Health Organization for Pudendal Education

Hello again Polly,
I would say that Dr Greenslade from the Bristol team is a great option for you. For one he is a nice, approachable guy and he studied under Professor Robert at least 4 years ago now, so is very clued up about pudendal problems.
I saw him about 2 years ago, but my problem (like yours?) included sciatica and piriformis issues as well as PN.
I've had steroid and botox into my p muscle with him in an attempt to try to calm things down but also try and identify if the piriformis is responsible for the PN or if that problem is further down the nerve. He has also done many PN blocks (not on me) so he has good experience of these conditions.
Another problem that a few people have reported is labral hip tears. I don't know a great deal about that condition but I would check it out because you have mention hip problems. I have hip pain too but it only kicks in after the piriformis pain builds up, never the other way around so it seems that my hip pain is due to the P muscle.
Let us know how you get on.
Good luck,
Helen

Hi again Helen - yes very difficult to know what came first, sciatic nerve, piriformis or PN ?? Seriously considering paying privately to see Dr Greenslade rather than to-ing and fro-ing. And definitely need to check out the labral hip tear - that's a new one. Again not sure which came first, hip pain or piriformis spasms. Will let you know how I get on.

Pols xx

Very interesting symptoms on the labral hip tear - the point at which the PN is affected is exactly the spot my chiro pointed out on his "skeleton". He said if you experience any numbess below you will need to see your Dr and possibly need an operation - this is where the entrapment will be and pointed at the area of the upper hip socket!!! Hmmmm something else to think about now. I do have symptoms of this including pain the the groin and restricted flexion. Needle in a haystack lol xx

I know with me for instance I always have piriformis pain to some extent, this builds daily. Then my hips join in then my groin. My hips and groin are never painful without this progressive build up and always in that order p muscle, hips then groin. That is why I put my problems all down to the p muscle. Do you have independent hip pain Polly? maybe that will indicate a separate hip problem which may show on an MRI scan??
Saw this . . .The labrum is a layer of fibrous tissue covered in a synovial membrane that lines the rim of the socket in which the ball of the femur sits. This cartilage provides cushioning for the joint and keeps the femur in place. A tear in the labrum can result either from injury or from degeneration due to impingement or other joint conditions. Labral tears can be painful and may cause symptoms such as locking or “catching” in the joint and pain in the hip or groin area.

Since labral tears are often difficult to detect during a physical examination, a doctor may use magnetic resonance imaging (MRI) with a dye injection to confirm the diagnosis.

I have had a pelvic MRN scan (London) and nothing much was noted in my hip (some initial signs of arthritis) Have you had or considered a pelvic scan?

Hi Helen

It's so hard to tell what is causing what now - at the moment the piriformis doesn't seem to be causing me very much pain as I have slept well for a week with no night-time spasms (that's when they were worse) - but that could be down to the chiro realignment last Friday and me doing some simple exercises to try and keep it relaxed. I do however still have pain on the outside of that hip joint, specifically on sitting as well as in the sit-bone that side, and still experiencing groin pain if I turn upper body only (must not do that!). Interestingly the chiro had pointed to this exact point in the hip joint as being the problem area. Seeing him this Friday and will take his advice on options. I think when you have lived with pain for years and it moves about from day to day it's so easy to loose track of where it actually started. Trying to become "body aware" and doing some meditation in bed before sleep and "listening" to what my body is telling me. Might be a good idea for me to write things down on a daily basis.

My chiro can arrange an MRI scan but I think it's cheaper to go via the GP - maybe he can write to him for me and get one organised. Or if I go directly to Dr G I guess he might arrange one? How confusing!!!

I am also considering going to a therapist in Bristol who practices the Dorn method of alignment - very gently and safely done. At least if I can get my bones in the right place and muscles relaxed it might help pinpoint the real problem area.

How are you doing now Helen - any progress on what the actual problem area is for you? Thanks again for the support - it really means a lot. xxx Polly

Dr G didn't ever seem interested in my pelvic scan and although he told me that they have an excellent powerful scanner in Bristol I have never heard of him employing it for pelvic nerve patients. He would be interested in a spinal scan just to rule the sciatica from a spinal cause out though, at least he was with me.
I would still go for scans though just to see if your hip problem can be identified by imaging.
If I ever get my referral to Bristol up and running again I may do a physio session there too, good plan, as I always have a lot of time to kill as I fly down (easyjet, SO cheap) luckily the weather has always been lovely, but I think I've seen most of Bristol now Because of the PCT debacle I am at a complete fullstop now and playing the waiting game AGAIN!
It's enough to make a girl bitter or mad or both. Good job I have a positive nature or I would think there was some NHS/ governmental conspiracy against me, OOPs apparently the conspiracy theory IS a trait of madness !

How frustrating!!!

Fingers crossed all gets sorted for you xxx

- just found out I can do a supline left lift to 90 degrees this morning - maybe the rolled up tennis socks in the periformis did do something??? It gets stranger by the minute. Am definitely going to cross-examine my chiro on Friday and go from there. He does X-rays although I would have to pay - but might be worth it.

I periodically get dreadful pain in my priformis; woke up today with a sore SIJ and felt as if someone stuck a knife into my buttock. The osteopath I'm seeing released it completely last time i had it so am hoping he can do the same again tomorrow.

I went to chiro a week ago and said I was very worried about the possible PN thing - he said not to as lots of other things could have caused the nerve to trigger slightly. I have a torn adductor muscle and groin strain which is impinging on the ischial tuberosity on that side. He did some trigger points in the back of the leg which made me scream . Said he can't touch the Ischial problem until adductor settles down. Also did trigger points in piriformis and another muscle nearby. Then did something to my hip to make to go back in place as it was locked. Have been better since and going back this Wednesday. Have got in a bit of a state about possible PN to be honest. Have been working on trigger points myself in the meantime and doing stretches, but those muscles are pretty stubborn. Left hip is much easier now although still need to be careful with the groin as it hurts when I change direction and forget to move my whole body instead of top first then legs lol.

Well all of that sounds very positive Polly. Hopefully once the adductor problem settles, everything will with a his help.
Take care, and remember 'Whole Body!!'
Helen