Hi - I am debating as to whether to have nerve block no. 3 done, this would be done at the pudendal canal location/alcock. My first one was done 11/25, and no. 2 done 12/30 - CT guided at ischial spine. I'm not in any rush for no. 3, but I have to make a decision one way or the other I guess. I have had a slight decrease in overall pain, my vaginal soreness is definitely reduced, less rectal pain. My leg burning (bilateral) is reduced, like 15%.... but I believe that is from Cymbalta. I started that about 5 weeks ago. I know the blocks would not help with the leg burning.
I am finding that I have ischial tuberosity soreness, burning all the time, so that has replaced the vaginal soreness as the most annoying symptom. Now I did have this before the first block, but it seems to be intensified now, so I'm not sure if that's just progression, or fallout from the blocks??? Maybe I just notice it more because the vaginal soreness is greatly reduced??
Does anyone know if I have block no. 3 done at the alcock canal location.... would that benefit that lower part of the pudendal nerve - the perineal branch I think? I looking at some anatomy of the nerves, and it would seem so.
Perhaps a block done at that site would help with this ischial tuberosity (not sure what else to call that area) pain/soreness?
There must be a purpose to blocking at this lower location, unfortunately the doctor that does the blocks is no expert on PN, he has only been doing them a short time, just a radiologist.
I had a fair amount of very low abdominal pain until around 12/9 - and that too has almost completly gone away. I don't really know if that is due to the first block or not.
PN always has surprises, every day can be slightly different. The low ab pain may be due to ovarian cysts that come and go, I have had a few, but in years past that never was an issue.
So if you have had the block done at the Alcock location, I would appreciate feedback. I have a Potter MRI scheduled in April, I hope that sheds more light on what my issues are.
Thanks everyone....
Debbie
any benefit to nerve block at alcock canal location?
any benefit to nerve block at alcock canal location?
Vag pain, leg burning 3/11, SIJ inj 7/11, Pelvic PT, Chiro/acupuncture,
2-CT pudendal blks 11/2012, did help, less deep vag pain
Potter MRI 04/2012 - Scar tissue/thickening at SS/ST, scar in Alcock canal -bilateral,
Hibner 6/12 suggests Botox (didnt do), 8/12 more pelvic PT w/ dry needling
Gabapentin 1800 mg, Lyrica 200 mg, 5mg valium, vicodin as needed
Trying to get rid of central sensitization burning pain in my legs, Valium seems to be helping
Looking into more mindfulness options. . . . .
2-CT pudendal blks 11/2012, did help, less deep vag pain
Potter MRI 04/2012 - Scar tissue/thickening at SS/ST, scar in Alcock canal -bilateral,
Hibner 6/12 suggests Botox (didnt do), 8/12 more pelvic PT w/ dry needling
Gabapentin 1800 mg, Lyrica 200 mg, 5mg valium, vicodin as needed
Trying to get rid of central sensitization burning pain in my legs, Valium seems to be helping
Looking into more mindfulness options. . . . .
Re: any benefit to nerve block at alcock canal location?
None of the blocks helped me. My impression is, after reading the PN sites for a while, that they rarely fix anything...
Re: any benefit to nerve block at alcock canal location?
One of the reasons Dr. Hibner uses CT guided block into Alcock's canal is to differientiate between pain coming from the posterior femoral cutaneous nerve (which could also accidentally be blocked during a block at the ishcial spine) and strictly the pudnedal nerve. If all pain is gone at Alcock's canal one can be more assured that pain is coming from pudendal nerve. You can read more in his article here http://tinyurl.com/3vs8y9v
Some believe that pain at the ischial tuberosity comes from the posterior femoral cutaneous and not the pudendal, but some patients have had pudendal decompression and their ischial tuberosity pain goes away or greatly improves so I think "sit bone" pain is still somewhat of a mystery as it could be caused by several different things.
I think it is likely that now that your vaginal pain is minimized you are more aware of the ischial tuberosity pain. But it is possible the block irritated the posterior femoral cutaneous nerve somehow. Did you have any numbing down the back of your leg after your pudendal blocks? If so the PFC nerve could have also been blocked and therefore irritated during the procedure. Is is possible that the block into alcock's might help with the ischial tuberosity pain (especially if it is medial to the ishcial tuberosity), but I haven't heard of very many people reporting improved pain at that level.
IT is very encouraging that the blocks have helped your pain. If it were me I probably would wait for the block into Alcock's until after the Potter MRI. If the MRI confirms pudendal entrapement and doesn't mention anything about posterior femoral cutaneous/inferior cluneal then in my opinion there is no need for the block as it is unlikely to cure your pain at this point. I think blocks have risk involved and there is no need to take that risk especially if you are considering surgery after your MRI.
Hope this helps a little.
Some believe that pain at the ischial tuberosity comes from the posterior femoral cutaneous and not the pudendal, but some patients have had pudendal decompression and their ischial tuberosity pain goes away or greatly improves so I think "sit bone" pain is still somewhat of a mystery as it could be caused by several different things.
I think it is likely that now that your vaginal pain is minimized you are more aware of the ischial tuberosity pain. But it is possible the block irritated the posterior femoral cutaneous nerve somehow. Did you have any numbing down the back of your leg after your pudendal blocks? If so the PFC nerve could have also been blocked and therefore irritated during the procedure. Is is possible that the block into alcock's might help with the ischial tuberosity pain (especially if it is medial to the ishcial tuberosity), but I haven't heard of very many people reporting improved pain at that level.
IT is very encouraging that the blocks have helped your pain. If it were me I probably would wait for the block into Alcock's until after the Potter MRI. If the MRI confirms pudendal entrapement and doesn't mention anything about posterior femoral cutaneous/inferior cluneal then in my opinion there is no need for the block as it is unlikely to cure your pain at this point. I think blocks have risk involved and there is no need to take that risk especially if you are considering surgery after your MRI.
Hope this helps a little.
-11/08 vulvodynia began around conception of first & only pregnancy
-3/10 sacral/sitting pain began after SIJD manipulation
-Progressive widespread pain- central sensitization
-PT, meds, injections, botox, ESWT = debilitated.
-5/12 Potter MRI - scarring of left ST, coccygeous & posterior alcock
-12/12 - left FAI/labral hip tear surgery
2014-2019 managed w/ gabapentin, massage, and lifestyle mod
2020 - big flare up
www.thepurposeofpain.blogspot.com
-3/10 sacral/sitting pain began after SIJD manipulation
-Progressive widespread pain- central sensitization
-PT, meds, injections, botox, ESWT = debilitated.
-5/12 Potter MRI - scarring of left ST, coccygeous & posterior alcock
-12/12 - left FAI/labral hip tear surgery
2014-2019 managed w/ gabapentin, massage, and lifestyle mod
2020 - big flare up
www.thepurposeofpain.blogspot.com
Re: any benefit to nerve block at alcock canal location?
Thanks Faith, I will read that article by Hibner. I see what you are saying, and perhaps waiting until after the MRI is good advice. I only went ahead with the 2nd one after 4 weeks to get it in last years medical expenses.... otherwise I probably would have waited a little longer.
I wonder if people that do get any kind of positive results from the blocks bother to post here? I do sense very negative feelings about the blocks, yet it is a diagnostic tool, and the physicans that administer them sure don't seem to advise patients about the low probability of any kind of long term pain relief. I know the doctor that did mine knew very little, and assured me he has had very good results, but he has only done 4, and two of them were mine. He has never done one at the Alcock location, so I'm nervous about that, but it is CT guided, and he is an excellent interventional radiologist. Your average pain clinic doctors that administer these blocks also are not PN doctors, they just do the block (usually with fluro), and don't really treat the whole problem. So, yes I think I will wait, and see what Potter says.
Thanks.. debbie
I wonder if people that do get any kind of positive results from the blocks bother to post here? I do sense very negative feelings about the blocks, yet it is a diagnostic tool, and the physicans that administer them sure don't seem to advise patients about the low probability of any kind of long term pain relief. I know the doctor that did mine knew very little, and assured me he has had very good results, but he has only done 4, and two of them were mine. He has never done one at the Alcock location, so I'm nervous about that, but it is CT guided, and he is an excellent interventional radiologist. Your average pain clinic doctors that administer these blocks also are not PN doctors, they just do the block (usually with fluro), and don't really treat the whole problem. So, yes I think I will wait, and see what Potter says.
Thanks.. debbie
Vag pain, leg burning 3/11, SIJ inj 7/11, Pelvic PT, Chiro/acupuncture,
2-CT pudendal blks 11/2012, did help, less deep vag pain
Potter MRI 04/2012 - Scar tissue/thickening at SS/ST, scar in Alcock canal -bilateral,
Hibner 6/12 suggests Botox (didnt do), 8/12 more pelvic PT w/ dry needling
Gabapentin 1800 mg, Lyrica 200 mg, 5mg valium, vicodin as needed
Trying to get rid of central sensitization burning pain in my legs, Valium seems to be helping
Looking into more mindfulness options. . . . .
2-CT pudendal blks 11/2012, did help, less deep vag pain
Potter MRI 04/2012 - Scar tissue/thickening at SS/ST, scar in Alcock canal -bilateral,
Hibner 6/12 suggests Botox (didnt do), 8/12 more pelvic PT w/ dry needling
Gabapentin 1800 mg, Lyrica 200 mg, 5mg valium, vicodin as needed
Trying to get rid of central sensitization burning pain in my legs, Valium seems to be helping
Looking into more mindfulness options. . . . .
Re: any benefit to nerve block at alcock canal location?
Hi, Debbie.
I have had 2 blocks so far and the second one helped me more than the first. I am doing poorly again and have my 3rd Alcock canal block in 1 1/2 weeks. I am glad I went through the blocks for diagnostic reasons as well as for some pain relief. Other docs make you jump through a bunch of hoops before doing the blocks, and now I have a firm diagnosis to work with, whether I pursue surgery or Botox or more PT?
I am looking forward to my next block and I will definitely let you know how it goes!
I had a 3-T MRI with the Potter technique (however not by Dr Potter herself) and it came back "normal", so I'm not sure how much help that was for me as there is definitely some sort of entrapment somewhere that is surely not normal. Having her read it might be more useful but it makes me wonder if it is really possible to diagnosis this through imaging.
MNMom
I have had 2 blocks so far and the second one helped me more than the first. I am doing poorly again and have my 3rd Alcock canal block in 1 1/2 weeks. I am glad I went through the blocks for diagnostic reasons as well as for some pain relief. Other docs make you jump through a bunch of hoops before doing the blocks, and now I have a firm diagnosis to work with, whether I pursue surgery or Botox or more PT?
I am looking forward to my next block and I will definitely let you know how it goes!
I had a 3-T MRI with the Potter technique (however not by Dr Potter herself) and it came back "normal", so I'm not sure how much help that was for me as there is definitely some sort of entrapment somewhere that is surely not normal. Having her read it might be more useful but it makes me wonder if it is really possible to diagnosis this through imaging.
MNMom
Re: any benefit to nerve block at alcock canal location?
Helo all,
I am gettinga block to the pudendal at alcokcs and am very nervous.
I have had botox with hibnerm adn a few dorsal clitoral nerve blocks under aneastethia with little or no relief.
so hibner wants to do this one.
How does a PN block at alcocks help clitoral sharp pain and that up into the urogenital triangle. sharp stiinging all the time cannot sit.
Will I be in pain afterwards or worse---I m sick thining about it/
any info or advice on what to expect or this block for my area of problen.
thaks
lexie
I am gettinga block to the pudendal at alcokcs and am very nervous.
I have had botox with hibnerm adn a few dorsal clitoral nerve blocks under aneastethia with little or no relief.
so hibner wants to do this one.
How does a PN block at alcocks help clitoral sharp pain and that up into the urogenital triangle. sharp stiinging all the time cannot sit.
Will I be in pain afterwards or worse---I m sick thining about it/
any info or advice on what to expect or this block for my area of problen.
thaks
lexie
Re: any benefit to nerve block at alcock canal location?
Lexie, it's hard to predict how you will respond to an alcock's canal block. Some people get temporary relief and then a flare-up when the steroid kicks in, some people get several weeks of relief. You should ask Dr. Hibner what percentage of his patients get any permanent relief from it.
Just as important as getting relief though, is that the results of your block can help in the diagnosis as to whether it's your pudendal nerve that is the culprit in your pain. Since the clitoris is innervated partially by a branch of the pudendal nerve, if the block is successful that can indicate pudendal nerve involvement in what's causing your pain.
Good luck with the block. Let us know how it goes for you -- I've been following your story for a long time and would love to hear some good news, finally!
Violet
Just as important as getting relief though, is that the results of your block can help in the diagnosis as to whether it's your pudendal nerve that is the culprit in your pain. Since the clitoris is innervated partially by a branch of the pudendal nerve, if the block is successful that can indicate pudendal nerve involvement in what's causing your pain.
Good luck with the block. Let us know how it goes for you -- I've been following your story for a long time and would love to hear some good news, finally!
Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
Re: any benefit to nerve block at alcock canal location?
Hello violet I am here in Phoenix and getting this done tomorrow morning.
Ove the past few weeks the sharp pain and stinging pain now only comes on after I pass a bowel movment. No pain or problen rectally at all.
It seems that once I have a bowel movment I am fine and then a few minutes later the sharp knife like and stining in the clitoral area.
so i think...........the slight stretching or the sensaton of the bowel movemnt is stretching the nerve higher up, other wise I can soemtinmes deal with it. but its the panic that sets in knowing something is wrong---an entrpament? will I get worse? then what do I do etc?
anway I must sign off now I am here in the hotel in phoenix and I am up at 7am for a 9am procedure.
will let you know.
thanks
lexie
Ove the past few weeks the sharp pain and stinging pain now only comes on after I pass a bowel movment. No pain or problen rectally at all.
It seems that once I have a bowel movment I am fine and then a few minutes later the sharp knife like and stining in the clitoral area.
so i think...........the slight stretching or the sensaton of the bowel movemnt is stretching the nerve higher up, other wise I can soemtinmes deal with it. but its the panic that sets in knowing something is wrong---an entrpament? will I get worse? then what do I do etc?
anway I must sign off now I am here in the hotel in phoenix and I am up at 7am for a 9am procedure.
will let you know.
thanks
lexie
Re: any benefit to nerve block at alcock canal location?
Hey Lexie,
How are you? Hope all went well with your procedure.
Violet
How are you? Hope all went well with your procedure.
Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
Re: any benefit to nerve block at alcock canal location?
Violet,
the procedure was very easy but I dont think it made any difference. After the block I was sitting in the bed in the recovery room and I felt the sharp severe stining in the place that seems to be hard to find.
I did get numb but it does not seem to get close enough the clitoral area and the deep stining area close to urogenital etc --hard to explain.
In some ways it felt like it did help a little and I htink when I passed stool while numb I did not get the severe sharp stinging in the clitoral area until the next day when the numbness wore off then I passes stool again---low and belhold major sever stining and sharp pain going up toward the clitoris.
Nopain meds are helping. the nurse said give it 3-5 day for the steroids to kick in well here I am today 3days in and I went to th bathroom again and then sat down afterwards. i thught i was going to pass out ehen I got off the train on a 30 min sitting. OMG. I know I have a major problem. I never got to see dr. hibner the whole 9 months I have been here. only his help Dr. castllanos and messages going back and forth to hobner.
I have had, botox by hibner, clitoral nerve blcok Dr.C, illioingul nerve block. dr. c-, genitofemoral nerve block, Dr. c and now this pudendal block to the alcokcs canal by a radiologist. I got some releif when numb cos I could sit with no pain but I did get some shapr pain while wiping myself at the clitoris so the block helped a little but it just seems all the blocks I have had just dont get to the 2 areas at all, none o them I can say --YES you got the spot. I feel if I got it in the right sot on the right nerve I would know it for sure. I regret no seeing hibner, but no meds are giving me relief. I cannot go the bathroom at all without this severe sharp stinging like glass somewhere deep at the vaginal opening up towrd the urogenitaltrainglea reas and then now up toward thec clitoris. I am on mirialx stool softner and even with soft sttol after passing it a minute or so later the stining and ahrp pain. its not in my rectal area at all nothing its all in the area to the side of the clitoris lower toward vaginal openng. I got this same pain the day I came out othe hopstial after my hysterectomy I thought I would collapse sitting in bed with the same pain, same location exaclty the same plus clitoral now which is new. I think its from the hysterectomy laproscopically done with no vaginal work done at all -it was all through the abdomen. Ae there any tablets that would just take this pain away and stining every time i go to the bathroom i dread going even peeing at at times makes this bad. Holding my pee in casue this to flare. I have tried, Neurontin, gabapentin, lyrica---vicodin--nothing. I would be happy just to find a drug to make this go away cos right now every day I get up----I dread everyday of my life now Violet. Dr. WEiss has suggested I see a pain managment dr. here in Redwood city ca dr. Wycoski but the cost is nealry $400 for first visit and nealry $300 for a follow up not to mention what he may prescribe in drugs. He does not take medicare and I have no drug coverage now on my disabiliy, I got rid of it when I left the usa a while ago.--do yu know of any drugs that would take the nerve pain stinging and sharpness. I must ahave an entrapment but which nerve who knows now---clitoral branch? pudendal? I nevr thought this would come back on me on a side I had no problems really to this extnt.--any pain tabs suggestions would at least give me the incentive to wake up ech day in no pain like glass cutting through me. its hell. i cannot pee, poop or sit.---give me a drug so I dont feel this nightmare anymore..----Dr. HObner without seeing me at all going by my feeback thinks I have a severly irritated nerve and he suggested this pudendal block. the area is hard to get to only i can show anyone and its not reached vagianlly only p by pressure around hte vulva area and it shoots right up into the clitoris sharp and just awful. Lying down now I have it too shooting up into the clitoris but starting from lower down.--anywya I must go as I am very depressed with the whole thing now Violet. Sorry for all the typos I dont haveit in me to back through all this and change them sorry--i guess I just dont care right now to be honest you kow---any info from anyone would be great and very much appreciated and most greatful to anyone who reads this.---love lexie
the procedure was very easy but I dont think it made any difference. After the block I was sitting in the bed in the recovery room and I felt the sharp severe stining in the place that seems to be hard to find.
I did get numb but it does not seem to get close enough the clitoral area and the deep stining area close to urogenital etc --hard to explain.
In some ways it felt like it did help a little and I htink when I passed stool while numb I did not get the severe sharp stinging in the clitoral area until the next day when the numbness wore off then I passes stool again---low and belhold major sever stining and sharp pain going up toward the clitoris.
Nopain meds are helping. the nurse said give it 3-5 day for the steroids to kick in well here I am today 3days in and I went to th bathroom again and then sat down afterwards. i thught i was going to pass out ehen I got off the train on a 30 min sitting. OMG. I know I have a major problem. I never got to see dr. hibner the whole 9 months I have been here. only his help Dr. castllanos and messages going back and forth to hobner.
I have had, botox by hibner, clitoral nerve blcok Dr.C, illioingul nerve block. dr. c-, genitofemoral nerve block, Dr. c and now this pudendal block to the alcokcs canal by a radiologist. I got some releif when numb cos I could sit with no pain but I did get some shapr pain while wiping myself at the clitoris so the block helped a little but it just seems all the blocks I have had just dont get to the 2 areas at all, none o them I can say --YES you got the spot. I feel if I got it in the right sot on the right nerve I would know it for sure. I regret no seeing hibner, but no meds are giving me relief. I cannot go the bathroom at all without this severe sharp stinging like glass somewhere deep at the vaginal opening up towrd the urogenitaltrainglea reas and then now up toward thec clitoris. I am on mirialx stool softner and even with soft sttol after passing it a minute or so later the stining and ahrp pain. its not in my rectal area at all nothing its all in the area to the side of the clitoris lower toward vaginal openng. I got this same pain the day I came out othe hopstial after my hysterectomy I thought I would collapse sitting in bed with the same pain, same location exaclty the same plus clitoral now which is new. I think its from the hysterectomy laproscopically done with no vaginal work done at all -it was all through the abdomen. Ae there any tablets that would just take this pain away and stining every time i go to the bathroom i dread going even peeing at at times makes this bad. Holding my pee in casue this to flare. I have tried, Neurontin, gabapentin, lyrica---vicodin--nothing. I would be happy just to find a drug to make this go away cos right now every day I get up----I dread everyday of my life now Violet. Dr. WEiss has suggested I see a pain managment dr. here in Redwood city ca dr. Wycoski but the cost is nealry $400 for first visit and nealry $300 for a follow up not to mention what he may prescribe in drugs. He does not take medicare and I have no drug coverage now on my disabiliy, I got rid of it when I left the usa a while ago.--do yu know of any drugs that would take the nerve pain stinging and sharpness. I must ahave an entrapment but which nerve who knows now---clitoral branch? pudendal? I nevr thought this would come back on me on a side I had no problems really to this extnt.--any pain tabs suggestions would at least give me the incentive to wake up ech day in no pain like glass cutting through me. its hell. i cannot pee, poop or sit.---give me a drug so I dont feel this nightmare anymore..----Dr. HObner without seeing me at all going by my feeback thinks I have a severly irritated nerve and he suggested this pudendal block. the area is hard to get to only i can show anyone and its not reached vagianlly only p by pressure around hte vulva area and it shoots right up into the clitoris sharp and just awful. Lying down now I have it too shooting up into the clitoris but starting from lower down.--anywya I must go as I am very depressed with the whole thing now Violet. Sorry for all the typos I dont haveit in me to back through all this and change them sorry--i guess I just dont care right now to be honest you kow---any info from anyone would be great and very much appreciated and most greatful to anyone who reads this.---love lexie