Results from 3t MRI from Dr. Potter: feedback appreciated!

[John1089]

Hey guys. So just to clarify, my main complaints are numbness/lack of sensitivity in the shaft and glans of my penis. Pain is not much of an issue.

Most of the findings were normal, but here is an excerpt of the report which details potential problems:

"The sacrospinous and sacrotuberous ligaments are symmetric. There is no entrapment of the pudendal nerves within Alcock's canal. There is mild asymmetry of the levator ani muscle. There is asymmetric scarring of the right superficial transverse perineal muscle which may cause entrapment of the inferior perineal branches of the pudendal nerve distribution."

Another small problem was "coccyx is minimally deviated to the left". Could that be causing pelvic floor problems?

There is some other stuff, such as mild hip synovitis and possibly postural related inflammations, but above is the details on the pelvic floor.

My main question: could this asymmetric scarring of my superficial transverse perineal muscle cause entrapment of the dorsal branches of the pudendal nerve leading to my penis? (causing numbness etc..) My urologist (who is not very familiar with the 3t mri and these results and wants me to follow up with dr. potter) said that entrapment of the inferior perineal branches would only cause problems in the lower anal area, of which I have none.

The end of the report notes that there is also "no scarring identified along the course of the dorsal nerves to the penis". So that was encouraging. But still, I feel like Im left in the dark about what may be causing my problems of numbness/decreased sensitivity? Maybe it is too small to pick up on an MRI/MRN?

Anyways, I will be seeing Dr. Potter sometime within the next two weeks to get further clarification/recommendations, but in the meantime, what do you guys think? Has anyone had success with dissolving internal scare tissue without surgery?

Thanks!

[helenlegs 11]

The problem being John1089 that this type of imaging is still in it's infancy. Not to say that it is not helpful, just that it is only helpful if something does show to explain the problem(s) and there are many people who have reported a scan which shows nothing much to explain pudendal problems.
These scan are always worth trying as long as you don't expect an ultimate answer. So yes to one of your questions. . .it can (and often is, perhaps?) the case that not everything can register on a scan to explain pudendal symptoms. . . yet??
However saying that, I'm not sure that your urologist is completely correct about the anal region only being affected by the inferior perineal branches. Take a look at this vid http://www.youtube.com/watch?v=xym2gly5lBQ The pudendal nerve is not explained until 7.42 mins in btw (pudendal artery before that) but the inferior perineal branches supply the superficial perineal pouch and muscles within that (so that ties in with the asymmetric scarring seen there which i think is past the perineum innervation so wouldn't cause a problem there or anally?? as nerve problems are found distal to a problematic area)
Saying that, a problem with the dorsal branch would seem a more likely pathology for the numbness you describe (what do others think?) But any pelvic nerve/muscle problem is sometimes prone to a 'wind up' or knock on effect (as many of us know) so etiology is not always reflected in the (perceived) main or only symptoms, which is altogether unhelpful!! Also tho',the full extent to innervation does not end at the exact point of the main nerve or even the branch of that nerve, as branches then branch off too.
Please any and all, correct me if I am wrong, as I am only going off what I have learnt here and via internet.

Because you don't have pain it is a difficult one as reproducing pain symptoms can aid a clinical examination but probably not in your case.
What about a pelvic PT examination to find tight muscles?

Hope you get some answers.
Take care,

Helen

[John1089]

Thanks for your feedback helen!

Yeah, I feel like the report is indicating that there could be *possible* entrapment but that it specifies that could lead to all areas of inferior perineal branch distribution.

You also mentioned the "knock on" or "wind up effects" synonymous with pelvic floor problems. Definitely familiar with that. I was thinking maybe this scar tissue could be causing tightness elsewhere in my PF muscles and that could maybe be causing minor entrapment of the upper dorsal nerves (causing numbness, etc).

In this light, I have actually had many appointments with pelvic floor therapists in the past to work on loosening up and correcting tight PF muscles. I now mainly do all self-work at home, both internally and externally with trigger points, because of money reasons. I think I should go see my PF therapist though, in light of these new test results.

I have also been doing some research about ways to dissolve internal scar tissue. Of course there is massage etc, but I also found two supplements: Avogen and serrapeptase. Both deal with breaking up fibrin in scar tissue and both have testimonials from a number of people claiming success. I'd be interested to know if anyone else has had success breaking up internal scar tissue naturally?

Thanks!

[Mod 10]

There is also ESWT although Electric Shock Wave Therapy can't be described as 'natural'!
You can find out about it from Dr Kirk Andrews in Cornwall, Ontario Canada.
Seemingly this therapy has worked for some. . . . but not all. I can't really comment further than saying it is available, although I would try it if it was more geographically and financially viable; but then I know that I do have scar tissue, so it would always be worth trying in my case.

[John1089]

Hi Mod, thanks.

There is definitely scar tissue. The report states it specifically. It just says there *might* be entrapment caused from it. But the scar tissue is definitely there.

I will look in to ESWT. Is it important its done with that doctor, because I believe I have seen it offered @ other facilities which are local to me in NY.

[Violet M]

The deviated coccyx and other asymmetries may suggest some pelvic misalignments -- which would not necessarily show up on an MRI. Have you been evaluated by a PT yet? There are some excellent ones in NYC. I realize your history doesn't necessarily suggest structural abnormalities but hey, some of these we are born with and problems don't show up until they are triggered by something.

Violet

[John1089]

Hi violet.

I have actually seen multiple pelvic floor therapists in the NY area. One was actually at Amy Stein's office in the city and the other is one she recommends up closer to where I live upstate. I have had internal and external work done. I do mostly home work (due to $$ reasons), internally and externally with trigger points/stretching, but I think Im going to go see my PF therapist in light of this test. Now she will have somewhat of a map to work with for problem areas..

[Violet M]

So did PT help at all? If not, you are probably right about not wasting the $$$. Did the PT's think you were entrapped?

If you have small fiber neuropathy obviously a nerve release surgery isn't going to help so I can understand why you are wanting a definite diagnosis but unfortunately, there is no way yet to definitively diagnose PNE with 100% accuracy. Some of the docs say they don't know for sure until during surgery.

Violet

[John1089]

To be honest, no, the PF therapy has not helped with the numbness. My therapists couldnt really give me a definitive answer on whether there was some kind of entrapment or nerve damage (which makes sense, as they cant say 100%), but they never ruled it out.

I did have some success in loosening up my PF muscles and bringing them back to balance with my sessions, but still not definitive answers on what could be causing the numbness, which is definitely driving me crazy a bit.

[AlBrown]

John,
For what it's worth I have the same symptoms as you and also had this show up on my Potter MRI. Whether it is the cause or not is debatable but I did hit the area pretty hard with various medical professionals including a few pelvic floor PT's to no avail. May try the Cornwall route down the road.