What do They Mean "Pain on Sitting" EXACTLY?

[ClareW]

When my symptoms started, the main ones were a foreign body in the vagina and vulval burning. When my doctor asked if I had 'pain on sitting' I replied "Yes", which presumably was part of the diagnostics for PN/PNE. At the time, it felt exactly as it would if I really did have a foreign body in the vagina and sat down i.e. very uncomfortable and sore. I thought that the 'pain on sitting' thing refered to the pressure put on the vulva/vagina/rectum by the seat of the chair. I bought a Togu u-shaped cushion and used it facing backwards with limited success.

The doctor told me that my coccyx was tender (even though I had no pain in that area at that time) and to buy an eggbox coccyx cushion. It was pure blis, like floating on air - I felt like I had my life back and could sit for hours with no ill effects. Now sitting for too long gives me some coccyx pain even with the cushion.

Recently, I can feel slight discomfort in my sit bones even with the eggbox cushion, which is something I never even thought about before.

Does anyone know exactly what doctors are referring to when they talk about 'pain on sitting'. If the question is used as part of the diagnosis, then it must be important to be sure exactly what pain they are referring to

btw, do those foam eggbox cushions loose their properties after a few months. Mine definately doesn't seem as supportive as it used to be..

[calluna]

Well, I know what it means for me. I have got some rather excellent pain relief running at the moment but I am still avoiding sitting apart from with my own particular cushions - if I forget and sit down without them, it most definitely does still hurt.

I have pain in the area innervated by the pudendal nerve. And when I sit down, that's the area that hurts. Very badly indeed. Sometimes it is the left side only - that's the side that the original damage was done. Sometimes it is the right side only - due to crosstalk between the nerves, i am told. More usually it is both sides together.

But always, always, always - the area innervated by the pudendal nerve. I have no coccyx pain, no sitbone pain at all, and never have had. We all seem to be different....



I don't know about the foam eggbox cushions, I've never tried them - are they memory foam? I've found memory foam cushions not to last very long - but I've found the Togu cushions to be quite wonderfully helpful with the U at the front.

[Rosemary]

Hi Clare

My vulva and the area around it is painful - i picked up a tip from someone on here for sitting with a homemade 'cushion'.

I bought two garden kneelers from B&Q- my husband cut each in half lengthways and stuck two matching pieces from each kneeler together with evostick glue so that it was thicker than using one kneeler. Then cut them horizontally to fit the depth of a hard chair.

When i sit i put one of these rectangular pieces under each buttock and raise the vulva area off the chair.

The kneeler foam is hard and hasn't squashed at all.

Hope this helps

Rosemary x

[molly]

Hi Rosemary,


My symptoms sound very similar tl yours.

I do wonder if it is partly due to muscle atrophy or wastage as these muscles that we use for sitting are simply never or seldom used as we avoid sitting like the plague. These would lead to less blood supply and wastage which then becomes part of a vious circle, add in hypersensitivity to the area in general and the result is like a tinderbox.


This is only my theory, nobody has ever said this is what happens, just seems to make sense,as any other muscle groups in the body would simiarly waste if not used.

Regards Molly

[Rosemary]

My symptoms sound very similar tl yours.
These would lead to less blood supply and wastage which then becomes part of a vious circle, add in hypersensitivity to the area in general and the result is like a tinderbox.


Regards Molly

Hi Molly

Funny that you mentioned this as i have been looking up about reversal of muscle atrophy on the internet this week to see if this is possible.

I have irritated nerves in one vulva so can compare the state of the healthy side with the other. I agree with everything you have written - my bad side is shrunken, paler and hypersensitive and i feel in a viscious circle too. I don't know how old you are but i am 58 and postmenopause which i don't think is helping - i have some localised Hrt to use now but did not have any vaginal atrophy or problems with soreness prior to all this.

I went for some acupuncture this last week it took away the pain for a while - it was dry needling sore trigger points which were in my middle inner thigh area and top of the mons pubis.Early days but the lady says she can help me.

I have some physio excercises but they are getting harder to do as more muscle seems to become locked up which is why i made enquires and was given Ruth Jones name - i have read that you think an assessment by her is worthwhile. Sitting for too long can make everything worse.

Hope that you are enjoying a sunny saturday pm where you are.

Rosemary x

[calluna]

Would just point out that unfortunately there can be shrinkage of tissues when there has been damage to nerves innervating that area for a continued period of time.

So yes, it does happen that the labia on one side will shrink. Mine is almost disappeared completely on the left side which is the side that the damage was done to the nerve back in 2009.

It is not due to muscle wastage or lack of blood supply or anything like that - it is a completely recognised symptom and entirely due to longstanding problems with the nerve...

[ClareW]

I do wonder if it is partly due to muscle atrophy or wastage as these muscles that we use for sitting are simply never or seldom used as we avoid sitting like the plague. These would lead to less blood supply and wastage which then becomes part of a vious circle, add in hypersensitivity to the area in general and the result is like a tinderbox.

It's interesting about the hypersensitivity idea. The physio that I see has advised me to try and gradually increase sitting time without a cushion, on the grounds that the nerve becomes increasingly hypersensitive if you avoid actions that affect the nerve eg sitting, sex etc. I asked my doctor and he doesn't seem particularly keen on this idea though - now I'm really confused

[molly]

I agree that damaged nerves go on to atrophy muscles, but the nerves are not destroyed just sending dowm negative sensations which quite naturally we then avoid as its painful..
I,m not saying I,m right on this but Ido think as we avoid certain physical positions not only are the muscles directly around the nerve effected but the whole structure around these as wel

Regards Molly

[helenlegs 11]

This is an interesting topic.

I have no pelvic floor problems, muscle hypertension etc but I do have PN . My problem begins higher up.
My saddle area is numb, cutaneously only, not densely and I have PN burning, electric flashes, itching, PGAD, all almost exclusively right sided but I have no imbalance 'looks wise'. However I do have sciatica from the same piriformis 'entrapment' and do have leg wasting (gastrocnemius muscle, inside calf part) on rh side and a slight dip in my bum (also r side) along the line of my piriformis muscle, although this is masked by fat just now , it is there .

I doubt we could positively say that any muscle wastage could indicate actual entrapment?? but obviously you had, sorry have entrapment Calluna. It would be interesting to see if there were any studies on lumbar back problems and visible muscle wastage. Is there a correlation to actual entrapment visible on MRI and degree of muscle wastage?

The other thing that is being discussed here is avoidance as you say molly. Avoidance is natural but when the pain becomes chronic it can, no, it will, cause more problems.
I do try to stand and walk properly (alignment) for instance, but I catch myself out so much. I wouldn't use my crutches until absolutely necessary either, wouldn't stay in bed all day unless I had the flu or something. I have pain in places but I still need to treat my body holistically and if I compensate and 'guard against' too much there will be consequences, just like there will be if I do too much but those aren't quite so permanent. A balance is required. . . .says me, 'reclining' with one leg elevated as if I'm asking someone to limbo under it or trip them as they pass.
We still need to move as normally as possible but when it comes to the pelvic floor this becomes nonsense.
I wonder if it is simply because motor function has been disrupted in that the motor part of the pudendal nerve has been affected? Mine is just the sensory part I'm sure. . . I can still DO all of the things required in relation to the pudendal nerve I just don't know WHEN I need to do the bowel bit until very late for instance or it's a surprise when weeing .

[Rosemary]

the nerve becomes increasingly hypersensitive if you avoid actions that affect the nerve eg sitting, sex etc.

My early symptoms in the outer vulva were gradual burning over time followed by foreign body feeling in vagina which was a ? for pudendal nerve being involved somewhere.

My physio emphasised that sex was a brilliant workout for pelvic floor muscles, drawing in blood to the area and the nerves sending all the correct messages to the brain that they are meant to do - a good way of retraining everything.

Luckily i have an understanding husband as for all the good it might do me i've not been able to go there because of the general pain.

Maybe do what you are comfortable with Clare.

Rosemary x