Health Organization for Pudendal Education

I'm sure i'm late to this discussion and maybe this has been stated. There are multiple articles stating that Piriformis syndrome can cause sacral nerve and pudendal nerve irritation - resulting in the painful sitting issue. I haven't resolved my issue yet but this has been working for me some:
1. Put large Ben Gay Hip patch on offending piriformis zone
2. deep piriformis stretches while wearing patch
3. Botox injection in piriformis to calm muscle
4. Graston technique by chiropractor to break up muscle scar tissue.

This is the road I'm on - I will let you know what happens.

Not a superficial assessment or recommendation - I've had this for 5 years, seen 38 Health Professionals in many fields for every possible diagnosis you can throw at me. If this is a stupid muscle issue I'm going to publish a book about it.

How did your problems begin dtroy?
I saw in your other posts that you mention a labral tear, did you ever get that sorted? I have looked into Graston technique a good while ago but wondered if the muscle was just too deep to reach and be 'scraped.' I just know that will hurt like . . . . , well it's going to hurt!
The other thing I would like to have given a go is ESWT in Cornwall but it's too far and expensive for me unfortunately.
I did have botox into the RH (worst) muscle and it did help the band of piriformis pain SO much. I have the problem bi laterally but the left side isn't anything like as bad and I don't have much PN on that side either. Anyway having that as a 'control' made me realise just how good the block had worked as when the unblocked side was bad I knew that the other side would have been really bad, and it wasn't. Unfortunately the botox didn't stop the nerve problems so I must have some bands or lesions causing the 'entrapment(s)
Good luck with your treatment,
Helen

Well yes, yes I did. I had arthroscopic surgery on my right hip - now my hip is better but all of my pain when sitting remains. so clearly that was not the source - maybe it contributed to the piriformis syndrome. I'm very hesitant to accept any decompression surgery or surgery for that matter after my hip surgery experience.

My pain started 5 years ago - i'd been working out like a monster and also working long hours sitting. I've really had about 20 different diagnosis, as I assume most people on this board have. Supposedly Graston is a technique used specifically for piriformis - so I'm all in.

I think the botox, stretching and direct graston is a multiple month strategy. We shall see, i've clearly been wrong before. Having had this for 5 years and rejected all drugs or other surgeries - I'm going to pursue this path.

Have you had the usual myofascial release or massage therapies on your P muscle to make you choose Grastons as the next step? Maybe I should have taken it up as an option too, still can I guess. You can be my guinea pig (sorry )
Do the easier piriformis stretches hurt? Mine do but I still do them a few times a day as they are beneficial. I think that is a true test of a piriformis syndrome if the muscle hurts to pressure and stretching. It's weather the piriformis is responsible for the rest of it. I'm sure as eggs is eggs that mine is.
I don't know if you will have any anaesthetic befor any botox shots, do ask. I probably shouldn't say this as you may tense up more but I am not a softy by any means, infact the needle through the skin and through the gluteus max muscle was fine. However as soon as it hit the P muscle I could have uttered every expletive known to woman. I almost levitated. Dr Greenslade put it down to having a 'strong response to the injection in relation to the provocation of her symptoms' in other words, IT HURT!!!
Don't mean to scare you, I'm sure you are tough too
Let us know how you get on with the treatment, hopefully you are barking up the right tree this time and it can be sorted.
take care,
Helen

I've had it all - internal, external - years of pt, hot yoga, cold yoga, accupuncture, rolling, art, you name it. I've had a botox injection in my piriformis and my obturator internus (I have a great pain guy - who will basically do whatever I propose). the botox did help some, but I'm not positive I dedicated the time and effort to stretch the crap out of the piriformis after that shot. I'm back to it again because I really don't want to get the genito/illioinguinal/illihypoghastric resected - I had a hernia operation and they believe it could be entrapped - but I'd say it's circumstantial proof and that concerns me. I don't want to be numb in my perineum or elsewhere.

I'll tell you about Graston tomorrow - i get it done tonight at 5:45. We shall see what it does.

I saw the post about bladder issues that might cause PN pain.

I have had a significant amount of pain at the tip of my penis; pinching and gnawing.

I ran across something about bladder spasms causing neuropathic pain, talked to my uro and tried Vesicare, 25 mg.

The pinching sensation was gone in 3 weeks. But I can't take Vesicare it is too constipating.

I changed to Detrol LA 4 mg, take one each morning. I am now on my second week and penis symptoms mostly gone.

I think that someone who ends up with PN pain can look toward a lifetime of having to challenge their and their MD's assumptions about what is the cause of their pain.

I think the human body can take a tremendous amount of punishment before it complains loud enough, by expressing what most of us identify as pain, so that the host of that body has to change its behavior to try to minimize the painful sensation.

A few weeks ago I watched a show on T.V. about a young female weight lifter, heavy weight division. She injured her arm and had to stop lifting until her injured was cured. Even though her physical injury had healed, she was unable to lift the weight amounts that she had previously until she changed her exercise routine. When she was finally able to lift her previous weight she noted that, when she lifted the weights (over 300 pounds), the weights weighed nothing at all.

In short, the human mind can do wonderful things but operates by mysterious rules. What I felt as a golf ball in my rectum might be felt as a tennis ball in the vagina by a woman. Sensations that will drive one person to the brink of suicide might be shrugged off by another as an annoyance. Etc, etc.

I am going to try 8 mg of Detrol to see if I can get rid of the rest of the pain.

Keep looking and trying new medications if you must. What works for one person might not for another.

Rick

Glad that things are improving for you rick Excellent news.
You have brought up a few good points about pain and how it is variably perceived by individuals. Then of course there is the chronic pain sufferer, who by all accounts in terms of the true purpose of pain, survival and fight or flight behaviours, shouldn't exist.
Contrarily, there could be the argument, that the stoic may further injure themselves as a result of just being themselves.
I am really interested in the 'pain dilemma' and wish that some of the books on subject were not so expensive, although Dr Andrews has posted some related articles/papers on the subject which I will check out asap.
As we get older, learn and experience much of what the world has to offer we adapt our behaviours, change and grow or cope incrementally.Until sometimes life throws a deal where the only options are to almost reinvent ourselves or learn new strategies.
I've decided to be Madonna
Take care,
Helen

I have found that the Graston Technique is very painful, yet has reduced significant pain in my gluteal seam and perineal seam. My Chiroprator focused on my Piriformis and my hamstring and inner thigh - am I bruised, yes - was it painful, yes - was I able to work all weekend without pain and ice - yes.

One of the best solutions I've found to date. may be premature to claim success but after 5 years of horrific pain, I actually felt better.

Absolutely amazed but so pleased for you. I am going to give it a go I think, would be daft not too really. I am also amazed that they can get deep enough with the tools they use. They are steel right? and they try and scrape right into the targeted area? That IS going to hurt, PHEW! Glad that you had the gain making it worth all the pain.
Good news Will there be more?
Helen

Hi all,

I thought I would share my PS experience with you all as it seems very relevant to your current discussion. Particularly with reference to Botox injections and Graston.

I started getting a regular pain in the butt (about 2/10 on the pain scale) about 18 months ago whenever I drove anywhere. I guess it was something that I had noticed before, but never thought too much about. Then, increasingly over the last 18 months, I would do something (out dancing once, pulling a heavy trolley another time) and my piriformis would go into spasm (about 6/10 on the pain scale) and I would go to the Osteopath, who would tell me I had a problem with my piriformis, probe and prod the area and give me some stretching exercises. This provided minor temporary relief, but not much more. If only I had done more of the stretching early on...

Anyway, after putting up with this for about a year, I decided enough was enough and went to my GP who put me on Napoxen and Diazepam and referred me to a Pain Specialist here in London called Dr Jenner. He sent me for an MRI, confirmed the PS diagnosis, added Sacroiliac Dysfunction to it and changed my medication to Lyrica and Celebrex. However, even after a month of ramping up the dose of Lyrica and although the pain was reduced by about 60%, I opted for the shots as my wife said the meds gave me behavioural issues.... and besides, I was also keen to get off the drugs asap. The shots seemed like an reasonable next step.

So, yesterday I had the shots. I was under for about half an hour while they did it - steroids in the sacroiliac joint, a caudal epidural and botox in the piriformis muscle. (He drew 4 small circles along the line of the piriformis, so I guess he shot it 4 times). I was home by lunchtime and feeling pretty chipper... Then the anaesthetic wore off and it hit me...and F*** Me did it hit me. Dr Jenner had told me I would probably curse him for 2 days after the injections, but if I thought I'd had pain before, I was mistaken. Like when I'd had a spasm before, I couldn't lie, I couldn't sit, I couldn't walk. The devil was in my bum and down my leg.... I'd been told I could take aspirin when I left the hospital. An aspirin?...it wouldn't even get close. So my wife called the local hospital who prescribed Tramadol which almost immediately took me off to sleep and a better place.

Amazingly, I slept rather well. I mean, you wouldn't expect to do so the night after you'd had a load of poison stuck in your lower back and butt, but I did. When I woke up, the devil's pain was gone, but it's still pretty flipping sore. I certainly have not yet resumed "normal activity" as some websites say is possible after 24 hours. Instead, I am walking rather gingerly around the house and mostly keeping fairly still, or at least as still as people with PS can keep. I am doing a mixture of standing and kneeling to write this. It definitely hurts more than it did before the injections, but again, what do you expect....I doubt I'll be doing any star jumps for the next few days and I'll definitely take another Tramadol tonight.

There is one other thing that I thought I should mention and it's what prompted me to start writing this in the first place. Earlier in the week I had been to see a Chiropractor called Mark Warren at Sports Clinic UK on the Finchley Road in London. I went because he specialises in ART and Graston and these are two techniques that kept cropping up with a search for PS on Dr Google. Obviously, it's too early to say whether the Graston/ART is going to work, and even so, it will be difficult to tell if it was the meds, injections, Graston or simple stretching at home that did cure it, but he did bruise up my glute something rotten. I remember feeling slightly embarrassed when Dr Jenner asked how I got the bruise, but as there were about 8 medics in the room, all looking at my bare arse, I didn't think it was the appropriate time for a discussion on alternative therapy and anyway, by the time I started to formulate a response, I was under.

I'll let you know how I get on with the injections/ART/Graston/stretching at home in a few weeks.

Best,

Jeremy