Health Organization for Pudendal Education

Hi everyone,

I hope you are hanging in there. I wanted to get some opinions about pain medication. I’ve had PN for the last 3 years. It mostly affects my rectum and the area surrounding it. It constantly burns, tingles, itches and I feel pressure and itchiness when I sit. For the first 2 years, I was able to control my symptoms with amitriptyline. I got off it because of the brain fog. Then, I went to pregabilin at 50mg but it didn’t do much for me. Constipation is my enemy. Around September of last year I had a bowel movement where I bled and since then, I haven’t been able to sit without a pillow. Since then, I’ve been able to manage because I was on 600 on pregabilin but I still needed my cushion to sit. I’m currently undergoing a flare up because I had a hard stool two weeks ago. All my symptoms are back. I’ve chatted with a psychiatrist because my anxiety levels are very high due to this and I need help. He suggested that I lower the lose of lyrica and combine it with amitriptyline, doxepine, or Zoloft to see if my symptoms can improve a long with my anxiety, obviously lyrica is not covering it. Even at 600, I still have the itching sensation symptoms, they’re just not as strong. I’m looking to get some opinions. Amitriptyline worked for me but unfortunately sometimes it would not allow me to digest food properly. Doxepine, I hear is similar to Amitriptyline and is good for itching. Zoloft is not related to nerve condition but it would only address the anxiety part. I’m not really sure what to do…. I just want my symptoms to improve. I’ve tried Botox and 2 nerve blocks and I’m also currently in PT. I might get Botox or never blocks again but in the meantime, I really need to figure out my medicine so I can get the most benefit.

Have you tried any topical creams like calmoseptine or capsaicin? I had really good luck with capsaicin for vaginal itching caused by pudendal neuralgia. It works by desensitizing the nerve endings. I used the soothenol brand but there are lots of different brands and types of creams. It burned a little bit when applied but then it calmed things down so I could go to sleep. Here is a peer reviewed article about it:
https://pmc.ncbi.nlm.nih.gov/articles/PMC1773800/

Interesting! Thank you Violet. I have not heard of these but I will look into Capsaicin. I’m using recticare now which has 5% lidocaine but sometimes it’s not enough for the itching. Did you ever use recticare, if so how did it compare to Capsaicin? If not, did you ever use any other ointments or medications?

I didn't use recticare. The itching I had was primarily vaginal so I used vagicaine (walmart's brand of extra-strength vagisil) that contained 20% benzocaine. Similar to lidocaine but not exactly the same. It was over-the-counter. It was helpful for pain. For itching, capsaicin was more effective.

Violet

Farce6537,
Maybe an unusual recommendation but it's affordable, low risk, and no prescription required, so here you go: I buy herbal sachets and make a "tea" (but don't drink it) and then pour some on to women's maxi pads, then freeze, so you have an herbal "pad-sicle" to apply between the legs, while lying in bed on a towel. Other times I just pour the warm tea on the pad and apply warm, and actually think I prefer it that way. Whatever herbs are in these sachets are especially soothing and calming for pains and itches down there.

I imagine you could do something similar with other herbal tea bags, but these are the ones I use:
https://www.amazon.com/Earth-Mama-Organ ... GQSHQ?th=1.
https://earthmamaorganics.com/products/ ... CgQpkiV_iO

They are actually meant to be used in a Sitz bath, but it's more convenient for me to use the pad method. I started using these while recovering from a pelvic surgery, and find it does reduce my need for oral meds when I'm in a bad flare.

Hi Farce,

I'm so sorry to hear about all your symptoms. I wanted to add a recommendation to what others have listed: I strongly recommend a stool softener. I was always on that when I was on pain meds (I varied the number I took with the pain medication dose but I think I usually took several a day), and I was given a prescription for it, making them substantially cheaper than the OTC. So, I would see if your doctor can give you a prescription for that.

I was also going to recommend lidocaine cream but then read that you've already been trying that. I got that as a prescription too, so you could check on getting it that way too.

Take care,
April