Health Organization for Pudendal Education

Hello people,

I’m looking for a little help concerning the connection between pudendal/pelvic floor disorders and hip pathologies.

My PN specialist and my sports doctor here in France are telling me that my PN pain cannot be caused by a hip pathology. I have a prescription for an arthogram but don’t know if there is any point going through with it. My pain concerns mainly the anus, penis, colon and perineum. I also suffer from lower back pain (the sacrum) which can go into the buttocks and even down the path of the sciatic. I have some hip pain, but not really enough to remark upon without reading the posts on this site concerning labral tears etc.

Can anyone help me out a little? I have the feeling that the US PN specialists are a little more open-minded on this and other issues? Perhaps I am wrong. Is it worth pursuing?

Also, is there any proof that one can wait too long before having surgery and that the nerve will never recover? My pain, although it stops me sitting, having much sex, thinking too far into the future and generally leading what might be called a "normal" life, rarely goes over the 3 or 4 mark on the pain scale. Is there an argument for living with the damn thing?
Love and respect,
Al
x

Hi Al,

alexm wrote: I have some hip pain, but not really enough to remark upon without reading the posts on this site concerning labral tears etc.

It sounds as though you've already read the informative thread currently going on regarding this topic:
http://www.pudendalhope.info/forum/view ... f=9&t=3487
There does seem to be an undeniable connection for some people with hip pathology and pelvic pain.
I do think the arthogram is worth pursuing. It may not explain or solve all of your symptoms, but at least it's something you could either rule out or confirm.

alexm wrote:I have the feeling that the US PN specialists are a little more open-minded on this and other issues?

Questionable. There's also some excellent advice in that thread, explaining the value of not getting into the details of your PN symptoms.

alexm wrote:Also, is there any proof that one can wait too long before having surgery and that the nerve will never recover?

Good question. I don't know if there's any proof out there. I do know that some PN surgeons believe it's better to address the entrapment as quickly as possible. But it really depends on the individuals pathology.

alexm wrote: Is there an argument for living with the damn thing?

Well, not as far as I'm concerned. Others may feel differently. It truly is up to you to determine what you can live with, and what you can't.
Hugs,
Karyn

I would agree with Karyn and get the arthogram, if only to rule that pathology out (or in of course)
I also get hip pain but put that down to piriformis spasm, as that is where that muscle inserts. I only get hip pain if I have a more intense piriformis pain and don't get hip pain alone as one might expect if it was a primary symptom (I could be wrong there)
Have you tried any cognitive therapy at all? It can help deal with pain at any stage but again as Karyn said , living with PN or opting for surgery can only ever be an individual decision.
Take care
Helen

Alex,

Please make sure you read the entire thread referenced above. You'll get a lot of good information there. My symptoms -- sacrum pain, buttock pain, pain down the leg, minimal hip pain -- were the same as yours prior to my hip surgery and now they're gone, as well as my PN. There is a fair amount of literature linking hip pathology and pelvic pain, but as detailed in the other thread, I wouldn't waste my time trying to talk your doctors into it. Here's just one example:


“Unique in women is the possible concomitant pelvic-floor pain that may occur in association with labral tears, hip impingement, dysplasia, and early and late arthritis. Because these hip disorders are more common in women, a thorough history should include the discussion of pelvic-floor symptoms. The obturator internus is considered one of the primary musculature sources of pelvic-floor pain that often presents with the complaint of deep vaginal pain. Because the obturator internus is a primary hip rotator, a hip-related cause of pelvic pain should be considered in the differential diagnosis when the pain is determined to be originating from this muscle and when other causes have been excluded.”

Hunt, Clohisy and Prather, Acetabular Labral Tears of the Hip in Women, Phys Med Rehabil Clin N Am 18 (2007) 497 - 520, at 503.

Get the arthrogram and then decide whether or not the connection is worth pursuing in your case. Arthroscopic hip surgery is a lot easier than PN surgery.

Thanks so much for all your help. Keep it coming!
One more question: is there any argument for doing the arthogram on one side before the other. I have heard that they cannot do both at the same time. For example, I have more pain on the left so should I start with a left side arthogram?
Thanks again,
Al
x

helenlegs 11 wrote: I only get hip pain if I have a more intense piriformis pain and don't get hip pain alone as one might expect if it was a primary symptom (I could be wrong there)

Very interesting, Helen!

Excellent, response, Lernica! Thanks so much for the education, compassion and helpfullness you've brought to this community.

Kind regards,
Karyn

alexm wrote:Thanks so much for all your help. Keep it coming!
One more question: is there any argument for doing the arthogram on one side before the other. I have heard that they cannot do both at the same time. For example, I have more pain on the left so should I start with a left side arthogram?
Thanks again,
Al
x

Start with the side where the hip, buttock, groin, and leg pain is most evident (not the PN pain). I had my right hip scoped first since it was more symptomatic, even though my PN symptoms were strictly on the left side. Both my hips were eventually scoped since they both had labral tears.

My surgeon never made me get an arthrogram since my labral tears were evident with regular MRIs. Be prepared for the injection of dye into the hip joint with a needle, which some people say can be painful.

Karyn, I'm just "paying it forward" since I got so much help from this forum during my own PN journey! In fact I think it was here that I first read about the hip/PN connection. It was also here where I learned about Dr. Andrew and ESWT, from whom/which I derived a great deal of benefit and pain relief.

Thanks again Lernica for all your help. After having reread the quote in your first mail (unique in women...), am I to believe that the fact that I am a man cuts down the chances of a link between hip pathologies and PN ? Perhaps a stupid question, but I'm not too worried about that
Best
Al

alexm wrote: After having reread the quote in your first mail (unique in women...), am I to believe that the fact that I am a man cuts down the chances of a link between hip pathologies and PN ?

Perhaps Lernica can elaborate, but my impression is simply that the study was done on women. If you read the above referenced thread, there are males with hip/PN, too.

Here's a link to an article regarding hip and pelvic pain in a man: http://theneurographyinstitute.cmail2.c ... E86323F7F9

And here's a link to a study of "posterior pelvic pain" (butt pain) and hip pathology involving men and women: http://www.ncbi.nlm.nih.gov/pubmed/19769913