Obturator Internus

[Ashley2486]

Hello,

I have been going to physical therapy for the last month and she has me doing stretches and walking. Yesterday I went to her and she found the muscle that is giving me my issues. Its the obturator internus on my right side. She says its very tight. She did some mysofacial release on that muscle yesterday after she dry needled the muscle.
My question is if my obturator internus muscle is the culprit to my issues, does that mean I have PN? She says I dont have it because I dont have much pain with sitting and she said im not in horrible pain when she presses on the Alcock's canal area... That muscle is giving me some aching when sitting, but I am not getting the sharp pains or burning in my vulva anymore since starting physical therapy. My biggest issue is with my bladder...I feel like I have bladder retention. It comes and goes. It feels like i am never relieved of that pressure...but it comes and goes. It isn't all the time. My physical therapist says the tight muscle could just be irritating that nerve.
Does it sound like I have pn or is it just issues with my bladder because of that tight muscle? Because I know that can press on the bladder too and cause issues.

[DakotaGirl]

How does one dry needle the obturator internus? That muscle is your internal hip rotator and it's kind of inside up high. I have obturator issues due to a labral tear, fai impingement and l-4l5 s1 herniations and arthritis.
I had dry needling done on the l4 area and piriformis yesterday with internal manual massage on the OI. How do they dry needle the OI?
And yes the PN is affected by the OI becasue I do get symptoms on the right side of the vaginal wall, urethra etc from it.
Some of the pain is also radiating down from the lower back. Most of my symptoms are urological in nature too.

[Ashley2486]

I'm not sure how she got to it dry needling, but I do know she got to a muscle that was causing me pain. To dry needle the OI she had me lay on the side of my pain, with that leg stretched straight out. She went through the bottom that way. She also went in through the front and dry needled. I'm not sure about the areas she did honestly. She did some massage internally afterwards and it was sore. I have very mild pain and even when she massages internally I'm not in a ton of pain at all. I honestly don't think I have PN. Wouldn't I be in more pain? I think the muscle is just tight. Idk how much the stretches are really helping tho. I'm just sick of these urine issues. They come and go.

[Ashley2486]

Dakotagirl do you have PN? Or PFD?

[stephanies]

Ashley,

It is a good sign if PT is helping your vaginal pain. The obturator muscle runs quite close to the PN and if pressure on that muscle increases your symptoms, it might be that your nerve is irritated. If so, it is tricky to figure out if muscle tightness is causing nerve irritation (which may be contributing to your bladder issues) or maybe you have the muscle tightness from the nerve sensitivity. Hope you keep making progress in PT and are soon relieved of your symptoms!

Stephanies

[DakotaGirl]

Ashley
I have Pfd with some aspects of pn I was told. My symptoms are urethral and urological. Pain around the urethra upon slight touch which is the nerve I think but maybe the nerve is compressed. I don't know anymore. They say my pelvic floor is very tight.

I just keep going to pt and it seems to help with the terrible feeling of pressure pain and frequency.

I did have blood in urine at my uro-gyn visit recently so a cystoscopy is planned to rule out anything. I do have mast cell IC also.

[Violet M]

My question is if my obturator internus muscle is the culprit to my issues, does that mean I have PN? She says I dont have it because I dont have much pain with sitting and she said im not in horrible pain when she presses on the Alcock's canal area... That muscle is giving me some aching when sitting, but I am not getting the sharp pains or burning in my vulva anymore since starting physical therapy. My biggest issue is with my bladder...I feel like I have bladder retention. It comes and goes. It feels like i am never relieved of that pressure...but it comes and goes. It isn't all the time. My physical therapist says the tight muscle could just be irritating that nerve.
Does it sound like I have pn or is it just issues with my bladder because of that tight muscle? Because I know that can press on the bladder too and cause issues.

According to physicians who are experts on pudendal neuralgia, pudendal neuralgia is neuropathic pain in the distribution area of the pudendal nerve. https://www.glowm.com/section_view/head ... /691#intro
So if you have a pudendal nerve that is irritated by the OI muscle and you have neuropathic pain in the distribution area of that nerve, then you have pudendal neuralgia. The bladder sphincter is in the distribution area of the pudendal nerve. One of the possible symptoms of pudendal neuralgia is urinary retention, the feeling of never feeling empty, or the feeling of constantly needing to go, because your pudendal nerve innervates the bladder sphincter.

There are many different causes of pudendal neuralgia. If your obturator internus muscle is tight and is pressing on your pudendal nerve and causing the pudendal nerve to be irritated then you have pudendal neuralgia caused by the obturator internus impinging on the pudendal nerve. It can be difficult to determine from physical exam whether the pain is coming from the muscle or the nerve. So, I'm not saying for sure you have neuropathic pain due to the tight OI muscle impinging on the nerve. But if as your PT says, the OI muscle is impinging on the pudendal nerve and causing nerve pain, then by definition you have pudendal neuralgia.

There are many different things that can cause pudendal neuralgia (PN). A tight obturator internus is only one of the things that can cause PN. An enlarged obturator internus can cause PN. Nerve damage due to herpes can cause PN. Pudendal nerve entrapment (PNE) can cause PN. Nerve damage from multiple sclerosis or lyme's disease can cause PN.

Pudendal nerve entrapment is only one of the things that causes pudendal neuralgia. You can have pudendal neuralgia without having increased pain with sitting. In the early stages of my PN, I had little to no pain with sitting. If you have pain in the distribution area of the pudendal nerve with sitting, then according to the Nantes team criteria for PNE, then you might have pudendal neuralgia that is caused by pudendal nerve entrapment. http://www.pudendalhope.info/sites/defa ... iteria.pdf So, I think it's a good thing that you don't have much pain with sitting, and that PT is helping, because that could be an indication that you don't have PNE, hopefully.

Violet

[Ashley2486]

Is it possible to just have issues with my obturator internus being too tight and causing my bladder issues without having the nerve impinged? I have done a little research and it sounds like there have been plenty of people with PFD with tight OI muscles but didn't have PN.

[DakotaGirl]

Anything seems possible with this because nerves and muscles are intertwined and complicated. If you are asking whether it will improve or not, I vote that through the tincture of time it will.
And it can also be tweaked in the wrong way as I have found out with both my hip and back setting the frequency off again.

[Ashley2486]

When I walk and do my stretches, my urine symptoms tend to get better. I just don't know why it's not releasing entirely. Does it just take some time sometimes??