Health Organization for Pudendal Education

Hello Friends,
It looks like I may have symptoms of PN- pain and burning in buttocks on sitting, also foreign body sensation in rectal area, numb feeling in buttock etc- diagnosed with different conditions for past few years- lumbosacral radiculopathy, immune mediated neuropathy etc- lots of tests- including MRI of pelvis -nothing conclusive, then I started reading about PN and looks like my symptoms closely mimic it. Started seeing PT trained in pelvic floor and found very tight pelvic floor muscles and started doing manual therapy, trigger point release etc for 3- 4 sessions. Also met with a yoga instructor who got better after alignment based yoga for the same problem. I know ,it is said yoga is contraindicated so very confusing. My PT says that the muscles need to be stretched so the the nerve can start gliding. She advised squatting, stretching poses to make muscles stretch etc. She appears to be very knowledgable about PN which she thinks most likely is from tight pelvis. I don't have any history of trauma but may be prolonged sitting at work and weights. I do have appt with Dr SA for formal evaluation and he has scheduled me for possible injection the next day.

I want to know if people have benefitted from PT or not and also with Dr Wise protocol of paradoxical relaxation? Should I wait for any injections to see if PT has any beneficial effects? Has anybody seen Staphnie Pendergrast- PT in CA for this?
Any advice will be greatly appreciated as I have been suffering from this pain and burning for past 2 years.

Hello Michael,

Welcome to the forum. I'm sorry you are on this journey with us.

If you just have pelvic floor tension without an entrapment, physical therapy, paradoxical relaxation, and stretching, etc. might be helpful. If you have a nerve entrapped by scar tissue or nerve compressed between 2 ligaments, these therapies may not help and stretching and squatting could further injure the nerve. Before I knew about PNE, my PT recommended squatting and it pushed me over the edge into full-blown pudendal neuralgia. So be careful.

Stephanie Prendergast is extremely knowledgeable about pudendal neuralgia and some people do see improvement from the type of PT she recommends. She holds seminars for other PT's on how to treat this problem, including how to do internal myofascial release of the pelvic floor muscles in which the therapist stretches the muscles using a finger (via the rectum in guys). Some people don't improve with PT and may go on to have surgery. I was one of those people who didn't improve with PT and I think it's because my nerve was impinged on by ligaments. I also had pelvic misalignment from chronically strained ligaments due to weightlifting. I can see how pelvic realignment might help relieve a nerve that is compressed by sagging ligaments or other structures. But I'm not sure stretching would be the way to go about it -- there are other ways to achieve pelvic realignment. Hermajesty on the forum can probably answer any questions you have about that.

A number of people have reported on the forum that they spent a lot of money on Dr. Wise's protocol but were not helped. In 8 years of moderating the forum, I don't remember hearing of anyone who improved significantly from the protocol. Obviously reports on the forum are not scientific though.

Best,

Violet M

I would echo Violet's concern about investing in the Wise protocol. definitely type his name into the search box and see some of the patient experiences that were posted. They have not been positive. Here is one thread: http://www.pudendalhope.info/forum/view ... hilit=wise

Thank you, Violet, for your reply. Do you know how to differentiate between nerve entrapment vs strain due to tight muscles? I did have MRI neurography of pelvis and the pudendal pathway was ok

Hi Michael,
and welcome
The trouble with imaging is that it is still in its infancy. The fact that the scan showed 'nothing conclusive' may not mean that there was no problem, just that the problem could not be seen with this (or any) imaging, tight muscles for example. I do hope that this type of imaging will be more helpful in the future but at the moment if something is seen GREAT! targeted treatment has somewhere to target At the same time the fact that a clear pudendal pathway was reported is also a positive in that conservative treatments may be all that is needed. Hope so anyway
Treatment should start with a progression through, lifestyle adaptations along side medication and physiotherapy. Often this works well if the problem is a tight pelvic floor or piriformis syndrome for instance, especially if the muscles are 'simply' tight and there is no trauma onset. The earlier the treatment starts the better, there is probably a quicker resolution to this problem too if treated in a timely manner.
I say 'simply' tight, as there is probably nothing simple about it, mainly because of an often seen 'domino effect' from pelvic problems.
The cause is often elusive but physiotherapy with someone knowledgeable in PN is a great way to be evaluated (I think a tight pelvic floor should always be ruled in, or out) and then treated. The home pages say all of this better than I can and more.
As treatment is a progression through stages mentioned, you will probably get a better handle on where your problem may stem from. Many people find that these conservative treatments are all that is needed, especially if the was no particular 'traumatic' onset.
Usually strain due to tight muscles is something that can be treated and eliminated with good physiotherapy. Of course there can be tight muscles without actual strain (if you are meaning exercise, weights etc) too. Sometimes just stress can cause muscle tension of course, it depends if we hang on to that stress and muscle tension unduly.
I read a blog post by one of the pelvic rehab girls (Stephanie P or Liz R ??, I think) where they mentioned sometimes finding a tiny trigger point in a muscle that felt like a lentil. They then use myofascial release on these trigger points to ease the problem. Job done well. . . . possibly needs more than one 'job done'
An actual entrapment is more likely to be due to a 'trauma', childbirth pelvic surgery, fall etc, again the home pages have it all there. It may involve scar tissue and lesions, pelvic ligaments. . .think I should stop there, just wanted to say Hi really.
Let us know what you decide to do with regard to treatment and who treats and of course the results.
Take care,
Helen

Thank you for your information. It was quite useful

michaelm wrote: Do you know how to differentiate between nerve entrapment vs strain due to tight muscles?

It's difficult. Most people try some sort of physiotherapy and other types of conservative therapies before considering the surgical nerve entrapment release route. If you just have pelvic floor tension without an entrapment the hope is that you will get some relief from myofascial release and trigger point therapy. When I tried myofascial release it set up a major pain flare-up and I turned out to be entrapped so my theory is that if you are entrapped, conservative therapies are less likely to help. I don't know of any published studies that verify the theory though.

Violet