PN or PNE

[Lovepeps]

my complaints started sometime in August. I got a pain in my butt and felt a feeling of pressure, as if something was stuck in it. my doctor gave me macrogol to soften the stool. this helped a lot, but the pressing feeling as if something was inside did not go away. on holiday in September. swimming almost every day.

I was so tired of feeling this way. the complaints went away for 2.5 weeks. then it came back. I also felt an arousal in my ass. after several days I started to feel a yellow annoying feeling in my clitoris. an arousal, so strong. my pelvic floor physiotherapist noticed a tight pelvic floor. After a number of treatments, massages of the butt muscles, I was free from arrousal for 5 weeks, but I did have pain when sitting and the feeling of pressure remained. I also regularly feel tingling in my labia. unfortunately the arousal is back again. especially after urinating, it feels like I have a bladder infection, but I don't.

I still have pain when sitting. now the pelvic floor physiotherapist wants to try dry needling. I don't use any medication, but I do use oxacepam to keep calm because all this makes me very sad and depressed. could this all be related to PN or PNE? and it can still improve. I haven't had any other accidents. the only thing I can think of is that I had a lot of stress and anxiety for 1.5 years, which caused me to start clenching my buttocks a lot. I am a 51 year old woman.

[Violet M]

It's possible it's related to PN or PNE but you would need to get a proper diagnosis from a provider who is knowledgeable about PN/PNE. Does your physical therapist have any experience with, or training, in treating people with PN/PNE? She should be able to do a pelvic floor exam and press on the pudendal nerve at the ischial spine and Alcock's canal to see if there is any tenderness there. If it is PN or PNE, yes, there is a chance for improvement with the right treatments.

Violet

[Lisa_]

Hello

I thought I'd add my question to this thread as it's related to PN vs PNE. If the pudendal nerve is irritated/causes pain in two locations along the distribution of the pudendal nerve, does this indicate whether it's more likely to be PN or PNE?

Thanks!

[onlysams]

Pelvic floor stuff can be tricky, but it's good that you're exploring different options like dry needling. Stress can definitely make things worse, so finding ways to chill out might help too.

[Violet M]

Hello

I thought I'd add my question to this thread as it's related to PN vs PNE. If the pudendal nerve is irritated/causes pain in two locations along the distribution of the pudendal nerve, does this indicate whether it's more likely to be PN or PNE?

Thanks!

That's a good question, Lisa. I could be wrong, but I think the answer is "no" just based on my own experience because I had pudendal nerve entrapment at the ischial spine (at the main trunk of the nerve) but my symptoms were primarily perineal mostly affecting one branch of the nerve. But it could potentially affect all 3 branches. Dr. de Bischop, who was a neurologist working with the surgeon who did my surgery, told me the type of pain and symptoms you have can depend on which nerve fibers are affected. So for instance you could have PN due to having Lyme's disease, but only certain nerve fibers are affected. Or you could have pudendal nerve irritation from a tense pelvic floor that press on the pudendal nerve in Alcock's canal between the obturator internus muscle and the levator ani muscle. This could give you the same symptoms as an entrapment of the nerve in the fascia of those muscles. This is just my speculation based on what makes logical sense so it would be interesting if you ask your doctor their opinion on this to see what they say.

Also, the inferior rectal nerve (a branch of the pudendal nerve) can come off of the main trunk of the pudendal nerve above the ischial spine (the most common area of entrapment) so you could have an entrapment at the ischial spine or alcock's canal but have no rectal symptoms.

Violet