Health Organization for Pudendal Education

So here is the scoop. I went to a Physicial Medicine and Rehabilation Doc who also was a D.O. (PS if you don't already know DOs in the USA have the same training as MDs, plus the OMT portion they get in Europe) I told him of my symptoms and he immediately thought of pudendal neuropathy associated with some type of pelvic floor dysfunction whether muscle, myofascial, or ligament related. I was amazed first doctor I have been to that I did not have to educate him. After a full typlical evaluation and an Osteopathic evaluation, he said I have you ever had hip pain. And of course I said yes, and told him of an injury I had to my hip about a year !/2 before my PN pain started. He then told me what hip without me pointing it out and then went on to tell me exactly the areas of my PN pain. When he asked if he was right.... I was amazed and said yes! We then went into an adjacent room were he had ultrasound setup. We first looked at my hip, which is screwed and will require surgery. Then we examined the muscles of the pelvic floor and the SS and ST ligaments and Obturator and such. He even pointed out my Pudendal Nerve, which he says is being compressed by my muscles. He said that my pelvic floor is working overtime as well as my right hip and butt muscles to support my bad hip. (By the way, my bad hip doesn't bother me nearly as much as the PN pain) He suggested that I need to definitely look at Arthroscopic procedures for my hip, because it is going to be difficult to treat the PN without it being fixed. When asked how we would treat the PN, he said that he uses Hydrodissection/Hydrodistension with great success and that he has treated PN with it before.

So, of course I have been researching it. It seems that there is a theory that when infiltrations or injections are helpful to patients it may not be do to the pharmaceutical effect of the injection, but the volume of space it creates around the nerve. The space allows the nerve to heal, thus shrinking inflammation and allowing for more blood supply. Therefore, when the volume dissipates the nerve is often a more normal size and the tissue that was compressing the nerve is not as much of a hindrance. And the below is an article I have found on this topic....

itle of document / Document title
Treatment of pudendal neuralgia by hydrodistension Alcock canal: a retrospective study in 18 patients refractory to corticosteroid injections alone = Pudendal nerve neuralgia cured by percutaneous Alcock canal distension. A retrospective study of 18 boxes
Author (s) / Author (s)
Mr. Khalfallah (2) ; Gohlen B. (3) ; Begué M. (4) ; Labat DD (1) ; Laughing T. (1) ; Louppe JM (1) , Robert R. (1) ;
Affiliation (s) of author / Author (s) Affiliation (s)
(1) service Neurotrauma, CHU Nantes, Hotel-Dieu, Nantes, France
(2) Department of Neurosurgery, Centre hospitalier de la Côte Basque, F-64100 Bayonne, France
(3) Department of Radiology, Centre hospitalier de la Côte Basque, Bayonne, F-64100 Bayonne, France
(4) Functional Rehabilitation Centre Mariénia, F-64250, Cambo-les-Bains, France
Résumé / Abstract
Düring past two decades, significant progress in The Definition and The Treatment of pudendal neuralgia Have Been Observed. Entrapment 'Areas and Criteria for the clinical diagnosis (Nantes criteria) are Identified. Infiltrations are Used "during the first Therapeutic approach. The fickle and transitory effect IS. They Are Based On CT guided injection Anaesthetic steroids and Around the nerve. Local Anaesthetic block effect Is an important diagnostic test and Leads To The diagnosis of pudendal nerve entrapment. Steroids are Used, Their aim is Not Demonstrated Efficacy. The Observed improvement Might Be Related To The steroid effect and to mechanical distension induced By The injected volume. Actually, only surgery has Demonstrated real improvment Of The patients. Later this IS are based conflicts and sectioning ligaments Opening the Alcock canal. We Suggest a possible nerve release by using a percutaneous CT guided Alcock canal distension. Physiological serum IS Used in this aim. We carry a retrospective study of 18 patients Treated by Alcock's canal distension. Our first results are similar to surgical delay. Thesis data must be confirmed by a prospective study.

Hello PN VT, i have read your post and have a similar story. I have a hip labral tear with FAI and i have PN as a result, my arthroscopic surgery may be scheduled in jan 2011. I am hopeful to have the nerve decompressed after the surgery. What was the name of your doctor? did he mention that the pudendal nerve could be ok with just the surgery and without the need for hydrodissection afterwards?

I agree with his theory of the hip causing the pudendal problem...the low back structures are involved but the hip must be corrected as well. I have tried prolotherapy however, only surgical correction of the hip will allow the muscles to relax. I would be interested to know if your doctor thought that arthroscopic surgery would be enough to help take the pressure off of the pudendal nerve.

hope to hear from you soon..p.s my hip does not even hurt that much, its the pudendal problem that is causing me to do the surgery.

Gregg

WOW! This is interesting... My hip doesn't hurt that much or often either. My doc's name is Dr. Fenton in Winooski, VT. He performed a hip injection on me to test the theory of the hip relaxing the PN pain. The day I got the injection I was not in very much pain, so I do not know if it helped or not. Dr. Fenton does feel that the hip surgery will help the PN problem, but of course has made no promises. I am going in on the 22nd to have him run imaging of the PN, via ultrasound. He is a rockstar with the ultrasound swears that he can find any problems or entrapments. He will image the whole pathway... I tend to be on the skeptical side when it comes to the ability of the ultrasound, but my wife who is an Anesthesiologist was VERY impressed with both his equipment and his ability. Anyway, I am going to proceed with the hydrodissection if we find anything. He will be using a mixture of dextrose and anesthetic, but no steroids.

I plan on having the hip surgery after the first of the year.

Hello, i had an ultrasound of the muscles near the ischial tuberosity (the sit bones), and the doctor told me that the ultrasound is not strong enough to see the nerves that our causing us problems....he said that he was able to visualize the siatic nerve but not the pudendal or perinel nerves. I had a musculoskeletal ultrasound and it was not able to see the pudendal nerve. I would be really interested if your doc is able to visualize it, it would be worth a trip to vermont since i am in philly.

The injection that you mentioned seems like a prolotherapy injection, not hydrodissection. Prolotherapy uses dextrose and lidocaine, the anesthetic, did the doc tell you that this was hydrodissection? My problem gets flared up whenever i drive too long and if i try to exercise with my right leg, which is where the tear is and the majority of my pn pain. What causes your flare ups?

How do you control the flares for the time being? I use ice, heat, valiums, and other muscle relaxers, like flexerill. I had several lidocaine injections into the hip capsule on the right hip which did make things feel better, and relaxed the muscles around the pudendal, but it did not restore functionality? I think there is a component of weak pelvic muscles, like the hip, glutes, and hamstrings, that play a role, and if you tear the labrum or injure your lower spine, that is when the pudendal gets compromised in some way. I have been dealing with this pain for 18 months...how about you?

Let me know how things go, good luck,

Gregg

Gregg and PN-SuffererVT, please let us know your progress. I have a labral hip tear and want to know if labral repairs are removing PN for people. Wishing you the best.

So far i have not had the fai/labral tear surgery yet, but after a cortisone shot, i think that may tell the tale, if it takes away the pne problems, then i will do the surgery. I tried prolotherapy, and all it did was flare things up.

I do think they are related because ever since i have had the labral tear, i have had the PNE problems.

I will keep everyone updated,
Gregg

I remember watching a TV show where a young woman in her early 20's had unexplained genital pain. Eventually, a problem with her hip was discovered and believed to be causing the genital pain. She had surgery. There was no follow-up to the story after that.

Sorry that I don't have more details, but it's interesting to know that her hip problems can cause PN-like symptoms.

Emily B.

so... I will get my hip injected this Tuesday. hope it cuts out my pelvic pain I'm afraid it won't... that would be too easy...but if it cuts out pain, that would really help direct me.

I had an injection directly in the hip socket. Made the hip feel great, but no change in PN pain. This was back in December. Sorry about the delay in follow up.

I went to the Centeno-Schultz Clinic in Broomfield, CO, and they talked about doing hydrodissection of the pudendal nerve. Has anyone had this procedure done yet? It sounds like it would be worth a try.