I had transgluteal pudendal nerve release with Dr. Conway. He found my nerve was growing through the ligament. He removed the ligament and I recovered quickly from the surgery but still have pretty much the same amount of nerve pain while sitting. Laying down or sitting on a heating pad or heated car seat dulls the pain quite a bit.
Does anyone know why heat relieves the pain? Has anyone had surgery where they found the nerve growing through the ligament? If so, what was the time frame before starting to feel less pain? I was hoping to have some resolution by now.
6 months today past surgery
Re: 6 months today past surgery
I’m sorry to hear that you still suffer even after having surgery.
My guess is that your Piriformis muscle is contracted and is causing these symptoms, based on what you describe.
I was first diagnosed with Pudendal neuralgia and was planning the same surgery, but after having an online appointment with another surgeon (Dr. Renaud Bollens, who was the one suggesting Piriformis surgery instead) I went to him in Belgium instead, and he said that 80% of my symptoms would remain if we would have done the Pudendal nerve release instead.
I hope you find some answers, what does your surgeon say about it?
/Mathew
My guess is that your Piriformis muscle is contracted and is causing these symptoms, based on what you describe.
I was first diagnosed with Pudendal neuralgia and was planning the same surgery, but after having an online appointment with another surgeon (Dr. Renaud Bollens, who was the one suggesting Piriformis surgery instead) I went to him in Belgium instead, and he said that 80% of my symptoms would remain if we would have done the Pudendal nerve release instead.
I hope you find some answers, what does your surgeon say about it?
/Mathew
Re: 6 months today past surgery
Hi lyndagelpi,
I also find tremendous pain relief from heat, but I don't know why. I wonder if the heat just floods the nerves with a different sensation? I'm sure it is really frustrating to not have noticeable relief yet. But, nerves do take a long time to heal. I did have some relief shortly after my surgery, but I continued to improve (gradually and not linearly) for a long time, well beyond 6 months, so I think it's too early to draw any conclusions about the success of the surgery. Have you reached out to Conway to see what he thinks is going on? Did he remove the SS ligament? I haven't heard the phrase "growing through the ligament" before, but it is very common to have it entrapped in a one, and the most common place for that is in between the SS and ST ligaments---the nerve goes between them where they cross.
April
I also find tremendous pain relief from heat, but I don't know why. I wonder if the heat just floods the nerves with a different sensation? I'm sure it is really frustrating to not have noticeable relief yet. But, nerves do take a long time to heal. I did have some relief shortly after my surgery, but I continued to improve (gradually and not linearly) for a long time, well beyond 6 months, so I think it's too early to draw any conclusions about the success of the surgery. Have you reached out to Conway to see what he thinks is going on? Did he remove the SS ligament? I haven't heard the phrase "growing through the ligament" before, but it is very common to have it entrapped in a one, and the most common place for that is in between the SS and ST ligaments---the nerve goes between them where they cross.
April
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lyndagelpi
- Posts: 7
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Re: 6 months today past surgery
Thank you April for the encouragement! Dr. Conway did remove the SS ligament and said my case was unusual as the nerve was not entrapped or impinged but grew through the ligament. Not focusing on the pain, managing with standing as soon as it starts to hurt (which is not always practical) plus heat or ice helps. Hoping to retrain my brain and staying positive while the nerve heals.
Re: 6 months today past surgery
Hello Matthew,
I saw some posts about your surgery with Renaud Bollens. Can i ask you what your symptoms were before surgery? Did you have a piriformis release or a classic laporoscopic decompression surgery?
My symptoms are mainly triggered when walking and standing up. The biggest problem is first a dull and later burning pain between the gluteal cleft/tailbone that gets triggered by walking and standing up. Sitting is not really a problem. The pain in the intimate area is rather mild as in occasional tingling and burning sensation.
I already had a tele consult with Bollens and he thought the piriformis muscle was the issue. He told me to have botox injections in the muscle. He also said that i would be able to sit comfortably. I somehow think that he didnt pay attention when i said my symptoms are mainly triggered by standing and walking instead of sitting.
Did you have similar symptoms? Im sure he is one of the top surgeons regarding PN, but in feel like he blames the muscle in most of the cases, whereas other specialists seem to disagree. Also the PT says my piriformis muscles are not cramped at all.
Have a good day
Rudy
I saw some posts about your surgery with Renaud Bollens. Can i ask you what your symptoms were before surgery? Did you have a piriformis release or a classic laporoscopic decompression surgery?
My symptoms are mainly triggered when walking and standing up. The biggest problem is first a dull and later burning pain between the gluteal cleft/tailbone that gets triggered by walking and standing up. Sitting is not really a problem. The pain in the intimate area is rather mild as in occasional tingling and burning sensation.
I already had a tele consult with Bollens and he thought the piriformis muscle was the issue. He told me to have botox injections in the muscle. He also said that i would be able to sit comfortably. I somehow think that he didnt pay attention when i said my symptoms are mainly triggered by standing and walking instead of sitting.
Did you have similar symptoms? Im sure he is one of the top surgeons regarding PN, but in feel like he blames the muscle in most of the cases, whereas other specialists seem to disagree. Also the PT says my piriformis muscles are not cramped at all.
Have a good day
Rudy
Re: 6 months today past surgery
Hi Rudy!
My symptoms were burning and stabbing pain in my whole pelvic area, redness and my erections were also affected. Sometimes it hurt when I sat down, and sometimes it could hurt when I had been walking/standing. It was worse during the day, and better night time.
I was absolute sure that I needed Pudendal nerve decompression until I spoke with Dr Bollens, and since he is literally the only one in the world who can perform this surgery in a minimally invasive manner, of course nobody else would recommend to have this done except him. I truly believe he is the most experienced and skilled surgeon out there in this field.
He recommended me to have the Botox injection into Piriformis together with local anesthesia, but I just did it with local anesthesia and skipped the Botox, since that is kind of an temporary treatment, and the anesthesia is more a test to see how you react. I felt a little relieved after the injection for a couple of hours, and that was the argument to operate my Piriformis. I also took some Cialis for about 1.5 month and it gave me some relief.
Dr. Bollens told me that he have operated some patients for Pudendal nerve decompression in the past who had some of their symptoms left, that later have come back to him to operate the Piriformis and they are now cured completely.
He also told me that if we operate the Piriformis and it doesn´t work, he will basically do the Pudendal nerve decompression for free later, so I wasn´t worried. And the cost to be operated by him is the same for both procedures, so I'm sure he really bases his statements on facts and clinical experience and not financial interest.
If I were you, I would have another consultation with him and almost debate him, if he makes a claim you don't agree with, question him. But I´m certain that he knows what he is talking about.
I hope this helps you and that you can move forward, maybe try to get the Piriformis injection with only local anesthesia and see how you react the following hours.
//Mathew
My symptoms were burning and stabbing pain in my whole pelvic area, redness and my erections were also affected. Sometimes it hurt when I sat down, and sometimes it could hurt when I had been walking/standing. It was worse during the day, and better night time.
I was absolute sure that I needed Pudendal nerve decompression until I spoke with Dr Bollens, and since he is literally the only one in the world who can perform this surgery in a minimally invasive manner, of course nobody else would recommend to have this done except him. I truly believe he is the most experienced and skilled surgeon out there in this field.
He recommended me to have the Botox injection into Piriformis together with local anesthesia, but I just did it with local anesthesia and skipped the Botox, since that is kind of an temporary treatment, and the anesthesia is more a test to see how you react. I felt a little relieved after the injection for a couple of hours, and that was the argument to operate my Piriformis. I also took some Cialis for about 1.5 month and it gave me some relief.
Dr. Bollens told me that he have operated some patients for Pudendal nerve decompression in the past who had some of their symptoms left, that later have come back to him to operate the Piriformis and they are now cured completely.
He also told me that if we operate the Piriformis and it doesn´t work, he will basically do the Pudendal nerve decompression for free later, so I wasn´t worried. And the cost to be operated by him is the same for both procedures, so I'm sure he really bases his statements on facts and clinical experience and not financial interest.
If I were you, I would have another consultation with him and almost debate him, if he makes a claim you don't agree with, question him. But I´m certain that he knows what he is talking about.
I hope this helps you and that you can move forward, maybe try to get the Piriformis injection with only local anesthesia and see how you react the following hours.
//Mathew
Re: 6 months today past surgery
Hi Lynda,lyndagelpi wrote: ↑Fri Jun 27, 2025 4:12 pm I had transgluteal pudendal nerve release with Dr. Conway. He found my nerve was growing through the ligament. He removed the ligament and I recovered quickly from the surgery but still have pretty much the same amount of nerve pain while sitting. Laying down or sitting on a heating pad or heated car seat dulls the pain quite a bit.
Does anyone know why heat relieves the pain? Has anyone had surgery where they found the nerve growing through the ligament? If so, what was the time frame before starting to feel less pain? I was hoping to have some resolution by now.
Just wondering how long ago your surgery was. The long recovery period can be difficult. I couldn't sit very much until 18 months post-op. I did not have the nerve growing through the ligament. Did Dr. Conway think there would be much difference in the type of injury to the nerve compared to the nerve being compressed between two ligaments?
Often there is a lot of muscle tension accompanying the nerve pain, which might be one of the reasons heat helps since heat is good for relaxing muscles. About 10 months after surgery when the nerve pain started to subside and I could tolerate it, I used a TENS unit to calm down the obturator internus and piriformis muscles. Alternating hot/cold sitz baths were also helpful.
Violet
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.
Re: 6 months today past surgery
The muscle tension point makes a lot of sense, heat relaxing those muscles probably explains why it dulls the pain for Lynda.
It’s interesting that you used a TENS unit around 10 months in. As for Dr. Conway’s question about the nerve being trapped through the ligament versus compressed between ligaments, I don’t know if anyone here has a definitive answer. But intuitively, the nerve growing through the ligament might mean more direct nerve involvement, possibly needing longer or more complex healing.
Hope you all find some relief soon.
It’s interesting that you used a TENS unit around 10 months in. As for Dr. Conway’s question about the nerve being trapped through the ligament versus compressed between ligaments, I don’t know if anyone here has a definitive answer. But intuitively, the nerve growing through the ligament might mean more direct nerve involvement, possibly needing longer or more complex healing.
Hope you all find some relief soon.
Re: 6 months today past surgery
Insane hot baths calm my horrible urinary urethral symptoms also for some time.But not always but most of the time.I think they relax nerves and muscles also.Gauxa wrote: ↑Wed Jul 16, 2025 5:53 pm The muscle tension point makes a lot of sense, heat relaxing those muscles probably explains why it dulls the pain for Lynda.
It’s interesting that you used a TENS unit around 10 months in. As for Dr. Conway’s question about the nerve being trapped through the ligament versus compressed between ligaments, I don’t know if anyone here has a definitive answer. But intuitively, the nerve growing through the ligament might mean more direct nerve involvement, possibly needing longer or more complex healing.
Hope you all find some relief soon.