Health Organization for Pudendal Education

How can you know which one is the real cause of pudendal pain?

I took Carisoprodol (Soma) and Cyclobenzaprine (Flexeril) and it seems to alleviate my pain.
since it is a muscle relaxer could it be used as a diagnose to indicate the difference between then (Pelvic floor tightness vs Entrapment)?


Another question, in people who had TG surgery and ligaments cut
is it possible to Sacrotuberous ligament become thick and entrap the nerve again?

thank u all

Hello Alex,

Some of the docs transpose the nerve to a new location during TG surgery so that it cannot become entrapped by the ST ligament again but I don't know if your physician did. It still would be possible to get entrapped in scar tissue though.

I don't know of any established protocol to tell with 100% certainty whether you just have pelvic floor tension or a nerve entrapment. Some of the docs will try Botox before surgery to see if that will relax the pelvic floor and relieve pain without having to do nerve release surgery. Taking an oral muscle relaxer would have a similar purpose and so would myofascial release of the pelvic floor. So you could try all of those things and see if they work. But currently, I don't know of any diagnostic tool that can tell you for certain whether you are entrapped or not.

Violet

The newer thinking on (almost?) any non life saving surgery to alleviate painful problems, seems to be 'don't do it' in the UK. They are using a cognitive with physio and exercise approach. The reasoning is exactly as you have suggested scar tissue from the surgery can cause as many problems as it addresses. I am NOT saying that I totally believe this should be the only approach btw. After a successful back op microdiscectomy at S1/L5 I am testament to surgical procedures being a triumph, I wouldn't have been able to get by without it, no doubt there!
I am about to have my first pain management appointment in half an hour so see how well they get the pudendal problem. Hopefully I will be happily surprised by their excellent open attitude to a 'rare' problem
Take care,
Helen

Violet M wrote:Hello Alex,

Some of the docs transpose the nerve to a new location during TG surgery so that it cannot become entrapped by the ST ligament again but I don't know if your physician did.

yes he did

Violet M wrote: It still would be possible to get entrapped in scar tissue though.

scartissue from ligaments cut?

i'm feeling a tightness in the back of my sacrum down to ischial tuberosity (both sides)
when i lay down in the fetal position

i'm not sure if it is tightness in ligaments(ST) or coccygeus muscle (when i do kegels the tightness becomes worse)

i've read the pudendal passes between piriformis and coccygeus

There are most likely other tissues cut besides just ligaments -- my guess is they entered the alcock's canal too? Some of the docs will cut fascia that might be tethering the nerve, some even cut away part of the obturator internus muscle if it is enlarged. In the TG the glutes are cut also -- maybe that is causing some of your tightness.

Violet

Violet


As far as i know only my ligaments ST/SP were cut,
but Prof. Robert also cutted some of the branches of internal
obturator nerves, then internal obturator muscle is not innervated anymore, so it can't
contract i guess.

when u say alcook canal, u mean something related to obturator internus ??


thanks

Alex, alcock's canal runs between the levator ani and the obturator internus muscles. Some people have an enlarged obturator internus muscle so even if it can't contract it might impinge on a nerve but my guess is, Dr. Robert would have addressed that issue.

But it seems like as you said, scar tissue could cause tightness too. Maybe some post-surgery PT would help.

Violet