Health Organization for Pudendal Education

Hi all, I'm also new to the forum and hoping to get some advice.

My story started 9 months ago, when I had pain in the right testicle that kept getting worse, accompanied by pain while urinating and a higher urinary frequency. I went to see a doctor which prescribed me antibiotics for 2 weeks, which initially seemed to provide some relief, but after a week the pain returned. During the next 3 months I saw 3 different urologists, and only the last one had a diagnosis: chronic pelvic pain syndrome. During that time I also started having referred pain in my right leg and foot (had a lower back MRI, came back okay), and some weeks later hip/buttock pain.

The urologist referred me to a pelvic floor PT for pelvic floor relaxation, and after some sessions the tension in my pelvic floor muscles was quite okay according to her. The testicle pain improved and is almost gone, but my other symptoms (pain while urinating, burning sensation in the penis and perineum) stayed the same. Because I was still having the leg and foot pain, and buttock pain, she advised me to see an orthopedician, who diagnosed me with femoro-acetabular impingement (FAI) and possible piriformis syndrome. He sent me to a regular PT, where the piriformis syndrome was confirmed. In the first session they did dry needling on the piriformis which seemed to improve all my symptoms, but now after some more sessions all my urological symptoms are back and maybe even worse then before. The pain in my foot is gone, but I still feel that the muscles in my buttock are very tight. I went back to the urologist already, but he told me that he isn't specialized in pelvic pain and can't do anything more for me than pelvic floor PT. He also doesn't know anyone in the area that could help me further.

I now have a difficult time connecting the dots, and I don't know where to go next and what I should have investigated next. Is this chronic pelvic pain syndrome the same as pudendal neuralgia? I have read several things about piriformis syndrome and labral tears/FAI on this forum already, but is it possible that all three issues (Pelvic pain, priformis, FAI) are connected? And could the piriformis syndrome be the primary cause of my issues? . I'm only 25 years old, and after all these months I'm starting to lose hope that I will ever get better. I also find it very annoying that all doctors i have seen so far do not see the bigger picture and only look at their specialization.

Hey Jack,

I'm also seeking information about the piriformis muscles role in PN. I originally had a really sore tailbone that eventually went away but was replaced by tingling/stabbing pain in my lower buttocks. Over the next 4 or 5 months it turned into pain in my scrotum, penis, thighs, down my leg and a host of other bizarre symptoms. I've read that the pudendal nerve being compressed can mimic or cause piriformis syndrome.

Jack, dry needling might ease the pain and muscle spams temporarily but if you have an underlying problem that isn't being addressed then I can see why the pain would come back. A good manual therapist, like someone who uses the Hesch method, might be able to help you with the underlying problem. If one thing goes wrong in the pelvis, there can be other accompanying problems. When I developed pelvic instability due to chronically strained ligaments I had accompanying problems such as PN, piriformis syndrome, sacroiliac joint dysfunction, and pelvic misalignment. It was all tied together. It doesn't make sense to just fix one of them without addressing all of the underlying problems together as a whole. For me the underlying problem was the ligaments so I had some prolotherapy and slowly started doing some strengthening exercises as well, once the PN was relieved from compression. But each person is different and it takes some research and seeing the right providers to figure out what they underlying issue is.

Violet