Health Organization for Pudendal Education

My dr. is going to try to get my insurance to cover botox injections into my obturator internus and levator ani muscles. Any advice or thoughts would be appreciated. I just had two trigger point injections last week in the psoas and q lumbaris?? no change...actually made the pain worse.
is botox a good idea? she said I would be put totally under and that it would be painful...she mentioned a few possible risks, and said she cannot say if it will work or not....but that this is the last trick up her sleeve. My PT seemed glad this was going to be done...I just feel like I am on this endless cycle of doctors, meds, procedures and nothing has helped....can't take it anymore..but no where to run. I guess I will try anything...but am nervous and concerned since the last injections made me have more pain than before.

I had botox into my piriformis muscle (just rh side, which is the worst one) and I have to say it is the only thing that has worked, even though it didn't work completely (nerve still trapped in scar tissue I think) but the effect lasted for about 3 months. I had the other side as a comparison so when that side tightened up ridiculously I really knew that the botox was working as that worst side would have been absolutely dreadful at that stage, and it wasn't.
I'd had some steroid shot into both muscles previously and they hadn't worked at all.
This process is diagnostic as well as used as a treatment. I must say that I haven't had any cause to regret having botox and would get my other side done if I EVER get my NHS referral sorted out.
A few have said that having too many injections could cause scar tissue, I'm not sure about that one, maybe, but I can't see 1 doing too much harm. I have also heard of someone who has had many botox shots and the process has been very therapeutic for them.
The only other thing I can say is that it hurt like hell!! which kinda proved that my P muscle is spasmed/scarred/weird?? Fine through the skin and glute (so brave ) but as soon as it hit my P muscle WOW!! I almost levitated!
Maybe it's a good plan to be sedated, but I wasn't given that option.
Good luck with whatever you decide, it is a tricky one as there are a very few stories where people have been worse off afterwards. Thankfully that is usually short lived.
take care.
Helen

I had botox into my obturator internus and levator ani and it made me much worse. I think maybe because I have sacroiliac joint dysfunction so the botox knocked out muscles that were stabilizing my SI joint causing my quadratus lumborum and hamstrings to spasm. It also greatly incrased my ischial tuberosity area pain. I am of course not a fan of botox after my experience, but even if this hadn't happened I think that you have to really think about the whole pelvis and not just the pelvic floor. Botox works to relax smooth muscles, but the pelvic floor tightness might not be the pain generator...it just might be a symptom of the pain. I think a lot of docotrs who offer botox need to stop, look at the patient's history/syptoms, and ask "what am I trying to accomplish here" because in reality botox cures very few people, if any. Most people have to continue getting the botox every 3-4 months (if it even helps) and that's because the botox is just treating a symptom not the cause of the pain. Not to mention it is ridiculously expensive and very difficult to get insurance companies to pay for it because it is still considered expirmental for the pelvic floor.

I don't know your history or where your pain is exactly, but because they did trigger points in your quadratus lumborum and psoas it is likely you have multiple issues going on (such as a labral hip tear or SIJD in addition to PN) or that those other issues are the cause of your PN. Did the TP injectiosn make the pain in your pelvic floor worse or the pain in your psoas/quadratus lumborum worse? If you have SIJD or a labral hip tear it makes sense why these TP injections made you worse because those muscles are working to stabilize the hip/SI joint so injecting a spasmed/painful muscle like that often will only irritate it more. I encourage you to think through your pain (and share more about your situation if you would like) and even ask your doctor what he/she is really trying to accomplish with the botox. If you have known SIJD I would reccommend not to get the botox because it will not help your situation.

I had botox for levitor ani muscle spasms and it stopped the spasms. I was put under and do not remember any pain. Insurance would not pay but because I think It was in network I did not pay and the hospital had to get a special letter from ins to stop hounding me. Good luck
Janet

hey:).. so far did any one of you guys achieve a good result from injections?

Injections... what is it suppose to do? stop the pain altogether? or few targetted regions? and if it works does it affect sexual function?

Hopefully they should stop a muscle from being in spasm as Janet said. The idea being that the muscle will stay relaxed. Although that may take more than one shot sometimes.
Can't comment about sexual function as mine was further up.
Helen