Hello, I wanted to share my case to see if anyone can give me a clue, please.
I am a 35-year-old man and I have been suffering this hell for the past 3 years.
It all started a few months after I began working as a driver, sitting for many hours, but the first strong pudendal pain I felt was while defecating. Suddenly, I felt a horrible burning pain in the anus that made me jump off the toilet, radiating to the penis.
I started having constant urges to urinate, my penis became hard and retracted in a flaccid state, and erections became difficult to achieve, tense and incomplete due to lack of relaxation of the corpora cavernosa (today I know this is called Hard Flaccid), anal pain when sitting, and a strong urge to ejaculate very quickly.
This lasted for 3 months and then, surprisingly, everything improved. The anal pain disappeared, my erections were perfect, and everything went back to normal.
8 months later, for no apparent reason, the nightmare returned — all the same symptoms — and from that moment on, I never improved again. 3 years have passed since that day.
My pudendal pain is clearly on the right side, from the anus radiating to the right corpus cavernosum.
I have had 2 MR neurographies of the pudendal nerve. In one of them, they reported increased signal and enhancement after intravenous contrast administration in the area of the right Alcock’s canal.
I have tried everything:
All kinds of exercises, stretching, DCT, labrum repair surgery in both hips without success. Later, investigating possible pelvic congestion, I underwent a venography and had pelvic veins embolized, with no positive effect.
I had an injection of 100 units of Botox in the obturator internus muscle with no effect at all. A CT-guided lumbar block also had no effect, which makes sense because my pain is very clear… inside the anus on the right side, in the area of Alcock’s canal.
I had 3 right pudendal nerve blocks at different times with lidocaine and corticosteroids, guided by CT into Alcock’s canal. They always produce the effect of greatly improving the completeness of my erections. The corpora cavernosa relax and can expand much more, and the pain decreases significantly as well.
So I decided to undergo right pudendal nerve decompression surgery via transperitoneal laparoscopy exactly 4 months ago, and I have not noticed any positive effect of any kind.
The surgery was performed by a neuropelveology surgeon with a lot of experience in this procedure in my country.
He said he cut the right sacrospinous ligament to release the nerve and also sectioned the fascia of the obturator internus muscle to fully release Alcock’s canal.
After 4 months, I feel the pain is somewhat worse than before surgery. I have no nocturnal erections, after defecating I have burning pain for many hours, and the penis remains in that hard, retracted state to the touch. I have frequent urges to urinate, and when I do, it burns. My anus/perineum hurts.
It is extremely frustrating.
Pelvic floor therapy, which in my opinion is overrated, makes me worse or does absolutely nothing.
I continue doing stretching consistently, yoga positions, and relaxation.
I notice that when I raise the leg on the affected side and rest it on a high table, stretching the obturator internus muscle on that side, and bring the leg toward my chest, the pain often decreases and the penis becomes soft. It only lasts a few seconds and doesn’t solve anything.
This has completely ruined my sexual, social, work, and family life, and I am constantly wondering whether it is worth continuing like this, losing my youth and the possibility of forming a family.
I am always thinking about whether the surgeon really released everything as he said. He also told me that the way he released it means it won’t be compressed again and there will be no fibrosis of the obturator fascia.
He showed me a video of the surgery, but I didn’t understand much of what I was seeing.
I don’t have many options left other than continuing with yoga positions.
He recommended another CT-guided block with corticosteroids and anesthesia, but I don’t want to receive more radiation — it’s been too much.
I keep thinking that the nerve may still be compressed, despite variations in symptom intensity, Hard Flaccid, and changes with stretching, rest, or positions.
I believe my surgery was in vain.
What do you recommend I do?
Thank you very much and best regards to everyone.
34M, Lap surgery, right Alcock canal 4 months ago. Pain, hard flaccid, urinary urgency.
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HardCowboy33
- Posts: 3
- Joined: Sun Jul 16, 2023 2:32 am
Re: 34M, Lap surgery, right Alcock canal 4 months ago. Pain, hard flaccid, urinary urgency.
Hello Cowboy,
The recovery from surgery can be difficult, especially when you don' t know which direction things are going to go. It is not unusual to have an increase in pain during the 3rd and 4th month. I was not able to resume walking until 5 months post-op and then I just started with 5 minutes a day. I had to take narcotics until 9 months post-op. So, this is not to say with 100% certainty that you will see improvements, but before you do anything major, you might want to give it a little more time to see if things will slowly improve. In the meantime you can do some things that relieve pain like alternating hot/cold sitz baths, especially after a painful BM, and avoiding things that cause flare-ups like sitting and PT. I could not tolerate pelvic floor PT until almost a year post-op and I couldn't sit much until 18 months post-op. You can try some topical ointments, creams, or sprays, like Premjact spray, or ointments containing lidocaine or benzocaine. I expect you are already using some oral meds which can also be helpful.
Regarding a post-op nerve block using corticosteroids, there are new guidelines out by some major medical organizations advising that there is no evidence for pudendal nerve blocks with steroids. So I see pudendal nerve blocks as primarily diagnostic and I agree with you about avoiding the radiation.
Not sure if it's available in your country but I did some hyperbaric oxygen treatments post-op. There was some literature showing that it could be helpful in healing nerves so my insurance paid for half of it, but I was advised by Dr. Antolak that if the nerve was still entrapped it would likely be a waste of money so I waited until after decompression surgery.
About a year out from surgery I used a TENS unit for the piriformis and obturator internus muscles to relieve pelvic floor tension -- about 2 hours a day as advised by my PT. I felt like it was helpful.
Those are a couple of suggestions. Hopefully some other members will have some ideas. Wishing you the best with your recovery.
Violet
The recovery from surgery can be difficult, especially when you don' t know which direction things are going to go. It is not unusual to have an increase in pain during the 3rd and 4th month. I was not able to resume walking until 5 months post-op and then I just started with 5 minutes a day. I had to take narcotics until 9 months post-op. So, this is not to say with 100% certainty that you will see improvements, but before you do anything major, you might want to give it a little more time to see if things will slowly improve. In the meantime you can do some things that relieve pain like alternating hot/cold sitz baths, especially after a painful BM, and avoiding things that cause flare-ups like sitting and PT. I could not tolerate pelvic floor PT until almost a year post-op and I couldn't sit much until 18 months post-op. You can try some topical ointments, creams, or sprays, like Premjact spray, or ointments containing lidocaine or benzocaine. I expect you are already using some oral meds which can also be helpful.
Regarding a post-op nerve block using corticosteroids, there are new guidelines out by some major medical organizations advising that there is no evidence for pudendal nerve blocks with steroids. So I see pudendal nerve blocks as primarily diagnostic and I agree with you about avoiding the radiation.
Not sure if it's available in your country but I did some hyperbaric oxygen treatments post-op. There was some literature showing that it could be helpful in healing nerves so my insurance paid for half of it, but I was advised by Dr. Antolak that if the nerve was still entrapped it would likely be a waste of money so I waited until after decompression surgery.
About a year out from surgery I used a TENS unit for the piriformis and obturator internus muscles to relieve pelvic floor tension -- about 2 hours a day as advised by my PT. I felt like it was helpful.
Those are a couple of suggestions. Hopefully some other members will have some ideas. Wishing you the best with your recovery.
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: 34M, Lap surgery, right Alcock canal 4 months ago. Pain, hard flaccid, urinary urgency.
I suspect waiting must feel like a lifetime and frightening. I hope soon you will get some reassuring signs in order for you to be hopeful.
As Violet has said nerve blocks should be thought of as purely diagnostic and are not helpful, even from a pain management perspective as they have to be repeated so often. I don't understand why a CT guided block was recommended, for most patients ultrasound will suffice. I agree with you in relation to unecessary radiation exposure.
Two other options, could be alternative or stronger pain medication or you could even try pulsed radiofrequency treatment. Pulsed radiofrequency didn't work for me but for some people it provides lasting relief.
Good luck!
As Violet has said nerve blocks should be thought of as purely diagnostic and are not helpful, even from a pain management perspective as they have to be repeated so often. I don't understand why a CT guided block was recommended, for most patients ultrasound will suffice. I agree with you in relation to unecessary radiation exposure.
Two other options, could be alternative or stronger pain medication or you could even try pulsed radiofrequency treatment. Pulsed radiofrequency didn't work for me but for some people it provides lasting relief.
Good luck!