Health Organization for Pudendal Education

I went to the doctor today and he is going to do an injection into the levator ani muscle possibly tomorrow. Can anyone tell me what to expect?
I have perineum pain and the hyper arrousal thing plus some pain in my rectum like something is in there. My muscles are always tight. do you think this will help? or hurt the situation?

Any information is welcome. My other choice is to get a 2nd Prudendal nerve block or nerve ablation

Sue

Do you know what drug will be injected into the muscle? Is it guided by ultrasound or done by sight alone? What kind of doctor is doing it?

I'm asking these questions because I'm also interested in trying the procedure. Dr. Andrews found a "trigger point" on my pelvic floor which, when pressed, referred severe pain into my lower left abdomen. But Dr. A. doesn't do trigger point injections.

I have had botox injections to the pelvic floor muscles. I flare terrible for a few days then about 7-10 days later I can tell the difference. Usually lasts for me 8-12 weeks and then it wears off. The botox has finally allowed me to do pelvic floor PT because before all the trigger points were so painful it would only make me worse. After botox injections I can manage to have PT work on my tight muscles. I also have had bupivacaine injections to the pelvic floor but they don't work as well for me. The botox has been done by Dr. Hibner.

I will find out today what is being injected but it isn't botox as it would have to be approved by my insurance.
My pelvic floor muscles are tight also and I would like to feel them relaxed. It is very uncomfortable. I will let you all know when I get back from Cleveland clinic today. I really don't have much hope that it will help but I have to try.

Thanks
sue

So a lidocaine/bupivacaine trigger point injection is only diagnostic (for short term relief, typically only hours), whereas a botox injection is therapeutic (lasting weeks, in order to allow PT)? And I gather that the first course of action would be to inject the lidocaine to see if the trigger point is the true source of pain?

Nyt, Is the post-botox PT work on your pelvic floor showing some improvement in your pain levels? Does your PT think that she's making some progress in working out the trigger points? How many trigger points in your pelvic floor do you have?

Sue, good luck today with your injection and please let us know how it goes!

Lernica wrote: Dr. Andrews found a "trigger point" on my pelvic floor which, when pressed, referred severe pain into my lower left abdomen. But Dr. A. doesn't do trigger point injections.

Did he say what muscle exactly has the trigger point? Levator Ani? The Levator Ani is made up of three muscles: pubococcygeous, iliococcygeous, and puborectalis. I like Amy Stein's picture of the female pelvic floor found here http://tinyurl.com/7xjyrwm She also explains which muscles are innervated by what nerves. Since the pain is referred to the lower left abdomen it makes me wonder about the psoas muscle. But I'm not quite sure which pelvic floor muscle would refer pain there.

Lernica wrote:So a lidocaine/bupivacaine trigger point injection is only diagnostic (for short term relief, typically only hours), whereas a botox injection is therapeutic (lasting weeks, in order to allow PT)? And I gather that the first course of action would be to inject the lidocaine to see if the trigger point is the true source of pain?

Yes, I've had both trigger point injections which bupivacaine and botox. The bupivicaine lasts only a couple of hours. My doctors does them before PT to help if a person cannot tolerate PT. I flared with both types of injections and am significantly worse post-botox. It will forever be a mystery to me. Good pelvic floor PT might help the trigger point more than injections in my opinoin. If you just can't tolerate the PT then try a trigger point injection with bupivicane. This trigger point however could be related to your labral hip tear though, you think?

Thanks, Faith. Good diagrams!

Dr. A. couldn't tell which muscle(s) he was hitting during his rectal exam (he doesn't do vaginal exams as he's not qualified by his chiropractor's licence to do so). But whichever muscle he hit hurt like hell (still does). Yes, it's the same side as my tight psoas muscle AND a labral hip tear. (Actually, my hip surgeon has now told me that I have a labral hip tear in both hips (lucky me), one worse than the other.) And it's the same side where I experience pain when having a BM.

I'm gonna try PT again after abandoning it last year because of pain flares. I'm extremely reluctant to do so because of the pain flares. That's why I'm also thinking about injections.

Interesting that even the lidocaine injection caused a flare with you. Are you sure it wasn't the PT (post-injection) that caused the flare?

Unfortunately the pelvic PTs in Toronto aren't qualified to do injections, and they don't work in comprehensive pain clinics where the doctors are. Instead, they tend to work in stand-alone sports clinics. So I do not have the option of doing an injection followed by PT. It's either one or the other, or both, but on different days.

Lernica wrote:.
I'm gonna try PT again after abandoning it last year because of pain flares. I'm extremely reluctant to do so because of the pain flares. That's why I'm also thinking about injections.

Possible, but I think it was the injection because I've had tons of PT without that kind of flare. The actual injections hurt me. I think maybe the nurse practitioner made a mistake because I bled a lot afterwards and felt a sharp prick during one of the trigger point injections. Some people say they don't feel them though. I just don't like needles being put in my vagina area anymore

I understand your hesitation about doing PT again. If I can get my SI joint to stay in alignment then I've thought about trying it again, but since PT is what caused most of my pain I'm hesitant too!

If you find a doc who does bupivicaine injections maybe you can get them and then a couple hours later go to PT...the effect should last awhile.

When will you have your hip surgery? if that is the cause of your pelvic floor trigger points then doing PT and have injections is just a temporary fix. Maybe you should wait till after you have your surgery?

Faith wrote:

1. If you find a doc who does bupivicaine injections maybe you can get them and then a couple hours later go to PT...the effect should last awhile.

2. When will you have your hip surgery? if that is the cause of your pelvic floor trigger points then doing PT and have injections is just a temporary fix. Maybe you should wait till after you have your surgery?

1. Good idea, Faith, except it's the post-treatment flare that I'm mostly concerned about. (Having survived shockwave therapy I think I can take the pain of the actual PT!) And the bpv injection won't last a whole week (which is the typical pain flare period post-PT for me).

2.I'm on the waiting list for the hip surgery so it won't happen before June! And most of my remaining pain (i.e. the pelvic floor trigger point) is on the opposite side, namely, the left side. I really want to get that pain under control/out of the way before the hip surgery, otherwise I'll be in a lot of pain on both sides during my post-op recovery (4 - 6 months, conservatively estimated).

I had my injection done yesterday into the Levator ani muscle trigger point. It was Marcaine and Kenalog. It wasn't bad yesterday but it seems to be short lived unless something happens from the kenalog. The doc said that I can't get another one until 3 months. So if it didn't work then I am out of luck for awhile. The next thing they are talking aobut is something with radio frequency ablation of the Prudendal. Anyone have any information on this??
the PGAD is back. And it is my most troubling symptom.
Thanks for the encouragement during this time

Sue