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[aussie_surfer]

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[Violet M]

Thanks so much for reply. Do you think that the lack of surgical case history for the IRN is because there are no ligaments or hard structures that seem to surround the inferior rectal nerve?

What you are suggesting makes sense but that would be a question for one of the surgeons, such as Bautrant who is experienced with the ischiorectal fossa area.

But what about patients that have rectal-only PN pain? Or can a lesion higher up on the main branch, cause rectal only symptoms??

That would be another question for the surgeons, but my guess would be that a lesion higher up on the main branch would be more likely to cause more than just rectal symptoms; however, Dr. de Bisschop told me that your symptoms depend on which nerve fibers are affected, and my symptoms were primarily perineal with the perineal branch being affected the most, yet pudendal nerve release at the ischial spine, alcock's canal, and shaving of the falciform process of the sactrobuterous ligament relieved the symptoms, so clearly the main branch was involved, even though my symptoms were primarily in one branch. So I don't think you can completely rule out the main trunk of the nerve even if your symptoms are just rectal. Can't remember what your response to a PN block was -- did it help at all? Was your block given at the ischial spine or Alcock's canal? Sometimes the IRN comes off of the main trunk of the PN above the ischial spine so a PN block there wouldn't necessarily relieve rectal symptoms if that is the case.

After my injury, all of my symptoms continue to be rectal, without any penile or other symptoms, apart from intermittent inner thigh stinging pain.

Inner thigh stinging can be due to a tight obturator internus (OI) muscle. At least that's what I was told by my PT. A tight obturator internus muscle can be caused by the pain of pudendal neuralgia. The IRN goes through the pudendal canal which is made up partly by the OI muscle and the levator ani muscles so if the IRN branch of the nerve is entrapped in the Alcock's canal by the OI or levator ani muscle fascia, that could be a problem. In that case, a pudendal nerve block into Alcock's canal could be diagnostic and nerve release in the Alcock's canal area might be indicated. But that would be another question for the surgeon. I'm just speculating based on my own experience.

Can't remember -- have you tried a ganglion impar block? https://arizonapain.com/treatments/gang ... par-block/
I know -- all of these nerve blocks aren't without a bit of risk involved but if nothing else is helping and your quality of life is rotten, it might be worth a try.

Violet