Health Organization for Pudendal Education

Several on this website have mentioned having piriformis pain they believe was precipitated by pudendal nerve pain. My question is, how long did it take for the piriformis pain to resolve? It is so severe at times for me, that I am considering seeing Dr. Martin to see if I need surgery. I have extreme tightness and pain in the buttock, along with numbness in the back of the thigh.

Hi Paulette,
I'm not sure there's a clear cut answer to PS in regards to PNE. I have heard from some that they developed PS after PN surgery. In my case, I had the PS pain before surgery and it remained afterwards. However, I also have what I would consider a severe case of SIJD. The SIJD seems to instigate the PS with me.
As you know, the PS aggravates the sciatic nerve. I wonder if this is where your numbness is coming from? Do you also experience sciatic symptoms?
With love and hugs,
Karyn

Karyn wrote: However, I also have what I would consider a severe case of SIJD. The SIJD seems to instigate the PS with me.

Karyn, I didn't know you had SIJD. Did you develop it post-op TG or have you had this a long time? Are you having any success treating it? This is something I am really researching and looking into a lot right now.

Paulette, have you ever had an EMG to diagnose piriformis syndrome? I know Vicki Sims, PT in Gainesville GA uses Dr. Ernest Howard in Atlanta, GA to diangose piriformis syndrome using EMG on SIJD patients. I am sure Dr. Martin probably does this as well though. Have your symptoms of butt-tightness/thigh numbness/pain worsened post-op?

Thanks for responding, Karyn and Faith. I recently read an article by a chiropractor about PS. He said numbness down the back of the thigh is a symptom of PS. That was the first time I had considered the numbness to be PS. Karyn, what kind of PS symptoms do you have? Do you have pain down the leg? I don't really have that typical symptom of PS, but I have buttock pain and the numbness. Sometimes the tightness is so bad, it is painful to walk, and the tightness is in the hip.

Faith, I had EMG's in Denver, but the Doc who did them said he couldn't do the FAIR test, because of all the fusions in my spine. I think you have a good point about seeing Vicki Simms or Dr. Martin. I think Dr. Martin does do the EMG's for the piriformis, and maybe his guy would be able to the FAIR test. Heck, I would rather go to Gainesville, because it is supposed to be so pretty there, but if I needed surgery, I would want Dr. Martin. So I guess I should call Martin's office! LOL. I have to admit the deep tissue massage my PT has been doing has eliminated much of the tightness. Maybe I should give PT more of a chance. The PS symptoms do seem to have worsened post op, but it is hard to tell, since that nerve seems to cause everything to hurt. I wonder how long it took Violet to get rid of her PS symptoms after surgery?

Faith wrote:Karyn, I didn't know you had SIJD. Did you develop it post-op TG or have you had this a long time?

I was being treated for it (unsuccessfully) for a couple of years before the surgery by a PT and chiropractor. Kinda strange - I had debilitating sacrum pain before the surgery and then none afterwards. Even today, the sacrum itself doesn't really hurt. However, it feels like I've got a pinched/stuck nerve on either side of it (posterior hips), that goes in a straight line, into my buttocks (piriformis muscle). Makes almost every movement extremely difficult. Needless to say, bending is virtually impossible and sitting and standing for long periods of time agrravate it, too. But know what bothers me the most? Driving! For some reason, just navigating around the slightest curve in the road will have me literally screaming. Feels like something catches and just sticks.

Faith wrote:Are you having any success treating it?

Not yet. I have an appointment with an orthopaedic doctor in a couple of weeks. I don't know about you, but I've had an extremely difficult time finding someone to pay attention to my PT records (with the exception of Dr. Conway).

paulette wrote: I recently read an article by a chiropractor about PS. He said numbness down the back of the thigh is a symptom of PS. That was the first time I had considered the numbness to be PS.

Right! That's what I was getting at with my other response to your post. I've also read that a chiropractor is the first line of defense for SIJD and PS. Yet ....
here I still am! And no; no sciatic pain down the legs. I did have that at one time, but the chiropractor was successful with stopping it from happening anymore.

Karyn,

I am learning that SIJD can be extremely difficult to treat and many PT's, chiros, doctors who claim to know about SIJD do not know enough to successfully treat really difficult patients like us (with multiple conditions). Her Majesty told me this a long time ago and I struggled to believe her, but the more I've read the more I understand there is way more to SIJD than just one hip being "higher" than the other. I saw a physiatrist who is nationally renown for SIJD treatment and has written articles and even she was stumped by my pain (she couldn't put all the pieces together). This website has a lot of good medical articles about SIJD/PS if anyone is interesting in reading literature http://www.sidysfunction.com/medical-articles.php

paulette wrote: I wonder how long it took Violet to get rid of her PS symptoms after surgery?

....Probably about 18 months because I didn't start PT until the 11th month after surgery. The therapist taught me how to use the TENS unit for piriformis syndrome. It helped more than anything else but I had to use it faithfully for at least 2 hours a day on each side. I had pain, tightness, and numbness in my butt, right leg, and foot but it is gone now. On rare occasions when I sit for a long time I can feel the piriformis tightening up but if I massage the area it goes away right away.

I agree with you gals that SIJD is more complicated than just one leg being longer than the other. I am not cured of SIJD and still have to be careful to avoid certain things but I can live with a very low level of pain now.

Faith,
Thanks very much for posting the article. Yes, I've read a few which are very similar. Sigh ....
I'm pretty sure Paulette has had SI injections - please correct me if I'm wrong! Have you had any done, Faith?

Faith wrote: I saw a physiatrist who is nationally renown for SIJD treatment and has written articles and even she was stumped by my pain (she couldn't put all the pieces together).

Well, that's very upsetting. Very frustrating for you, too; I would imagine.

My sciaticia was so bad before and after surgery, I could hardly walk... I don't know if I had all of the same problems you mention... One thing led to the other.. My symptoms are slowly decreasing... This am Gretta and I went out for our daily walk.. It seems my tail bone is really sore now. Or could it be rectal inflamation? . I had a hard time , we didn't go as far as we usually do... My bottom just seems to be so heavy , like swollen and irritated... Maybe it is a sign of healing?? I wish. . My surgery was just a year ago now, I am not well yet but I am going to be... It sounds like I had or have the piriformis or did have, not near as bad as before... I believe in time we will be as well as Violet is now.
The surgeries really play havoc with all of the nerves and tendons. Sighhhhhhhhhhh.

Karyn wrote: Have you had any done, Faith?

Yes, I had one SI injection done with steroid/anesthestic. It did do anything for my pain. Most SI injections are intraarticular injections (into the joint), but I think only people with a torn SI joint capsule or arthritic damage to the joint itself will benefit from a traditional SI injection. Don Tigney SIJD expert recommends periarticular injections http://thelowback.com/fix.htm#management and I think this makes sense as a lot of people's pain is originating from the ligaments being lax and unable to hold the joint in place not from damage to the joint itself. Now in a very actue stage of SIJD where the joint gets really aggrevated an intraarticular SI block might relieve some pain, but I know in my case I need periarticular injection because I have ligament laxity (hypermobility) issues. I think it's rare to find a doctor to do this however. I don't knwo if it would be similar to the injection I had to the ST ligmament by Hibner, but it hurt like crazy!