Health Organization for Pudendal Education

Many of us seem to have bad hips. My right hip has bothered me for ten years and lately has been getting worse. So far the doctors have no explanation for the pain. I am awaiting the results of an MRI.

I figure that one of the reasons that my hip pain is getting worse is the wonky way that I sit on a chair, kind of tilted sideways and balancing on one or the other hip. So I will try to avoid doing this in the future.

How many others have hip pain? What has been your diagnosis? What do you do to relieve the pain? How do you try to avoid causing pain? Thank you for your responses as it will help me evaluate my own hip pain.

Hi Lernica,
I assume you had an x-ray with no loss of joint space. If that was already done, an MRI is better at revealing issues involving soft tissue. I had severe hip pain due to bone on bone in my right hip and had a modfied hip replacement (resurfacing) March 2010 that cured that problem completely. I wish PN was as easy to fix as that was.

Don

Donstore-

Can you explain more about the hip resurfacing procedure? Did you have this done before or after you had pne? I have a major issue with my hip having no joint space and arthritis. My orthopedist about a year ago recommended a total hip replacement which scared me to death - I am 41 and he said I had the hip of a 65 year old. I'm going back to see him in 2 weeks to discuss if there are other options and to ask him to do an mr anrthogram to rule out any other things like a labral tear. Who did your surgery? my hip is getting worse and worse to the point that I'm starting to limp and have trouble walking at times which is not good when you have a young chid like I do. My pt is also convinced it's a major part of my pne / crps pain cycle.

Thanks!
Merrie

Hi Lernica,

I'm one of the hip pain people. My right hip has bothered me since my teen years, so for about a decade or more. I first remember it hurting in eighth grade while playing competitive tennis!

Over the years, I've been diagnosed with several things: IT band syndrome, bursitis, weak adductors, etc. I do actually have a chronically tight IT band. Finally this year I was diagnosed with femoroacetabular impingement, a labral tear, and piriformis syndrome. I have mild femoral retroversion in that hip also.

I have always had lateral hip pain (pain on the side of the hip). About nine months ago, it started radiating posteriorly and kind of pinching when I walked. I developed a chronic dull ache just posterior of the greater trochanter. About six months ago I developed a deep groin pain that radiated out laterally, meeting my other pain to form a nice semi-circle around the hip.

My PN pain is predominantly left-sided, but I really think quite a bit of it is left over from a nerve block gone wrong and endo adhesions. So, my right hip pain is probably connected to my overall pelvic dysfunction, but not to any specific areas of pain. Truly though, I'm so much more of a PFD patient these days than PN.

Finally, I've actually developed some groin pain in my left hip too over the past six weeks. This could be from compensating for my right hip or some aggressive stretching. Or, I could have a similar impingement/tear issue on that side. I try to stay active, and walk three miles about 3-4 times a week and do light upper body weights. So it's possible I've injured it from over-compensation and change in my gait. I've not had left hip pain until now, but I have left sided back pain at the SIJ region, and there is a small number of people whose hip dysfunction refers to back pain.

Lauren

pomegranate wrote:
I have always had lateral hip pain (pain on the side of the hip). About nine months ago, it started radiating posteriorly and kind of pinching when I walked. I developed a chronic dull ache just posterior of the greater trochanter. About six months ago I developed a deep groin pain that radiated out laterally, meeting my other pain to form a nice semi-circle around the hip.

My PN pain is predominantly left-sided, but I really think quite a bit of it is left over from a nerve block gone wrong and endo adhesions. . . . Finally, I've actually developed some groin pain in my left hip too over the past six weeks. This could be from compensating for my right hip or some aggressive stretching. Or, I could have a similar impingement/tear issue on that side.

Lauren

Lauren, we have the exact same symptoms, including the same sides (right hip, left PN)! And endometriosis too! Lucky us! Are you considering surgical options for the hip?

Lernica wrote:

pomegranate wrote:
I have always had lateral hip pain (pain on the side of the hip). About nine months ago, it started radiating posteriorly and kind of pinching when I walked. I developed a chronic dull ache just posterior of the greater trochanter. About six months ago I developed a deep groin pain that radiated out laterally, meeting my other pain to form a nice semi-circle around the hip.

My PN pain is predominantly left-sided, but I really think quite a bit of it is left over from a nerve block gone wrong and endo adhesions. . . . Finally, I've actually developed some groin pain in my left hip too over the past six weeks. This could be from compensating for my right hip or some aggressive stretching. Or, I could have a similar impingement/tear issue on that side.

Lauren

Lauren, we have the exact same symptoms, including the same sides (right hip, left PN)! And endometriosis too! Lucky us! Are you considering surgical options for the hip?

I know, right? Lucky us! We should form a club!

I really do believe I just had an unfortunate nerve block experience with my first round of PN blocks. I think somehow the left nerve was damaged/nicked/altered/whatever, because my left sided pain has ever so slowly decreased over the past 18 months. And it didn't start until four days after the block once some numbness finally wore off. There's no official explanation, but that's the connection I can make. Also, my gyn surgeon who performed my laparoscopy released a major adhesion on the rectal wall where some tissue was twisted upward. The location of that adhesion corresponds directly with the area of my predominantly left sided rectal pain that started up about nine months ago. Add all that to some lower level pre-existing bilateral pain from 2009, and you've got a perfect storm! I'm the queen of comorbid conditions, apparently.

Anyways, YES, I am considering surgical options, specifically for my right hip. I'm about to make a post on that in the coming days. Being (almost) 26 and having hip pain that interferes with walking one's dog, standing at work, car trips, etc. is NOT normal! I realized that for most of my adult life I have leaned to the left, and avoided putting weight on my right hip. Again, not normal. However, I'm in a really good place with my pelvic pain right now. If this hip diagnosis had occurred 18 months ago, I would have said no way to hip surgery due to my already overwhelming pudendal/pelvic pain. But I'm just so functional that the idea of hip surgery and rehab sounds hard but doable. It's a risk I'm willing to take.

I'm planning on starting the diagnostic process for my left hip as soon as possible. Apparently, there's a high probability of bilateral problems in those of us with impingement and tear issues. If you think about it, it makes sense. If the head of my right femur is retroverted and shaped slightly funny, the left one could have developed that way too.

I will be posting in case updates soon once I wrap my mind about my upcoming hip surgery.

Lauren

pomegranate wrote:
I have always had lateral hip pain (pain on the side of the hip). About nine months ago, it started radiating posteriorly and kind of pinching when I walked. I developed a chronic dull ache just posterior of the greater trochanter. About six months ago I developed a deep groin pain that radiated out laterally, meeting my other pain to form a nice semi-circle around the hip.

Lauren

Oh how I relate. . . I know you also mentioned piriformis syndrome Lauren and I honestly think my tight P muscle is the cause. The tighter and more spasmed it gets the more the pain radiates from my hip to groin. (in a shallow cup/bowl 'line' at the front, top of legs)
I did have a botox injection into my RH, (worst side) piriformis and although it did nothing much for the sciatica (scar tissue) it did help the hip and groin pain. I didn't have botox in the LH side and still got the hip/groin pain there which speaks volumes to me.

I've now had an MRIs of both hips which show degenerative changes including a torn labrum, synovitis, calcific tendinosis of the gluteus minimus insertion, etc. etc. My hip surgeon now wants me to do (a) an arthrogram (ie. an MRI with dye inserted into the hip) and (b) a diagnostic lidocaine injection. I've done a bit of internet research and they sound like very painful procedures to me! Has anyone had them done? My pelvis is already so sore and inflamed that I don't think I can take any more pain. Added to the pain factor is the surgeon's view that even if he fixed my hips, he doesn't think it would resolve my pelvic pain. So I'm not very motivated to undergo further testing. What do you all think?

Hi Lernica,

I never had an arthrogram on my right hip, although they are the gold standard for diagnosing hip joint dysfunction and pathology. We based my surgery on the fact that my x-rays and regular MRI showed impingement and I had clinical symptoms of a labral tear. Good thing, b/c my tear was huge, and I also had a bone spur that didn't show up on the MRI. I was tired of waiting around, so I'm glad I went for surgery without insisting on waiting for an arthrogram. However, we will go straight for the arthrogram on my left hip when we decide to start the diagnostic process on that hip.

I've heard conflicting views on the arthrogram and pain. Some people say it caused a flare in hip pain, and others say it was just mildly uncomfortable but no big deal. I don't think it would affect your pudendal pain, unless your muscles spasmed in response to the hip pain, thus impacting the pelvic region. I DID have a diagnostic lidocaine injection, and my hip was sore afterwards for about 4 days. The first day after was the worst. But, the injection didn't do anything to pelvic pain, positively or negatively, for those 4 days. For the couple hours of numbness after the injection I did have less pain sitting on the injected side.

It's definitely not a promise that hip surgery would help pudendal/pelvic pain. For me, my hip was impacting my life so much that I didn't care if hip surgery lessened pelvic pain; I just wanted my hip to be better! Plus, we want to have children, and there was no way I could carry a pregnancy with that bum hip. It just gave me too much grief as a petite person, and I could not imagine 25-30 more pounds on it.

For you, if your hips impact your life tremendously, perhaps further testing is warranted. But if they're just an afterthought, I probably wouldn't take the risk either. Good luck with your decisions, and hang in there.

Lauren

I am in a similar quandry with combined hip pathology and pne. I have not had an arthorgram but MRI and X-ray show I have essentially no joint space left in my hip due to severe osteoarthritis. It had gotten significantly worse over the last year. 2 orthopedic surgeons have recommended total hip replacement but my pne dr is very against it at this point. My pt feels strongly that the hip pathology is part of the pain complex and is pushing me towards hip surgery.

I have had several hip injections with lidocaine and decadron over the years. The injection itself is not very bad at all. I do get some releif for 4-6 weeks with the injections although nothing hugely earth shattering in terms of helping the pne pain.

I am still undecided about what to do. It's all so confusing.

Merrie