Can steroid injection to S2-S4 help PN

[Balenul]

One of the reasons PN doctors have given steroid injections to the pudendal nerve lower down than S2-S4 is because the nerve entrapment is often at the site of Alcock's canal or the ischial spine, a bone protruding into the pelvis lower down than the lumbar spine. The rationale for the injections at the ischial spine or in Alcock's canal is for the steroid to relieve inflammation in those areas and allow the nerve to glide freely again. An injection higher up at S2-S4 would not relieve the inflammation at the site of entrapment. So, theoretically a steroid injection at the site of entrapment made sense, but recent guidelines from some major medical organizations indicates that there is no evidence for pudendal nerve steroid injections . So, basically over 20 years of accepted protocol has come into question. It's true an injection at S2-S4 could provide temporary relief of PN symptoms since it would block anything distal to that injection, but it would not be diagnostic for a nerve entrapment or therapeutically treating the site of entrapment. It would just provide temporary symptom relief.

Violet

They have few ideeas about what they are doing....is sad.Y s2 s4 blocks all .And is not clear if is the pudendal but i guess will work even for distal branches.I am kinda dissapointed in doctors for now

I think for urethral symptoms especialy urinary blocks don t works good...even if is a pudendal or the perineal branch problem.I think no matter if is the main nerve or a perineal branch problem even if you block both you can have a false result and no symptoms relief.....I admit a perineal branch block i didn t do yet.Same for s2 , s4.Problem is i have zero sitting pain aftee 4 yeaes zero and makes things confusing

[Violet M]

Yes, unfortunately there is no way of knowing with 100% accuracy if the nerve is entrapped before trying surgery. My understanding is that some patients do not have sitting pain even with an entrapment. I didn't at first, although it developed later as the pain got worse.

I can understand your disappointment with doctors, Balenul. It can be exhausting going to many appointments and feeling like there isn't any solution. I believe they have a good heart and sincerely want to help, but there are some things they just can't fix.

Violet

[April]

Hi Balenul,

I'm sorry about your struggles getting good information and help. I can't remember if I noted this in an earlier post or not, but I wanted to note that I did not and still do not have sitting pain. And because that is a little unusual, I sometimes get messages from others who also don't have sitting pain, so I don't think I am alone. And Hibner once told me that he thought that in some people, sitting opens up the ST-SS region in a way that reduces pain. So, it seems clear to me that sitting pain is not a necessary criterion for a pn diagnosis or even a pne diagnosis, which is what I had.

Take care,
April

[Balenul]

I remember you told me April .I remember you also had severe urethral symptoms.Hibner is kinda out of ideeas and sadly i was abit dissapointed by him.Botox did not help me and now he wants to try a higher botox dosage or pudendal surgery even if we have no data is a entrapment.....all my problems are in the stupid urethra.This symptoms are making me mad.Pudendal blocks failed 2 times but as i said i am not sure how good they are for urinary symptoms.....

[April]

Hi Balenul,

I'm sorry. That sounds really disappointing and frustrating. Have doctors (Hibner or others) explored the possibility that it is another nerve? Have you seen a urologist? I think Hibner may be a urogynecologist, but it may be useful to get input from a urologist. Or maybe a pain doctor who specializes in pelvic pain?

Update: I just read an earlier post from you (in 2023) and I see that you have pgad. That does sound like pn, but the strong urethra symptoms are a bit a surprising. Maybe surgery should be something to consider? As you've probably read in other posts, there is no easy way to determine for sure that a nerve is entrapped, but if Hibner proposed it, I assume that was based on a careful review of your history and medical records.

April