Health Organization for Pudendal Education

Hi everyone,
Hope everyone is doing well. I have aquestion ..Ive asked this before,but checking again, in case anyone new sees my information. and can relate.
Does anyone have throbbing/ aching anal rectal pain? --directly at the opening of the anus and the area just outside of the anal opening on each side. My pain began on the right but eventually became bilateral.
If you do, and have found any medicine or treatment that has helped you would you please share it?

I have the above, it is constant. I had been doing a bit better for a little while but have had a bit of a relapse,after some medicine changes that probably disturbed the balance of my body, and caused me to worry, which then caused tension,in pelvic floor and then pain!
I believe that constant unconscious clenching of the pelvic floor muscles, and some other factors, are causal.

We all are different, but if you've experienced pain of this sort, in this area of the body, and had improvement, could you let me know what helped you? (At this point, Im not considering further surgery., as it would not suit my particular case.

Thx so much in advance...and I wish everyone the best!

Cymbalta and rectal opium/Bella Dona suppositories help ease my rectal pain. Not completely but better than nothing.

HI Patti
Thx for your post. Im glad you're doing better!

I remember trying Cymbalta several years back when I had only urinary issues, and at the time ithe drug made it even harder for me to pee: (urinary hesitancy) Some classes of drugs (anti-cholinergicis and try-cyclic meds have done that to me.
I still have t urinary issues in varying degrees and attribute all the pushing to get the pee out, to be least partially causal for my rectal pain, as.. The pushing causes the spasm..
About the opium/bella donna supps did you have to try them a few times before you felt some relief or did you feel it right away. For example when I first tried Dilaudid rectal supps my pain went down right away...But over the years I became tolerant and now, after a long time at 12mg I get little on no relief from them. I can still go up more , but not sure if that will work, or if pain doctor will agree to it.

I tried Bella donna/opium supps a few years and did not feel anything relief wise on the first try ....so figured they weren't going to help...Is it something I should've have tried a few times before giving up on them?
I assumed i would see at least some relief right away? (like an analgesic or pain med usually works). Did you feel this relief with the first use of your suppository?
Thx very much!
Kathy

No the suppositories did not right away. It took intensive pelvic floor PT a good 4-5 months when I noticed the suppositories would actually give me some relief. I'm approaching 1 year of PT with no end n site.

Thanks Patti for the info.
Maybe I gave up on those bella donna supp too soon..i was expecting immediate relief as I'd had with the dilaudid supps for years. But I became tolerant and have had to keep going up on them.

I also need intensive PT...I've had much Pt, but I think I just never found the right one...timing was off or the knowledge level was lower etc. One doctor, whom I had a long talk with and who understands pelvic floor issues. told me that some PTs are also just better with "hands on work" than others.
The one I have now seems to understand my issues, shows me exactly where my trigger pts are, and can re-create my pain by pushing on them. She also explains everything, while the others just went to work on me, without giving me much description of what they found and why. All I heard from them was "tightness " which of course I already knew!
I had made some minor progress with my current PT, but then had a setback 2 weeks ago when my pain doc made a medicine change, with good intentions... It threw off the balance of things, my pain spiked and I worried, ...all creating more pain.
M y PT re-assures me I can get the progress back if we keep working. A doctor partner and other providers feel this PT is something I really need ...I pray they are right.

Did you keep using the bella donna/opium supps, all that time while you were waiting for some pain relief?
Thanks for the info and hope your PT is helping.
Kathy

Kathy,

I think you are in NJ. Are you able to go to Philly for PT? I have experience with some excellent PTs there. PT has never helped me, but if you think you can benefit, let me know.

Stephanies

Thanks Stephanie,
For the Pt recommendation. I do have one locally that I think is the best PT Ive seen thus far. Unfortunately it will take some time before I will see lasting improvement. It's just hard dealing with the pain meanwhile.
She wants me doing self PT at home, but PT flares me for now, so my pain needs to be better managed before I can do self PT daily.
(a catch 22 situation)..My doctor, nurse etc are working on pain management, but with pain like mine,its trial and error.
My emotions of fear, and anger etc play a big part.

My previous post in this thread describes a bit about my PT, the work she has done with me, and why I think that she is better for me than others have been.
(I pray I'm right about this,, as it's always hard to know for sure.. until God-willing lasting improvement happens..

If you are near North -Central NJ...this Pt could be worth a try for you too, if you are interested.

Thx for telling me about the PTs you know of.
Take care,
Kathy

Yes I still use suppositorieson a daily basis. I use them rectally. Find they work better for me via this route. My goal if off all oral meds and use these for long term care. Less side effect profile.

Kathy, have you tried nitroglycerin ointment? It's typically used for anal fissures but there was a PT who used to post on our forum who used it for rectal PN pain.

Violet

Hi Violet
No they have not mentioned Nitroglycerin ointment...they gave me an ointment called' Nifedipine 1% Polyoxomer. Apparently its supposed to relax muscles, but It has made no difference for me... anytime Ive put it on.
I have heard of Nitroglycerin tho...I wonder would it be helpful for the throbbing pain I feel?
I will mention it to my pain mgmnt doc. I also have a urologist who works with my PT.
He is interested in my case, spend time with patients and is much closer to my home than my pain doc, so maybe a visit to him may be in order.

My pain mgmnt doc is working on some changes to my pain pump now, so he will probably insist on dealing with that first. but I will try to also mention your suggestion. He tends to "cut me off" when I try to offer my ideas via phone.
The changes he is making take time tho,and meanwhile I so need something to get me through each day.

I use dialudid rectal suppositories but they are no longer effective ..and we will have to go up higher dose wise again (but these opiates create bowel issues. It's often hard to know if I really have bowel issues, as I 'go' usually every other day on average, but I have that awful feeling of pressure...PT says it from the muscle spasm,etc
It would be so great if an ointment could help numb this one painful area... and I could get rid of the more complicated meds.
Thx so much Violet I Will check into it.
Take care,
Kathy