Health Organization for Pudendal Education

Here are the abbreviated results from my MRI done in New York and read by Dr. Potter:

There is a paucity of presacral fat but no presacral or precoccygeal soft tissue mass.

There is symmetric thickening of the sacrotuberous ligaments, but without defined scar entrapment of the pudendal nerves. The fat planes around the pudendal nerves in the posterior margin of the Alcock's canal are constrained by the thickened sacrotuberous ligaments. There is mild scarring of the ischial rectal fat at the inferomedial branches of the pudendal nerves in Alcock's canal. There is a moderately large varix in the right anterior aspect of the pelvis, posterior to the pubic symphysis, but no features to suggest pelvic venous congestion syndrome.


Impression:
MRI of the pelvis demonstrates symmetrically thickened sacrotuberous ligaments, effacing the fat planes around the pudendal nerves at the posterior margin of the Alcock's canal, with scarring inferior to the attachment of the ligaments, in the inferior margin of the "Alcock's canal affecting inferior branches of the pudendal nerve branches bilaterally.

Having had this issue for so long -like most of you-I've become quite familiar with anatomy.....However, if anyone would care to put this in simpler terms, I would be very grateful. I have read quite a few Potter MRI reports, but I don't remember coming across anything mentioning "fat planes".....what is the significance of this? Also the mention of "inferior"....."Inferior margin....inferior branches".....

Also.....what areas of the body do the inferior branches of the pudendal nerve innervate specifically?

I'm trying to look on the bright side....hanging my hope on the phrase "but without defined scar entrapment"...am I being silly?


Thanks so much,

Jackie Ouch

Fat planes are just areas in the body where there is fat. It is bounded by specific areas that is why it is called a plane. For example,there is a wedge-shaped space on either side of the anal canal which is bounded superomedially by the pelvic diaphragm, laterally by the obturator internus, and inferiorly by the skin. This space is the ischiorectal fossa and is filled with fat, which is almost liquid at body temperature and allows for easy distension of the anal canal during defecation. I do not know the anatomical boundaries for the fat planes Dr. Potter is speaking of.

Inferior pudendal branches would be the perineal and dorsal nerves. She might consider the rectal branch but since in the majority of individuals it branches before Alcock's canal I know she is at least talking about the perineal and dorsal nerves.

Not to burst your bubble but you do have scarring and the thickened STL could easily be impinging on your pudendal nerve. In my report she never used the word entrapped but just scarring and I was entrapped as found during pudendal decompression surgery.

Response to MRI from local professionals:

Gynecologist "You have to have surgery you're entrapped"

Pelvic PT "no amount of PT will help this issue"

Another Pelvic PT "this MRI is actually good news........"No where does it say "entrapped"....we can work on getting the ligaments to glide....".

Of course I want to believe the last one!!

Any thoughts?

Thank you,

Jackie OUCH

Jackie, I had thickened ST ligaments. Dr. A had a difficult time getting the needle through when he injected me for the PN blocks. Never had a Potter MRI though. One of our former HOPE directors also had thickened ST ligaments. We are both doing GREAT after PNE surgery. Haven't you already tried a lot of PT? I can just picture the ligaments gliding as the last quote said -- and irritating the pudendal nerve as they are gliding. I believe that is basically what was happening in my case. Sorry -- you asked for my thoughts so I gave them. I could be completely wrong.

Violet

Violet M wrote: Sorry -- you asked for my thoughts so I gave them. I could be completely wrong.

Maybe, but I don't think so. I also had "thickening of the ligaments", noted on my Potter MRI. As with others who had this abnormality recorded, it was found during surgery that the PN was entrapped in this area.
Just curious, JackieO - What sort of treatment did the second PFPT recommend for getting the ligaments to glide, without causing further damage/injury?
Kind regards,
Karyn

Thanks so much for replying Violet and Karyn.

Yes. I have had ALOT of PT, and with 2 different pelvic floor therapists.

A therapist I trust very much said that the Potter MRI has given us a road map as to exactly where we should work on releasing the nerve.....However, as you stated.....I'm thinking that anything done to assist the ligaments to glide, will also aggravate/cause friction to the nerve. I am probably trapped in the same area you ladies were.

Please tell me more about your surgery, recovery, surgeon and success....in a private message if you'd like. Any encouraging news at this time would be most helpful.

Thanks again,
Jackie OUCH

Jackie, you can read my signature -- about success of surgery. Did PT help you? Pelvic floor PT prior to surgery really aggravated my pain -- caused week-long flare-up of burning pain.

My surgery was done by Bautrant with SS ligament being severed to release the nerve, part of the ST ligament was shaved away at the falciform process, and nerve was released from fascia in alcock's canal. Can't remember if he cut away part of the OI muscle but I know he does in some surgeries. I did not have the ST ligament completely severed due to pretty major pelvic hypermobility prior to surgery.

Can't say the recovery was easy. I had increased burning pain post-op, probably from nerve irritation during surgery. But slowly that faded away and I have a great life now. With all that said, surgery is not for everyone. I would not go into it unless your current quality of life is pretty poor. I was basically lying down most of the time with pain 24/7 even lying down.

Best,

Violet

Another fact from the Potter MRI that I missed upon first reading:

"Ischiocavernosus and bulbosphongiosus muscles appear attenuated bilaterally"......This apparently means the muscles are "unnaturally thin".....

Could this be caused by the nerve being entrapped?

Thanks so much for all your replies.

Less pain,

Jackie OUCH

Maybe due to decreased use and blood supply (atrophy) associated with neuropathy? Just a guess. Often nerves and blood vessels run alongside each other so if a nerve is compressed, the blood vessel may be too.

Violet