Health Organization for Pudendal Education

Ok , is possible to still have pudendal neuralgia or pudendal entrapment without positive nerve blocks ? First time i had a diagnostic block when i only had a constant sensation to urinate in my urethra that never dissapeared after urination ( sensation was very strong like a huge pressure inside ) , many times the more i urinated the worst sensation became.Even in the better days i never felt fully empty.I never had urine left in bladder even if sometimes i urinated normal most of the times i struggled to urinate...I also had burning , stinging , pain or the feeling something is in my urethra ( a foreign body ).I had bilateral pudendal block at ischial spine and all got numbed but i still had this sensation ( block was useles )....even flared me for a few weeks.

Second time i had the next bilateral block with Hibner when i had almost no more urinary symptoms ( 1600 gabapentin saved me for 10 months of this symptoms ).But i did the block cause after the urinary sensation got almost normal i started to have Pgad....now i had lidocaine and steroid plus botox in pelvic floor....Again they did nothing , zero.I suspect maybe my Pgad was from stopping Zoloft same time i started Gabapentin but is just a guess.So no effect from this blocks ( he even did botox in my pelvic floor ) but in 2 months the urinary symptoms slowly returned.....now even 2800 gabapentin do zero and Lyrica or other meds never did much.

Internal therapy helped my urinary symptoms ( i did it 2 months only cause in Romania we have no therapeut , it seems now we have one , i will check it this days ) but after i stopped it the symptoms slowly returned.....after few months i started to take Gabapentin and the miracle happened for 10 months.

The fact gabapentin stopped this sensations shows me is cleraly something neuropathic....internal therapy worked also but never ever like gabapentin.

Now i have again huge urethral sensations and nothing works....good part is Pgad got better but urethral sensation are more than enough.I never had sitting pain , never...only urethra and Pgad.

So back to my question , is possible to have problems with pudendal and negative nerve blocks ? I think i read some posts about persons with urinary sensations that had no relief but i don t remember if they had pudendal neuralgia / entrapment after all....

Ty in advance !

Ps : sry for grammar mistakes but i am in huge symptoms atm and is not my first language.

Hello,

I don't know for sure the answer to your question. The Nantes Criteria for Pudendal Nerve Entrapment lists pain relieved by pudendal nerve blocks as one of the essential criteria for pudendal nerve entrapment and the article describes it this way:

"Pain Relieved by Diagnostic Pudendal Nerve Block

Anesthetic infiltration of the pudendal nerve9 significantly
relieves pain for the duration of local anesthesia. This is an
essential criterion, but is not specific as it simply indicates
that the pain is situated in the territory of the pudendal
nerve; pain related to any perineal disease (e.g., anal) would
also be relieved by pudendal nerve block and other types of
nerve lesions would also have a positive diagnostic block
when they are situated distal to the site of infiltration. A
negative block does not formally exclude the diagnosis when
it is not performed with sufficient precision or when it is
performed too distally (e.g., in the pudendal canal, while the
pudendal nerve lesion may be situated at the ischial spine).
The infiltration technique (with or without CT guidance, with
or without neurostimulation) has only a minor impact on the
positive or negative response to nerve block."
https://www.pudendalhope.info/wp-conten ... iteria.pdf

Typically pudendal nerve entrapment is significantly worse on one side but pudendal neuralgia can be bilateral.

Another interesting article by Dr. Possover is at the following link:
https://www.researchgate.net/publicatio ... Entrapment
He suggests radiculopathies at S2-S4 can be responsible for pudendal pain and bladder hypersensitivity. Have you ever had that area blocked?

Violet