amitriptyline

[esthome]

Since giving birth over 8 months ago which resulted in nerve damage, I have had a full feeling in my bottom as if something is in there even if there isn't. I also have new nerve pain since a simple gynae procedure was carried out nearly 12 weeks ago. I have recently been taking amitriptyline and have increased the dose to 50mg which has dulled the electric shock/burning sensations but has not helped with a dull ache I have in my bottom. My gynae told me not to increase above 50mg as I am petite (just under 8 stone)

I am due to see gp on Thursday but wondered if anyone had any thoughts on whether I should increase the amitriptyline or maybe combine with another drug. I seem to be tolerating the amitriptyline ok other than dry mouth and a bit fuzzy headed when I first stand up from lying down. The ache in my bottom is like a tooth ache sensation but im not in agony, it is it more uncomfortable and annoying.

Thanks

[nyt]

Congratulations on your new baby! I am so sorry to hear though that since their arrival you've had problems.

50 mg is quite a normal dose for amitriptyline when used for neuropathetic pain. Much higher doses are used for depression. Many doctors add Lyrica or Gabapentin to amitriptyline. Sadly, when it comes to medications it really is trial and error to see what works for you. You might want to see it there is a pelvic floor PT specialist in your area that can evaluate you. They might be able to figure out the cause of the dull ache whether it is obturator internus muscle or maybe piriformis muscle. I do not know if you are seeing a physician that could help determine which muscle(s) are causing the ache and if some trigger point injections might help. The International Pelvic Pain Society website has a list of physicians that specialize in pelvic pain and is a good place to start to find a physician that has a good understanding of pelvic pain, more so than a regular gyn or even a regular pain specialist. Even though the medications are the same to treat neuropathetic pain no matter which nerve is causing the pain determining the source of which nerve(s) is causing the problem can be quite a challenge when it comes to the pelvis.

Amy Stein's book "Heal Pelvic Pain" and Dr. Weiss's book "Headache In the Pelvis" have good information in them with many stretches and work you can do on yourself. You can purchase them on Amazon or your local library might have them.

[esthome]

Thanks nyt. If the ache is in my rectum could this still be muscular. It's not my butt cheeks, its definitely an achy rectum. The kind of ache you feel when you need to go to toilet. I just presumed it was part of the pudendal nerve problem. I have thought about physio but I'm scared it will flare things up being prodded and poked around. I wish I knew whereabouts the nerve got stretched/damaged as my first symptom(foreign body in rectum) came on at 5months pregnant. It esculated further after the rapid birth. Whilst I'm happy I have a baby, this has tarred the experience for me, which is very saddening.

Thanks

[nyt]

Your rectal ache could be muscular, could be from nerve, could be a combination. You might want to try using valium rectally and see if that helps. You just use the pill and insert. I know you would need a prescription but it is the only thing that I have found has helped my rectal problems. I actually alternate using the valium vaginally and rectally because if I use it all the time rectally it brings on rectal spasms. You also might want to check out the website for patients with IC because they use a variety of medications vaginally or rectally for their symptoms. Some of them have to be made at a compounding pharmacy but it might give you some ideas of what can be used besides just valium.

It is possible that PT could flare you. The only way to know is to see one and ask them to go very gentle. If they don't work with you in a manner that you are comfortable with then go to somebody else. The first PT I saw was very new to pelvic floor PT and she really flared me. I went about 6 weeks and then quit. It took me almost 2 years before I would consider going again because the first PT only increased my symptoms. It was lack of knowledge and inexperience on the PT parts as well as my lack of knowledge. Plus, at the time the doctors really hadn't gotten a handle on all that was wrong with me at that time. It was early on in my journey. When I decided to try pelvic floor PT again I started asking all my lady friends if they knew anyone and that is how I found the person I see now. She is fantastic and she always listens to me, if I tell her something is too much or I had a delayed response she will cut back on what she does or what she is having me try at home. I've been going off and on to her for about 4 years. We work very well together.