Prolapse surgery 8 weeks ago and struggling with pain HELP

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Prolapse surgery 8 weeks ago and struggling with pain HELP

Postby maria331984 » Wed Apr 05, 2017 8:34 pm

Dear ALL! - please give me some advice...

I am 33 yrs old with 2 little kids. 8 weeks ago I had sacrospinous hysteropexy and a rectocele repair.

I. What happened and how I feel:

1. I woke up from the surgery with excruciating pain in my right buttock (on the inner side, next to my coccyx bone), I couldn't move from that pain. My doctors said that it's normal and it will pass and it's due to the sutures being there.

2. Pain got a little bit better after a week although bowel movements were agonizing and I felt that stabbing pain in my right buttock and rectal pressure.

3. After two weeks I still had pain but I was driving my car and going out a bit. I felt like I am feeling a bit better.

4. At 3.5-4 weeks pain spread to my hip and started radiating to my knee but the most painful thing was sitting for a while, just unbearable. Main pain still in the buttock and inner side of buttock.

5. Pain was more and more excruciating in my buttock and my doctor decided to remove the sutures - I had that done on March 23rd. Pain did not go away and recovery was very painful for a week.

6. 4 days after suture removal I landed in the ER with excruciating pain, they did an MRI and MRN. MRI was normal and MRN showed sciatica inflammation on both sides, more on the left, but I don't have any pain on the left.

7. Now (Over two weeks after sutures removal) I have terrible, burning pain in my buttock around my piriformis, rectal shooting pains once in a while and terrible hip pain. Bowel movement are fine and regular, no pain there. Sitting is very painful, like sitting on a broken glass. Standing gives me some relief. There is also some pain in my perineum. When I have a more active day and I walk a bit my whole pelvis on the right is in agony.

I take Gabapentin 300 mg 3x a week (started 1 week ago) and ibuprofen 600 3x a day. I feel like gabapentin helped a bit.

II. What the doctors are saying

1. My Surgeon claims that sutures did not touch any nerves and surgery was perfect and a success. He is puzzled why I still have pain after removal of sutures.

2. I was scared about pudental nerves so I went to see Dr. Jerome Weiss and he did a manual exam, pushing on branches of my pudental nerves deep on the right and on the left in the vagina. On the left I had no pain but on the right he replicated my buttock pain and hip pain, that was exactly the pain I was having. He also touched other areas on the outside of vagina but I have no pain there. He said he diagnosed pudental neuralgia and he will treat it by doing some manual relaxation on my obturator, which is very tight and painful. He also recommends Baclofen and Diazepam suppositories.

3. I went to the pain clinic and they recommend pudental nerve diagnostic block with steroids. I booked it for the 17th of April but I don't know if I should do it as I am not sure what the diagnosis really is. They also recommend injections into Piriformis. They didn't offer any more tests.

4. I went to the best pelvic pain PT here and she did some external manipulation and suggests that my pirifomis and obturator are in a spasm. After her massage I felt some relief for 30 minutes.

III. My questions

1. Is it possible that I have nerve damage - how do I test for this?
2. Can pudental neuralgia be diagnosed by this manual exam?
3. What to do next? Surgeon and pain clinic strongly suggest pudental nerve block...

On top of all this I am an emotional mess and feel disabled and like will never recover. I take oxycodone to calm myself down a bit. They also prescribed Cymbalta but I haven't started it yet.

My pain never really goes away, I can calm it down with gaba, oxy, ibuprofen but it's always there and gets worse as the day goes by. It's very deep inside my buttock and it's also painful to touch my buttock. At night it feels like burning.

Thank you!
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Joined: Wed Apr 05, 2017 7:52 pm

Re: Prolapse surgery 8 weeks ago and struggling with pain HE

Postby Violet M » Thu Apr 06, 2017 5:50 am

Hi Maria,

It must be incredibly difficult to deal with this when you have small children.

As I am looking at this picture on you-tube it appears that during a sacrospinous hysteropexy that the uterus is attached to the sacrospinous ligament to help hold up the uterus. The area of attachment appears close to the area where the pudendal nerve crosses between the sacrospinous and sacrotuberous ligaments. Not being a surgeon, I can't say for sure how close it is but I do know that there has been an instance of a surgery similar to yours where the pudendal nerve actually had a stitch through it and once the stitch was removed, the pain improved significantly. So, I don't know what the chances are that might have happened to you but it is something to consider if all else fails.

You can read how to test for nerve damage at our website's diagnosis page.
The manual exam is very important in the diagnosis of pudendal neuralgia. Diagnosing pudendal neuralgia with 100% accuracy is difficult because there are so many deep structures and other nerves inside the pelvis but I think an experienced PN doctor such as Dr. Weiss should be able to get a pretty good idea from the pelvic exam as to whether that is the correct diagnosis because I'm sure he knows the landmarks well.

The nerve block is considered diagnostic for pudendal neuralgia but most people who post on our forum haven't had long-term relief from nerve blocks. Some people have gotten worse from nerve blocks although we don't hear of it very often on this forum. I think it is reasonable to have a nerve block to confirm the diagnosis but Professor Robert cautions against having more than 3 and I don't think their team uses steroids anymore. If PT seems to be helping, that might be the way to go. If there is something like a misplaced stitch irritating the nerve, I think it is unlikely you would get much relief from PT. If you aren't getting relief and you aren't comfortable with what your doctors are saying, then getting a second opinion from another PN expert would be smart.

PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
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