Health Organization for Pudendal Education

Hi To Moderators and everyone!
I have been a member for a long time but haven't visited thia site for a quite some time.

Ive been working with a savvy PT since late 2014 ( who brought me to a certain level of relief with her work, her knowledge of the pelvic anatomy and reaassurance that I would get better
She didn't feel that I had true PN as in her countless exams I did not present like hermany other PN patients ..She was able to work on these areas on me and I didn't feel pain.

So I became much more active , going out to dinner, and various events, even the World Series! but I still cannot sit without awful pain, so I have to kneel on a cushion combo I use. .After activity I have more pain, but I bounce bck to baseline. Driving is the worst and takes longer to 'bounce back from' as the painful spot ( my anal opening is pushed on ) and I can't kneel while driving! So I rarely drive and still feel like Im stuck at home a lot and dependant on hubby and kids to drive me.. I so want my life back after years of this..

I heard about freezing the PN from a facebook friend who had pain like me and has had a considerable improvement since having the PN frozen a couple months ago.
Im going to call her to hear more about as she kindly offered her number.
I live in NJ and the doctor she saw is in Baltimore.

I am not sure my pain is from the PN or from other nerves around the area. I have posted a lot in the past, but my pain is throbbing,as if I am being hit in anal area by a baseball bat. Also after all this time , my CNS is so over-stimulated that this painful state is my norm, and my body clenches as soon as I get out of bed. I sleep fine, but the pain kicks in the moment Im on my feet ...
I believe my fear is a big component in my pain now, but it certainly didn't start my pain. I also have bladder issues (feeling of incomplete emptying . I think my gentle pushing to get the last drop out has also upset my pelvic floor as I've done this since teen years,..to feel "empty", However the anal pain is my main concern.

Just wanted to know more about freezing the pudendal nerve or any nerves in that area. To be able to sit directly without pain or even less pain would be a dream come true.
Could someone pls tell me more about this.. moderators or anyone?. I am going to call the kind person who offered to tell me her experience but since Ive been through mqny failed procedures ( over the years) I am wary of being disappointed once again.
Thx so much everyone and Happy Holidays!

Kathy,

Does your pain respond to pudendal blocks at Alcock’s Canal? I ask because I believe you only have anal pain (no perineal or vaginal pain) and some people with only anal pain have their rectal branch split off the main trunk of the PN prior to Alcock’s and that might be something to consider as the cryo is also done at Alcock’s. You can search the threads on here under “cryo” to see what has been posted.

Stephanies

Hi Stephanies
Yes my pain is only felt at rectal opening and the areas right near the opening ( the part that touches the surface most when you sit). I thankfully , don't have vaginal pain. I've had the occasional burning in the urethra a few times in a year.. Thankfully, it passes esp, if I stay calm (which is hard for me!)

I have had several blocks over the years (both guided and unguided. My former pelvic pain doc and her colleague preferred to do blocks by feeling the area, (which makes no sense to me) but most others I had were guided.
Only one block worked for me, and that was to 2 smaller nerves that are very near the pudendal. (the inferior cluneal nerve and the PFCN). That block numbed me for a few hours and was the criteria needed for a nerve re-section surgery I had with Dr Lee Dellon in 2012.. that surgery was a huge mistake! and may have been the cause of my anal pain,(before that I had sit bone pain tho!)

After that surgery, I had the same area blocked again, This time it didn't work..
When you say the rectal branch is' split off' from the main trunk of the PN prior to Alcocks, is that a procedure that is done, or it the way they are, anatomically?

Would really love to try this procedure, as my online friend had it and is sitting for over an hour at a time!! How wonderful that would be!
Thanks StephanieS in advance!
Kathy

Kathy,

There are anatomical variations of the pudendal nerve. For about half the population the rectal branch comes off the main trunk after the nerve enters Alcock’s Canal. For others, it branches off prior to Alcock’s, which would make blocks and cryo in Alcock’s ineffective. Blocks, and sometimes PRF, are given prior to cryo and if you don’t respond to the block, the doctor does not do the cryo. I had cryo after a short lived, but successful block. The cryo did not help my pain. The results seem quite mixed, as with many other treatments for PN. In reading some of your other posts, it seems like you are considering that your pain is due to muscular tension from fear of pain or stress. If you have had success with treatments geared to stress reduction or emotional work, my personal thought is not to pursue cryo because it is a procedure with risks and there are some people who have gotten worse. My best to you.

Sincerely,
Stephanies

Can the 3T MRI indicates if the rectal inferior branch splits before take the Alock way? I was recently blocked my Alock channel and despite that several parts get free of pain, my anal zone is still under pain. I guess it´s because that branch was not affected by the block. So my question would be if there´s some kind of block that can affect my rectal inferior branch in the case that it splits before the alock channel. Or maybe the impair ganglion block be helpful in my case? Clearly, painkillers can´t stop nor partially help on that anal pain. Did you try to control your pain with any kind of topical ointments? Best wishes for you.

My rectal branch could be seen very, very faintly on some images from an MRN done at John’s Hopkins. Some of the effect of a block at Alcock’s may be dependent on where the doctor places the block in Alcock’s, the distal portion or the proximal portion, i.e. before or after the split if indeed the branch comes off inside Alcock’s. I have heard some doctors say they fill the canal with the numbing agent. Maybe you can ask the doctor who did your block where it was placed or try another one?

Stephanies