Health Organization for Pudendal Education

begin this year i started pelvic floor therapy and still got no relief at all ... i'm 4 months into PT and still the same basline pain and symptomes ...

my main symptome is anorectal pain ,
like something is stuck inside with a horrible urgency to defecation/ tenesmus..

its 24/7 pelvic pain without relief ...

is it pudendal neuralgia?

The inferior rectal branch of the pudendal nerve innervates the anal sphincter. So, it could potentially be pudendal neuralgia. Pain on one area can cause muscles to be tense nearby. Does the PT think it is pudendal related?

The inferior rectal branch can come off of the main trunk of the pudendal nerve differently for different people. For some people it comes off the main branch above the ST/SS ligamental grip while in other people it comes off below that. So a typical pudendal nerve block given at the ischial spine where the main trunk of the nerve runs between the ST and SS ligaments will not necessarily give an accurate diagnosis as to whether the inferior rectal nerve is involved. So it's a bit more tricky to get an accurate diagnosis.

Have you tried any local creams or suppositories with medications such as gabapentin, valium, tinzanidine or ketamine to relieve the pain? Are you able to sleep at night? If not, clonazepam might be helpful. I also have heard of nitroglycerin cream helping rectal symptoms.

Your PT might be able to tell you if a TENS unit would be helpful in relieving some of the spasms. Here is an interesting case study of how it worked for someone with rectal hypersensitivity:
https://pubmed.ncbi.nlm.nih.gov/15104377/

A ganglion impar block can be helpful for rectal pain, although as with all invasive procedures there is a slight risk.

Violet

Marky,

Your symptoms could be pudendal neuralgia. I am familiar with the 24/7 kind of pain you describe and I’m sorry you are dealing with it too. I did years of PT with very knowledgeable therapists and found it only caused my pain to increase. PT can be helpful when muscle tension is the underlying issue but, in my case, not for a nerve issue.

Stephanies