Health Organization for Pudendal Education

Hello All,

Well, I'm nine months out from surgery on my left side and I went to a new PT because I've moved. She examined me and found my right obturator with no problem then when she checked for the left one, she couldn't find it. Now this is a very highly recommended, experienced PT. After about 5 minutes she found a tiny little bump and then she said I think that's it. Of course then she gave me exercises to strengthen it. But I don't just walk with ONE LEG...of course, it's atrophied.

The right leg jerks in half so hard that it hurts my knee. The pain is killing me and I've been seeing a spine doctor. He told me that I have spinal stenosis at L5, S1. I think that this is the root of my problem. I think that's where the obturator went! Plus the right hip hurts me.

Some of you may remember that I had stress incontinence before pudendal surgery and I was hoping that that would take care of it but it's worse than ever. The new PT said that I leak a lot more than stess incontinence. I believe it's all related.

Can anyone tell me what they do about this rather than surgery? It really scares me to have surgery on my back. What about the pudendal nerve? It's so close to the area.

I would really appreciate any advice that you have.

Kate

Hi TinyDancer,

Are you really 85% better after your surgery with Dr. Hibner?If so, could you kindly tell in detail which symptoms have been resolved or improved and which haven't.In addition,have you developed any new symptoms after the surgery.

Kind Regards,
Ali

Ali,

I have to say that I now know that the nerve is absolutely shocked when the scar tissue is removed. Depending on where the scar tissue is, how long you've had it, and how scarred the nerve was, you will have different outcomes.

My pudendal pain was 85% better but lately I have had worse incontinence and leg spasms. I feel that that is due to my L5, S1 spinal stenosis. These are two problems that occurred at the same time for me and it's hard to say what causes each symtom. And I think that is what caused the obturator to atrophy to almost nothing. It's not possible for the surgery to cause as much atrophy as is there.

I have not had my regular PT. I am moving and seeing someone new and my muscles have spasmed because I haven't been seeing her.

But the anal pain is gone, even with bowel movements. The deep vaginal pain is gone. The numbness is completely gone. The tailbone pain was taken care of by acupuncture. The only pain that is left is vulvar pain on the left side and the PT that I'm seeing doesn't know if it's from the pudendal nerve or the L5,S1.

Have you had the surgery with Dr. Hibner, yet?

Kate

Kate, heres' a good website that lists non-surgical treatments for spinal stenosis:

http://orthoinfo.aaos.org/topic.cfm?topic=a00329
http://tinyurl.com/dxpvl4a

Here's a copy of the list:


Nonsurgical Treatment

Nonsurgical treatment options focus on restoring function and relieving pain. Although nonsurgical methods do not improve the narrowing of the spinal canal, many people report that these treatments do help relieve symptoms.

Physical therapy. Stretching exercises, massage, and lumbar and abdominal strengthening often help manage symptoms.

Lumbar traction. Although it may be helpful in some patients, traction has very limited results. There is no scientific evidence of its effectiveness.

Anti-inflammatory medications. Because stenosis pain is caused by pressure on a spinal nerve, reducing inflammation (swelling) around the nerve may relieve pain. Non-steroidal anti-inflammatory drugs (NSAIDs) initially provide pain relief. When used over the course of 5-10 days, they can also have an anti-inflammatory effect.

Most people are familiar with nonprescription NSAIDs, such as aspirin and ibuprofen. Whether over-the-counter or prescription strength, these medicines must be used carefully. They can lead to gastritis or stomach ulcers. If you develop acid reflux or stomach pains while taking an anti-inflammatory, be sure to talk with your doctor.

Steroid injections. Cortisone is a powerful anti-inflammatory. Cortisone injections around the nerves or in the "epidural space" can decrease swelling, as well as pain. It is not recommended to receive these, however, more than 3 times per year. These injections are more likely to decrease pain and numbness but not weakness of the legs.

Acupuncture. Acupuncture can be helpful in treating some of the pain for less severe cases of lumbar stenosis. Although it can be very safe, long-term success with this treatment has not been proven scientifically.

Chiropractic manipulation. Chiropractic manipulation is generally safe and can help with some of the pain from lumbar stenosis. Care should be taken if a patient has osteoporosis or disk herniation. Manipulation of the spine in these cases can worsen symptoms or cause other injuries.

The obturator internus comes from the L5, S1 area. So, it seems plausible that stenosis there could be the cause of the OI atrophy. I hope that you can find some relief without having to go through another surgery. From what I was reading, it sounds like conservative therapies can help a lot so hopefully they will work for you.

Thanks, Violet. Information helps so much.