Health Organization for Pudendal Education

Congratulations on your new baby!

The pudendal nerve runs near the OI in the alcock's canal. Any tenderness there? Sometimes it's hard to tell if it's the muscle or the nerve in this area. Often if it's myofascial without the neuralgia component you would expect PT to help, not make you worse. If you can't get this sorted out with PT and the pain continues maybe you could try a 3T MRI from Dr. Potter in NYC.

Violet M wrote:The pudendal nerve runs near the OI in the alcock's canal. Any tenderness there? Sometimes it's hard to tell if it's the muscle or the nerve in this area.

I think that the alcocks canal is partly formed by the fascia of the obturater internus muscle itself. So as Violet says it is hard to tell whether it is the muscle or the nerve which is the initiating problem. A tight OI muscle could constrict the alcocks canal creating pain.

http://en.wikipedia.org/wiki/Obturator_fascia

The internal pudendal vessels and pudendal nerve cross the pelvic surface of the Obturator internus and are enclosed in a special canal—Alcock’s canal—formed by the obturator fascia.

The French surgeon Robert also describes the alcocks canal in this article.

http://www.tipna.org/info/documents/PNE ... Robert.pdf

The nerve trunk then passes ventrally, medially and caudally and enters the perineal region via the lesser sciatic foramen. It lies under the plane of the levator ani m. and enters within a duplication of the fascia of the obturator internus m., which forms the pudendal canal described by Alcock

The probe passes ventral to the sacrotuberal ligament and enters the splitting of the fascia of the obturator internus m. which forms Alcock's canal, in which travel the trunk and branches of the pudendal n and the inferior rectal n

In the perineal region the nerve. has mainly aponeurotic and muscular relations, where it is applied to the medial aspect of the obturator internus m.
in Alcocks canal, formed by a duplication of the aponeurosis of this muscle

So there appears to be a very close relationship between the nerve and OI muscle. There was also an Italian paper published about this ( see below) where pain was caused by fibrosis of this muscle which created pressure on the alcocks canal. There are lot of other nerves in the pelvis as well though so look into all possibilities for the pain.

http://www.ncbi.nlm.nih.gov/pubmed/20665515

Thank you

When the PT presses and it causes tenderness, she said it was at the OI muscle and that the muscle is tight. I do not have sitting pain, so does it seem likely that the muslcle is putting pressure on the nerve?

Congrats on the new little one in your life!!! It sounds very reasonable that the OI is spasming and causing your pain. If PT doesn't work look around for an experienced pelvic pain specialist that could do trigger point injections in the OI muscles either with Marcaine or Botox. It can't be any run of the mill gyn. You need to find someone like my wonderful Dr. Howard who does them all the time and teaches others how to do them. You can look on the International Pelvic Pain Society website to find pelvic pain dr's in your area. Maybe you could find one if PT doesn't work the injections would give it a good kick start. Prayers sent your way for a speedy recovey.

pregmom wrote:
When the PT presses and it causes tenderness, she said it was at the OI muscle and that the muscle is tight. I do not have sitting pain, so does it seem likely that the muslcle is putting pressure on the nerve?

It is a possibility. If it is the case when your muscle relaxes the pain should go away or at least reduce.

There are so many different causes of pelvic pain though. So consider everything , it could be other nerves ,muscles or ligaments causing the pain.

Well I'm back here again I don't get it. I have been thru PT, and she says the muscles in my pelvis feel better than when I started PT, however, I am no better. My symptoms are this weird uncomfortable sensation in the left sided vaginal wall and also when I palpate externally inside my sits bone it is tender. Since starting the PT, now when I sit for too long that uncomfortable deep vaginal wall sensation seems to get worse. Its a feeling like I just wanna go in there and 'stretch' it! When I go to PT and she works on that spot its like a hurts so good feeling I cannto explain it....kind of the same when I palpate inside the sits bone, it hurts but at the same time feels good. Also feel a bit of relief when I touch my toes or squat with my legs spread as if stretching the pelvic floor. I can't really say I have 'burning' or electric shock types of pain, no urinary or bowel issues, and am able to have intercourse with only minor discomfort. I went to the gyno yesterday whom has been following me, she did an internal and was able to elicit the pain internally. She said the pudendal nerve was farther back from where she was touching, she also did a rectal and pushed toward the sits bone area which was painful. I'm on 400mg of neurontin which is not helping. Also, the gyno stated yesterday she wants me to continue with the PT. I'm thinking of looking for a new PT. Any thoughts on the symptoms? Does it sound like PN?

Forgot to add that I also have like a lancinating pain from inside my left groin towards my left hip in the buttock area. Another uncomfortable pain.

Your pain sounds very similar to what mine was -- with that uncomfortable feeling along the side walls of the vagina. The obturator internus muscles are on the side walls and the levator ani is more toward the back. The pudendal nerve runs between them and innervates the lower third of the vagina, the vulva, and the clitoral area. So at some point, it branches off and comes farther toward the front. I remember that physical therapy helped the muscles spasms but it didn't take away the pain because it was the nerve that was causing the pain. I'm not sure what the doc means by the PN is farther back -- maybe she was referring to the PN at the ischial spine where it runs between the ST and SS ligaments.

So are you on 400 mg of neurontin a day? I've read you have to be on at least 1800 a day for it to be effective for nerve pain.