Health Organization for Pudendal Education

I've been suffering from rectal, perineum and penile pain for the past 5 months. I get it worst when I sit down but other positions also cause it. I can feel a lot of tension in my perineum area when I'm not in pain. This is the root cause of my problem. When I sit down I can feel the tension and then the pain comes. I managed to reduce the tension by massaging my very tight sphincter muscles. This reduced a lot of tension but there is still a lot of perineum tension and my symptoms remain. The physio I'm seeing could not find any internal trigger points and instead has me doing stretching and breathing exercises as well as external massage. Can these techniques help release internal tension? I'm doubtful. The breathing exercises actually cause me some pain as well.

Reckless, when something causes additional pain I see that as a red flag to discontinue it. Even Dr. Wise, the headache in the pelvis guy, told one of my friends if you aren't seeing improvement within 6-12 sessions of PT you probably aren't going to.

Well the only thing that I feel will help me is physio because that's the only thing that will get rid if the tightness I feel. I could have a nerve block but that won't get rid of the tightness that is causing the pain.

Reckless, it's possible that the only thing that will help you is physio. But how do you know that tense muscles are the root cause of your pain?

In my case, the only thing that finally allowed my muscles to relax was releasing the entrapment of the nerve. If the nerve is entrapped, it could be sending the wrong signals to your muscles causing them to be perpetually contracted and tense.

Well first of all the tension was even worse than it is now, I then massaged my sphincter muscles which reduced a lot of tension. It was quite painful doing so as they were very tight. This completely eliminated the pain I had during bowel movements.

I know the tightness is the cause because i can feel so much tension in the perineum area and when I sit down it feels so uncomfortable. Also when my bowels are full I can sit down without pain which indicates to me that something is being stretched inside and hence relieving the pain.

I'm thinking of using a dilator to help stretch things. I'll speak to my physio about it.

It feels like I need to push something large outside of my back passage to fix it.
If I was a woman I'm sure getting pregnant and pushing out a baby would cure me.

I would just point out that the feeling of having a foreign body inside the rectum (or vagina) is very characteristic of pudendal nerve problems, as is pain and discomfort when sitting.

Whether your tight muscles are causing the nerve to have problems or whether it is the other way around, is very hard to tell. I think that the only way forward is to go with what reduces your pain. I agree with Violet - if something is causing you increased pain on a continuing basis, then perhaps it is sensible to question whether it is going to be able to help in the long term. Also, please do bear in mind that there have been several people on this forum who have had their PN made worse by inappropriate physio.

Have you had the opportunity to try any medication to help with neuropathic pain?

Hmm, I'm confused. Yes you could be right that maybe it's the pudendal nerve which is giving the impression of tightness. It might explain why the tightness feeling goes away completely when the pain kicks in. I always found that strange.

But as I said, when my bowels are full I can sit for quite a long time without pain. This is likely due to something being stretched inside. Also urinating and having a bowel movement feels good because my pelvic floor muscles are relaxing.

If worst comes to worst and I see no signs of improvement then i'll have to try a nerve block in a couple of months.

Think trying the nerve block could be a good idea as it is sometimes therapeutic as well as diagnostic reckless, good luck with whatever you decide.
Helen

I must respond to this post as I initially had very clear trigger points internally at "5 o'clock and 7 o'clock" when I was first examined by the PT and Dr. Vancaillie.
I went back to the PT after not sitting for months and taking Endep and it appeared that those trigger points were not giving off the same pain they once were.
The PT thought it could have been either that the Endep was having some effect or that the decompression (from not sitting) was giving some relief.
Either way I am not cured because sitting still brings on symptoms (after a delay, I must add).
My MRI shows entrapment and the trigger points were consistent with that, but I've probably released a lot of the tension that had built up over long periods of sitting.
I am going to do a diagnostic nerve block once I aggravate the PN a little more by sitting. Just now I am not too bad, but if I can go into a "flare" they will be able to judge the efficacy of the block...

Unfortunately I also have to report worsening with PT, especially by internal intrarectal trigger point release. First two sessions were ok, then major worsening came, so I decided to stop it. My problem is more related to dorsal nerve (distal pudendal) having pain in penis, scrotum, groin area. No major worsening with sitting.
I had very good peroid with only mild pain, till November, now I am struggling heavily.
Probably will head on Alcock block (altough there is no pathology in Alcock), but the block should numb everything distal from Alcock.
I would like to avoid dorsal nerve decompression operation at all cost, but am afraid that this option cannot be ruled out. I can imagine to live with the pain I had in summer, but current state of art is totally devastating, both mentally as well as physicaly.