Health Organization for Pudendal Education

Those who have known SI joint laxity and PN (violet you are the only one I can think of) what problem do you fix first? When I saw LoRetta, dr Hibner's PT, she says I have widespread joint laxity including the SI bit that the PN is the main issue right now. So if the PN is fixed will it not just happen again if I have SI joint laxity?

Faith, I never really had the SI joint laxity fixed except for one prolotherapy injection into the R SI ligament. Just having PN surgery lowered my pain levels immensely and so far (7 years later) the pain has not returned, in fact it is only improving.

The reason I think surgery fixed it and that the pain will not return is because if the pelvis is out of alignment with ligaments sagging, that puts undue pressure on the nerve that's running between the ligaments. If you release the nerve from between the ligaments then you've released the impingement on the nerve.

Thanks for your input Violet. I have thought about prolotherapy, but Dr. Hibner's Pt didn't think prolo would help me until I got the PN calmed down. So you had your prolo after surgery?

I guess I'm confused though because if you release the impingement on the nerve from between the ligaments but your ligaments stay "lax" then whats to keep the nerve from re-entrapping? (This may be an ignorant question as I am sure I dont' fully understand exactly how TG surgery is done). Like especially if I have TG with Hibner who doesn't sever the ligament?

One more question: Why don't you think SIJD is a problem for you anymore? Or are you just out of alignment but the pain isn't a problem because you had decompression surgery?

I just can't seem to find many people with both PN and SIJD (both here and other SIJD forums I am on) to help me understand how one with affect the other.

Faith,think of it as though the nerve is squished between two of your fingers. If you remove one of your fingers is the nerve still squished? If an entrapment is due to a nerve being compressed between 2 ligaments, when one or both of the ligaments are cut releasing the nerve, what's the nerve going to get compressed or re-entrapped by? Of course it's always possible for the nerve to get re-entrapped in scar tissue but that would be a different type of entrapment not due to ligament laxity.

How does SIJD cause pudendal nerve compression? This is my theory but I could be wrong. If you have SIJD your pelvis is most likely misaligned so your pelvis is probably sagging on one side causing the nerve to be compressed between the ST and SS ligaments. If you cut at least one of the ligaments, the compression is released even though your pelvis is still misaligned.

I'm probably still out of alignment - haven't really had it evaluated lately. Over time maybe the ligaments may have healed a bit since I'm not doing extreme exercise anymore. I never really did much to get back into alignment other than that one prolotherapy injection post-op because my pain levels are very low now. There's one core strengthening exercise I do for the transverse abdominus but I'm sure it's only providing minimal benefit.

Dr. Bautrant said my ligaments were hardened and sclerosed which also contributed to irritation of the nerve -- probably because the nerve was rubbing on them. That's my guess.

Doesn't Hibner sever the sacrospinous ligament still? If you have a compression between those two ligaments, it seems like one of them would have to be cut to relieve the compression.

Thanks Violet! Great explanation. Yes, I think Hibner still severs the SS ligament, which I am ok with. I just have a problem with the ST being severed especially since it looks possible from some anatomy books that the SI ligament runs into the ST ligament

So did you not have pain though right in the SI joint itself? Did you ever have an SI block? I have had an SI block, but it didn't take away my pain, whereas the PN block did for a few hours.

Yes, Dr. Hibner severs the SS ligament, transposing the nerves and does NOT repair the SS ligament.

Faith, I never had a block into the SI joint itself or an SI block. My SI pain was a piece of cake compared to the pudendal pain so I didn't want to stir things up any worse than they already were in the SI area.

Hi Faith,

I saw you mention in another thread that you were looking at either decompression surgery or SI fusion surgery. While SI fusion surgery might help some people with SI pain, I have never heard of one single person with pudendal neuropathy, who had the pudendal neuropathy fixed through SI fusion. In fact I have heard of some individuals who exacerbated or initiated a case of pudendal neuropathy through fusion. Of course I don't know everybody out there. Have YOU heard of anybody whose PN pain was cured by SI fusion? Or is there anyone reading this whose pudendal nerve was helped through SI fusion?
Just something to think about, because I feel strongly that if you have made the decision to have a surgery, and you are considering which to have, decompression is the way to go.

Got To agree with HM Faith, the idea of any fusion just sounds SO big an op and almost 'undo-able' if things don't work out ? I know that decompression surgery has made some worse, I think the figure is 1%, most improve or stay the same. Of course things have improved so much, even recently, so I'm sure those figures will be increasing for the better all the time.
I can understand you needing to get it all figured out as far as is possible to make an educated decission, but that's my tuppence worth.