I have been having pain in my sacrum that is debilitating. I believe I injured myself on a bicycle and the pain originated the the area of my pudendal nerve. I now have terrible sit pain and I can't stand for very long. My symptoms have progressed over five months with no end in sight. Is it possible that my pudendal nerve is responsible? I had a 3T Mri and it showed no entrapment on any nerves. I have seen a pain guy and have had some shots with no releif.
Thanks
sacrum pain
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HerMajesty
- Posts: 1134
- Joined: Sat Sep 18, 2010 12:41 am
- Location: North Las Vegas, Nevada
Re: sacrum pain
I had SIJD (sacroiliac joint dysfunction, which includes a variety of possible patterns including sacral torsion) and sacral Tarlov cysts; and both frequently cause sacral pain with or without pudendal neuralgia, so it is worth getting checked for both.
Getting checked for SIJD is a hands-on process, not a medical test. You need to find a PT trained to assess for SIJD. Some of the pelvic floor PT's listed on this website are trained in SIJD; other good bets are PT Manual Therapists or Sports PT's.
Getting checked for Tarlov cysts involves asking a Radiologist to look for them on your existing MRI; they will show up on the 3T you already had but might have been ignored by the radiologist. This is because many Radiologists have been trained that Tarlov cysts are "artifact", but they can in fact cause pudendal neuralgia by crowding out and compressing the sacral nerve roots. Symptomatic Tarlov cysts cause sacral pain in the majority of cases.
Also do keep in mind that using the 3T MRI as a tool to find pudendal entrapment is a fairly new technology and an MRI that does not find any entrapment does not necessarily mean that there is no entrapment - there are no studies on this. When cyclists get PN it is often due to scarring / entrapment in Alcock's canal. I don't know how that would fit in with the sacral pain though.
Getting checked for SIJD is a hands-on process, not a medical test. You need to find a PT trained to assess for SIJD. Some of the pelvic floor PT's listed on this website are trained in SIJD; other good bets are PT Manual Therapists or Sports PT's.
Getting checked for Tarlov cysts involves asking a Radiologist to look for them on your existing MRI; they will show up on the 3T you already had but might have been ignored by the radiologist. This is because many Radiologists have been trained that Tarlov cysts are "artifact", but they can in fact cause pudendal neuralgia by crowding out and compressing the sacral nerve roots. Symptomatic Tarlov cysts cause sacral pain in the majority of cases.
Also do keep in mind that using the 3T MRI as a tool to find pudendal entrapment is a fairly new technology and an MRI that does not find any entrapment does not necessarily mean that there is no entrapment - there are no studies on this. When cyclists get PN it is often due to scarring / entrapment in Alcock's canal. I don't know how that would fit in with the sacral pain though.
pelvic pain started 1985 age 14 interstitial cystitis. Refused medical care from age 17, did GREAT with self care for years.
2004 PN started gradually, disabled by 2009. Underlying cause SIJD & Tarlov cysts
improved with PT & meds: neurontin, valium, nortriptyline, propanolol. (off nortriptyline & propanolol now, yay!)
Tarlov cyst surgery with Dr. Frank Feigenbaum March 20, 2012.
Results have been excellent so far; but I won't know my final functional level for a couple of years.
2004 PN started gradually, disabled by 2009. Underlying cause SIJD & Tarlov cysts
improved with PT & meds: neurontin, valium, nortriptyline, propanolol. (off nortriptyline & propanolol now, yay!)
Tarlov cyst surgery with Dr. Frank Feigenbaum March 20, 2012.
Results have been excellent so far; but I won't know my final functional level for a couple of years.
Re: sacrum pain
To: thecatch24,
Sadly I can relate to exactly what your going through with the low back sacrum related pain. It is very debilitating, I can't sit for long, I can't stand or walk for long, and it even hurts to lay down as the day wears on.
I have a very complicated case brought on from the childbirth of my Son (4th degree laceration she repaired right in the birthing room), but my PNE symptoms didn't present theirself until 4 years later and came on suddenly one afternoon out of nowhere. I've been suffering with extreme chronic low back pain, 2 rectal prolapses (2 surgeries to repair them), rectocele, pins and needles in my low back and perineal area (mostly rectal) which runs down my legs into my feet at times, burning, stabbing, sharp lightning bolt pains shooting down my legs, extreme weakness in my low back, knees, and legs, just way to much to list as the list can go on for quite a long time.
Before my first rectal surgery I did have a Pudendal Nerve Motor Latency Test (PNMLT) and it did determine that my nerves were transmitting slower then average and my surgeon said that showed I had some type of nerve damage. He also did a rectal exam and pressed on my low back area and was able to recreate the pain and said he believed I had PNE. I live near Chicago so I haven't been able to find any Doctors who know or understand this and I've been living between different doctors, neurologists, and pain management specialists for the last 8 years. I haven't been able to work since 2009 and was laid off (basically fired) because of all my medical conditions and doctor appointments and these doctor bills are eating all our savings away. I'm at my ropes end in all this and pray to God above a miracle doctor will come from above to Chicago and treat the PNE patients.
I hope your finding some relief since you posted this and feeling better.
Sadly I can relate to exactly what your going through with the low back sacrum related pain. It is very debilitating, I can't sit for long, I can't stand or walk for long, and it even hurts to lay down as the day wears on.
I have a very complicated case brought on from the childbirth of my Son (4th degree laceration she repaired right in the birthing room), but my PNE symptoms didn't present theirself until 4 years later and came on suddenly one afternoon out of nowhere. I've been suffering with extreme chronic low back pain, 2 rectal prolapses (2 surgeries to repair them), rectocele, pins and needles in my low back and perineal area (mostly rectal) which runs down my legs into my feet at times, burning, stabbing, sharp lightning bolt pains shooting down my legs, extreme weakness in my low back, knees, and legs, just way to much to list as the list can go on for quite a long time.
Before my first rectal surgery I did have a Pudendal Nerve Motor Latency Test (PNMLT) and it did determine that my nerves were transmitting slower then average and my surgeon said that showed I had some type of nerve damage. He also did a rectal exam and pressed on my low back area and was able to recreate the pain and said he believed I had PNE. I live near Chicago so I haven't been able to find any Doctors who know or understand this and I've been living between different doctors, neurologists, and pain management specialists for the last 8 years. I haven't been able to work since 2009 and was laid off (basically fired) because of all my medical conditions and doctor appointments and these doctor bills are eating all our savings away. I'm at my ropes end in all this and pray to God above a miracle doctor will come from above to Chicago and treat the PNE patients.
I hope your finding some relief since you posted this and feeling better.