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? pudendal nerve therapy
lindy142 posted:
Pls give me some info on what options I have for the treatment of pudendal nerve pain. I'm interested in finding out about what myofascial release therapy entails & what other treatments are out there. I already go for SI joint injections & depo medrol injections with some relief in that area only.
Peter Abaci, MD responded:
Hi Lindy,

Pudendal nerve irritation is associated with pain in the genital region and can be aggravated by prolonged sitting. In some cases, pudendal neuralgia can be brought on by excessive pressure (as is sometimes seen with cyclists) or from trauma to the anatomy (for example, childbirth).

There is also a school of thought that pain and pressure around the pudendal nerve and pelvic region can be caused by excessive muscle tightening. This is where myofascial release therapy may be helpful. One of the approaches is termed the "Wise-Anderson Method" which is based on the research and recommendations of their work done on myofascial pain in the pelvis. They have an interesting book out called A Headache In the Pelvis that you should consider checking out to learn more. I have worked with a few physical therapists who specialize in this type of treatment, including one of the contributors to this book, and I have certainly seen some success.

In general, there are no recommended surgeries for this problem, and nerve blocks and trigger point injections may be of only limited value.
Giannoni replied to Peter Abaci, MD's response:
Hi Dr. Abaci,

I was diagnosed with pelvic floor muscle disfunction thee years ago. Since then I've tried trigger point therapy from a good phys therap, have had injection marcan, etc. and recently Botox. The doctor said my pelvic floor muscles are less tight yet I'm still in a lot of pain (gets worse as the day progresses and worsens just in time for bed to a level 7 or .

The pelvic pain doc said pudendal entrapment could also be a factor. I hear that surgery for this condition isn't the best way to go as it could effect the bowels, etc. Yet, I've read that some patients get pain relief. I'm taking more pain meds (Tramadol/Oxycodon) but am still in pain. Also increasing the Cymbalta to 60mg from 30mg (a week or so into this).

I don't have much of a life since I can't walk or sit or even stand for any length of time. I don't visit with friends/family very much nor can I have company. I know I'm depressed but I am hopeful enough to continue the search for a solution. Any advice from the group or the doctor would be much appreciated!
Peter Abaci, MD replied to Giannoni's response:

I appreciate your frustration with this problem and the impact that it has had on your daily activities. In doing some research on your interest in pursuing pudendal nerve decompression surgery, I wanted to give you some things to think about to help you decide what to do next.

First of all, diagnosing true entrapment of the pudendal nerve may not be clear cut. One recommendation uses this criteria: "if the pain is unilateral, has a burning quality and is exacerbated by unilateral rectal palpation of the ischial spine, with delayed pudendal motor latency on that side only." You may want to talk to your doctors about how confident they are in the diagnosis as a first step.

Another issue has to do with how successful is the surgery, even in experienced hands? In reviewing some of the published studies on the outcomes of decompression surgery, it seems as though there certainly are studies out there that show positive results. But, I would recommend caution in interpreting these results because the studies are typically done on only a small number of patients and the follow up is usually brief. For example, one study done in France had good results, but only followed their patients for 3 months after the surgery. In my opinion, the evidence thus far is limited. If you know of a surgeon who performs this surgery, you may want to ask to speak with other patients who have had it done and see what their experiences were like over time.

I hope this helps!

Featuring Experts

Peter Abaci, MD , is certified in anesthesia and pain management by the American Board of Anesthesiology. Dr. Abaci received his undergraduate educat...More

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