Can steroid injection to S2-S4 help PN

[sweetMama]

I started to feel what I think is PN 6 weeks after hysterectomy. Very strange that is it after 6 weeks, but here we are.

I also have spinal fusion 8 years ago on L4-S1 so not sure at this point what is the reason.

But from what I am reading, the PN comes out of S2-S4 branches.

Can do steroid injection to thsi area help?

Thank you for this site and hopefully we can all get support

[April]

Hi SweetMama,

So sorry to hear of your recent pn symptoms. I haven't heard of that treatment before. The closest thing I can think of is a pudendal block, which directs both a numbing agent (for diagnostic purposes) and steroid (for treatment) on the pudendal nerve (not on the source of the nerve at S2-S4). And I haven't heard of many people benefiting from the steroid. Have you met with a doctor about your symptoms?

April

[Violet M]

Sometimes scar tissue can form over time after a surgery so symptoms may not show up immediately. I don't know if that's what has happened to you but I'm sorry to hear you are going through this. Is your pain worse on one side or is it pretty much the same on both sides? Unilateral pain is sometimes associated with a nerve entrapment.

If you have developed scar tissue in the area of the peripheral pudendal nerve, an anesthetic block at the nerve roots S2-S4 might block the pain temporarily, but it would not likely help permanently if the scar tissue is farther down the nerve. I don't see how a steroid injection would help if the problem is lower down. To me, it would make more sense to try a pudendal nerve block because the peripheral nerve would be more likely to be damaged during a hysterectomy than the nerve roots in the spine, but I could be wrong. Another possibility would be that the muscles and/or ligaments could have been tightened up to stabilize the pelvic floor after the loss of the uterus and if they were tightened too much, it could possibly stretch the nerve, especially if the sacrotuberous and sacrospinous ligaments were involved - because the pudendal nerve goes between those ligaments. Over time, the stretch could be stressing the nerve. But this is all just speculation on my part because I have a very bad habit of brainstorming. However, it could be worth asking your gyn if either of those scenarios are a possibility.

Violet

[adelphos2]

Hi,

Did someone make this diagnosis or is this a term you are using to describe your current pain? Steroid can be injected around the S2-S4 nerves individually through openings (foramen) in the sacrum. This is usually just done at one spinal nerve level. To get to all the sacral nerve roots of the pudendal nerve, it would be more common to do a caudal epidural injection. However, that is rarely done. Most common is to inject steroid around the pudendal nerve as it is passing through the pelvis.

[sweetMama]

Thank you all

My pain I feel is on both sides. Very hard to sit any period of time.
I guess I need to ask the gyno how he closed me up? Maybe he stretched something too much ?
My main start of pain is at clitoris and it feels just both sides

[Violet M]

You could potentially try a dorsal clitoral nerve block for diagnostic purposes if that is the only place you are having pain. It is one of the branches of the pudendal nerve.

Violet

[Balenul]

Blocking s2 - s4 can help pudendal pain yes i read some articles some time ago.

[Violet M]

True, but if the pathology is lower down in the peripheral nerve I'm not sure you would want to risk a steroid injection at S2 to start out with if the pudendal nerve is the main problem. The dural sack typically ends at around S2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5346404/ so there is the potential for developing arachnoiditis from a steroid injection in that area. Yes, it's rare, but it can happen.