Is Pelvic Floor Dysfunction the same as PN?

[Ashley2486]

My symptoms started out a few months ago with strange urination issues of frequency and incontinence and painful intercourse, and burning in vulva. About a month ago there is mild pain with sitting. I started seeing a pelvic floor PT and she did a evualtion on me. I didn't have any pain in the areas where people with PN normally have pain. She said I do have tightness on that side deep near the Alcocks, but when she pressed in the area I wasn't in a whole lot of pain. She says I have Pelvic floor dysfunction and the muscles are tight and irritating the nerves. Is pelvic floor dysfunction the same as PN? Or can PN cause PFD?? Does it seem like I do only have tight muscles if I wasn't in pain in the areas where PN patients normally have pain?
She wants to try dry needling in so of my trigger points on the buttocks. Has anyone tried this before with any benefit?? I am just so worried I have PN even tho she claims I don't. I don't know how much experience she has with PN, but she is a very experienced pelvic pt and had helped many women.

[Violet M]

You can have pelvic floor dysfunction (PFD) without having either pudendal neuralgia (PN) or pudendal nerve entrapment (PNE). However, often people with PN or PNE have PFD. But maybe it's best not to get too caught up in all of the terms and what causes what, but instead focus on what you can do to get well. It sounds like your pain is mild at this point so that's promising and maybe a good reason to continue with PT if it's helping you. I haven't tried dry needling so I can't speak from experience. I don't recall anyone reporting getting worse from it though.

Violet

[Ches]

If you do have pelvic floor dysfunction, what additional symptoms would be necessary for PN?
very new to this, and I've read the Nantes document many time in the past week, and I'm more confused than ever.Are the ischial tuberosities in the pudendal nerve zone? I can't tell for sure from the illustrations. But my pain (especially after days when I try to sit, even briefly) definitely gets worse at night, and often prevents sleep, because no position is comfortable.This flare from sitting can last for days. I try not to take medications, because most will create constipation. Bowel movements per se are't painful, but afterwards, my skin tingles for about 30 minutes. The so called "golfball" feeling is absent, but when I walk, the tender spot just to the left of the rectum can indeed feel like a small foreign body.

I am scheduled to see a pelvic floor pt next week, and have read many posts to learn what to expect. Have also read the Wise book, which in the end, is depressing to me.

[Violet M]

PFD and PN share many of the same symptoms, however I think some distinguishing factors would be that with PN, it is more likely to be painful along the course of the nerve if the examiner presses on the nerve via the rectum during a clinical exam. Also, with PFD, I think you are more likely to experience relief from myofascial release whereas with pudendal neuralgia, you might experience more of a flare-up if the nerve is pressed on. A tight pelvic floor can cause the nerve to be irritated and thereby cause PN. So it can be a little tricky to distinguish between the two. You also have to keep in mind your history, likely causes of your pain, and whether the pain is triggered by stress and anxiety or whether it is positional. Then you have to factor in whether the pudendal neuralgia is caused by a nerve entrapment or by something else. So it's complex.

The ischial tuberosities are very close to the pudendal nerve zone so the pain can definitely refer there. I had pain in the area of the ischial tuberosities although the worst pain was just medial (toward the center of the body) to them.

Violet

[flyer28]

Violet I would like to ask you, you wrote that it is important "whether the pain is positional or stress/anxiety related:...Do you mean that
a) positional pain is highly indicative for PNE/PN
b) stress/anxiety related pain is more leaning toward Pelvic Floor Dysfunction as a diagnosis?
thanks

[Violet M]

Violet I would like to ask you, you wrote that it is important "whether the pain is positional or stress/anxiety related:...Do you mean that
a) positional pain is highly indicative for PNE/PN
b) stress/anxiety related pain is more leaning toward Pelvic Floor Dysfunction as a diagnosis?
thanks

Flyer, it depends on your definition of entrapment. If you say that tight pelvic floor muscles impinging on the pudendal nerve is entrapment, then I think stress and anxiety could be the cause of the tight muscles. But if your definition of entrapment is fascia or ligaments entrapping or compressing the nerve, then I do not believe stress/anxiety would cause that type of entrapment.

There is a distinction between PNE and PN. You can have PN without having an entrapment.

I believe positional pain can be indicative of PNE which is also the conclusion of the Nantes team in the criteria they listed, with sitting pain being one of the essential criteria. (Although they did say that over time the pain may become constant -- not just when sitting.) My pain was positional (especially with sitting) and aggravated by activity. To me it makes sense that if the nerve is being constantly irritated mechanically by ligaments or fascia, that positions and activities would aggravate it while anxiety wouldn't make any difference.

When people say they can go on vacation and their pain completely disappears and they say that anxiety and stress increases their pain rather than activity or sitting increasing their pain, to me it makes sense to conclude that their pain could be related to something other than a ligament entrapment.......but I could be wrong.

The trick is to figure out whether your pain is caused by a mechanical entrapment, by anxiety/stress, or something else like a damaged nerve from a fall or surgery. Any of those can be accompanied by PFD. It's not a matter of having either PFD or PNE or PN. You can have both PFD and PNE or both PFD and PN. Or all 3. They are not mutually exclusive.

Violet