tell you from my own experience what pudendal neuralgia felt like. Mine started out with very mild symptoms. I never had severe shooting pain like some websites describe neuralgia. Originally it felt more like a bit of an annoying itch and some urinary irritation/burning. Eventually I developed a lot of burning pain in the perineum, and then it later it felt like I had been hit in the crotch with a baseball bat. It became difficult to sit. Sex was difficult. Urinary frequency/urge/burning were difficult. As I healed after surgery the symptoms slowly became mild again.

If your pelvic floor muscles are tight, that leads you to the question, what is causing the muscles to be tight? - which leads you to the chicken and egg discussion which we have had numerous times on this forum over the years. Which came first, the chicken or the egg? Or you could ask - which came first, the pudendal nerve pain or the muscles tightness. Which is causing which? When it comes to the pudendal nerve, can it be the cause of the pelvic floor muscles being tight? Yes, because it innervates some of those muscles. Just the pain of pudendal neuralgia can cause you to tense up your muscles. So, my question to your physical therapist would be -- what is causing my pelvic floor muscles to be tight? Is it possible there was damage to the pudendal nerve in your accident, and that the damaged pudendal nerve is causing the pelvic floor muscles to become tight? Or did the accident damage the muscles causing the muscles to spasm and impinge on the pudendal nerve? I'm not sure anyone can answer those questions with 100% certainty.

Next my question to him would be -- what nerve innervates the penis? If he answers "the pudendal nerve", then ask him why your symptoms aren't consistent with pudendal neuralgia when your pain is in the distribution area of the pudendal nerve. What other nerve would it be?

My 4th question would be -- is there tenderness along the course of your pudendal nerve, particularly at the ischial spine or Alcock's canal when the nerve is pressed on via the rectum? Did he check you internally for pain? When my PT did an internal check she knew immediately that it was the pudendal nerve. So did Dr. Bautrant. So, I think it is important for the PT to check that.

Sorry, I went on too long. Just trying to figure out my own confusion. Good luck figuring this out.

Violet

Hi violet
Thanks for your reply for a long time now I've not had any symptoms at night and it seems like it's almost gone in the morning. I have been trying to work out what causes the symptoms and where its coming from. I have a very manual job as a heating engineer and I find during the week when I'm working that's when it's worse and at weekends is less.
At the beginning I has an MRI which shows I have a small bulge on my L5 S1 lower back disc but it's not causing any compression to nerves,and the doctor who went through it with me said it's possible been there years due to my manual work and that we have only found it because of the testing. Any what I've found is that my symptoms are very much linked to the position of my lower back and seem to get worse as I bend and move. So I'm wandering if the MRIs missed something as when I fell I landed on my lower back/top of bum although I did not feel any pain this seems to be when my symptoms started.
I've see a few specialist now and it seems they all have there own ideas what I need is some to start ruling stuff out,I didn't have a pn nerve block as the pain management specialist wasn't convinced it was th pn and tbh it was very expensive as they do it with ct scan.

I forgot to say as my bladder fills I find the tip of my penis becomes very cold and I almost get a stinging feeling also when I go to the toilet it either reduces the pain or increase is so found example when wake up and don't have any symptoms it's sometimes the first wee that sets it off or is it the fact I've gone from laying to moving my body.
One more thing if you remember after 3 weeks of having the initial symptoms they completely vanished for a whole week,so why did they come back if what was causing the issue had gone why come back??

Hi violet sorry for all the questions but I'm struggling to find someone to actually talk to properly about all my symptoms, do you know if PN always has physical evidence of what's causes it?

[Violet M]

Hi Matthew,

The fact that your symptoms are related to movement and seem to subside after resting would make you very suspicious that there is something mechanical going on. It's typical for people with PN to have an increase in symptoms after movement and a lowering of symptoms after rest. Sometimes the increase in symptoms doesn't show up until several hours after activity. But it sounds like with your heavy labor, you could either be straining the muscles which then press on the nerve, or if the nerve is possibly entrapped, the movement irritates the nerve as it rubs on the surrounding structures such as ligaments, if it can't glide easily. Or, if it's a back issue then the nerve roots in the spine could be irritated with movement. So, it's tough being a detective and figuring all of this out but I'm sure you have some instincts as to what might be going on. What are your instincts telling you?

I have no idea why your symptoms would have vanished for a week and then come back. Were your activity levels the same the whole time? Maybe your muscles were tight but then relaxed over several weeks but then maybe a certain way you moved at work caused them to spasm again. Or maybe the nerve was damaged after the accident and started to heal but then you moved a certain way at work that set it off again? Just brainstorming possibilities.

In answer to your question whether PN always has physical evidence for what causes it, the answer is not always, but sometimes it does. During surgery, the surgeon may discover that the ligaments that have the nerve going between them are tight, or the ligaments can be hardened and sclerosed. Or there can be obvious scar tissue encasing the nerve, or the nerve can be entrapped in fascia. The problem is they can't always tell with certainty until they do surgery. But that's why it's important to have nerve blocks before surgery so you can be pretty sure of the diagnosis. There can be many factors involved such as genetics, body build/musculoskeletal build, a possible infection, etc., that wouldn't show a physical cause. This page lists a bunch of possible causes. https://www.pudendalhope.info/category/symptoms/
But for you, since the symptoms developed right after a fall, it would make sense to suspect that the fall had something to do with it. That it caused some kind of damage to the nerve or the surrounding structures that are now impinging on a nerve.

You said the nerve block is too expensive, partly because they do it under CT guidance. Some doctors do it under fluoroscopy (x-ray)which would be cheaper but I don't know if there are any near you who would. Some use ultrasound. Might be worth checking into.

Violet

[matthewroots77]

Hi Matthew,

The fact that your symptoms are related to movement and seem to subside after resting would make you very suspicious that there is something mechanical going on. It's typical for people with PN to have an increase in symptoms after movement and a lowering of symptoms after rest. Sometimes the increase in symptoms doesn't show up until several hours after activity. But it sounds like with your heavy labor, you could either be straining the muscles which then press on the nerve, or if the nerve is possibly entrapped, the movement irritates the nerve as it rubs on the surrounding structures such as ligaments, if it can't glide easily. Or, if it's a back issue then the nerve roots in the spine could be irritated with movement. So, it's tough being a detective and figuring all of this out but I'm sure you have some instincts as to what might be going on. What are your instincts telling you?

I have no idea why your symptoms would have vanished for a week and then come back. Were your activity levels the same the whole time? Maybe your muscles were tight but then relaxed over several weeks but then maybe a certain way you moved at work caused them to spasm again. Or maybe the nerve was damaged after the accident and started to heal but then you moved a certain way at work that set it off again? Just brainstorming possibilities.

In answer to your question whether PN always has physical evidence for what causes it, the answer is not always, but sometimes it does. During surgery, the surgeon may discover that the ligaments that have the nerve going between them are tight, or the ligaments can be hardened and sclerosed. Or there can be obvious scar tissue encasing the nerve, or the nerve can be entrapped in fascia. The problem is they can't always tell with certainty until they do surgery. But that's why it's important to have nerve blocks before surgery so you can be pretty sure of the diagnosis. There can be many factors involved such as genetics, body build/musculoskeletal build, a possible infection, etc., that wouldn't show a physical cause. This page lists a bunch of possible causes. https://www.pudendalhope.info/category/symptoms/
But for you, since the symptoms developed right after a fall, it would make sense to suspect that the fall had something to do with it. That it caused some kind of damage to the nerve or the surrounding structures that are now impinging on a nerve.

You said the nerve block is too expensive, partly because they do it under CT guidance. Some doctors do it under fluoroscopy (x-ray)which would be cheaper but I don't know if there are any near you who would. Some use ultrasound. Might be worth checking into.

Violet

Hi violet I've had so many tests that I'm not sure what my instincts are telling me tbh evidence wise I've found out 2 things from all my tests. I have a high tight bladder neck which I believe has been there alone time,however I don't actually know that as its only from the urologist tests that I know,secondly I've got a bulged disc on L5 S1 no obvious compression as per whoever looks at the Mri,however i did a tough mudder and fell onto my lower back/very top.of bum and that's when everything seemed to start.
The initial symptoms were a sting in the tip of my penis I had it for about 3 weeks and had on the same day I went fishing for a week and literally the day I arrive I noticed it had gone and everything was normal it almost switched off. At the time I happened to be on an antibiotics for a possible infection?? I was given them by an out of hours doctor who fort I may have an sti,I didn't so maythats was a coincidence. My symptoms came back about 8 days later which seemed to be triggered by sex as that's the last thing I did,and then I was up most of the night weeing and this time I had pain in the prenuim. I really won't know what way to go

[harry_nerve]

Be very careful with these so called physical therapists. They milked me of thousands!
I had bad compression and they made matters worse and happily took my money.

[matthewroots77]

Be very careful with these so called physical therapists. They milked me of thousands!
I had bad compression and they made matters worse and happily took my money.

Hi

How did you find out you had a bad compression and what were your symptoms?

Thanks Matt

[harry_nerve]

Through MRN imaging and alot of the typical symptoms like sitting pain, bladder urge etc