Pudendus Neuralgy after hemorrhoid sclerotherapy?

[groberg]

Hello there, im 24 years old and i just bumped into this Website and heard of this disease for the first time.Im wondering if i may have it. That is my story:

Over a year ago, i went to a doctor because i had a skin issue on my butt which was 100% related to using way too much soap in that area. The doctor wasnt just prescripting me a cream, he did also a sclerotherapy on my 1. grade internal hemorrhoids without letting me know that in advance. what an idiot! i didnt want that!. moreover that was not causing the skin issue. at that time the skin issue wasnt really noticeable in terms of bothering.
Anyway, at the same evening after the sclerotherapy i experienced extreme burning at my anal area for a short period of time. After that, i developed severe nearly permanent pain at my sphincter. That pain includes burning, itching and maximum oversensitivity. It feels always like an open wound, especially when i walk. I have all these symptoms eventhough proctologists and dermatologists say everything looks very fine and they dont know how they can help me. i used steroid creams, made blood tests and bacterial, fungus, tests. but literally nothing makes it better. that medication name, i got injected is called polidocanol and it has tons of sideeffects and is known to be toxic. i cant believe one single injection destroyed my life since 1 year. so much unspeakable pain because of that...
I just want to share my story here, and i know it sounds cruel but it is as it is. i appreciate opinions here. be careful, cheers.

[Violet M]

Hi Groberg,

I am really sorry to hear that this procedure caused you increased pain.

You could try some nitrogycerin suppositories for pain relief. https://www.webmd.com/drugs/2/drug-1592 ... al/details

For healing and pain relief you could also do alternating hot/cold sitz baths at least for times a day if possible. I did this for months after my PNE surgery and I believed it helped the nerves to heal. You sit in very warm water 2 minutes, then in very cold water for 30 seconds alternating back and forth 4 times. This brings fresh blood to the area and takes away toxins and is also very soothing. It helps relax the pelvic floor muscles as well.

You could also try a compounded cream with drugs like ketamine, baclofen, and gabapentin. Have you tried valium suppositories?

Just brainstorming here. Hope you find something that helps.

Violet

[groberg]

thanks for your input...
i havent tried any of the drugs yet but i have been to the neurologist today and he said that he is certain, that its a sensory nerve damage of small nerve branches around the sphincter. by the way i forgot to mention in the last post, that i have also a numbed area close to my pain area.
his main suggestion in terms of treating the pain is using chinese medicince accupuncture.
besides drugs like epileptica, which he didnt recommend because of sideeffects, there is nothing really school medicine can do about it as he said.
i´ll give tcm a try and if i have tremendous success with it, i will tell here...
otherwise i see another neurologist.
im really sceptical but i hope really bad this is going to fix it.
cant live for the rest of my young age in pain because of ONE injection. this is just ridiculous.

[Violet M]

If it is small fiber neuropathy that would be even more reason to do the sitz baths for healing, I think. I'm surprised your doctor did not suggest something like lyrica for the pain. I did not have any success with acupuncture but I think it is worth a try and I wish you luck with it.

Violet

[harrydone]

Hello there,

I found this forum entry after a google search of my treatment and the following complications.

After sclerotherapy for hemorrhoidal disease, I experienced starting pain after about half an hour after the procedure. This pain has been alternating with discomfort (paresthesia) for six weeks now. It is in the area of the anus or sphincter and in the area of the urethra. The painkiller Tramadol does not help with the pain. My proctologist was unable to find a cause. Could my pudendal nerve or one of its branches be damaged, compressed or inflamed?

I hope that Groberg is feeling better now. I would be very happy to hear about experiences and treatment recommendations.

[Violet M]

Hello Harry,

The inferior rectal branch of the pudendal nerve innervates the external anal sphincter, and the perineal branch of the pudendal nerve innervates the external urethral sphincter. Since your pain is in those areas you could potentially have some pudendal nerve irritation, but the goal would be to find out what is the cause of the nerve being irritated. You would probably need some diagnostics to figure that out. If you can find a pudendal neuralgia specialist in your area that would be a good place to start. A pelvic MRI might show if there is some scar tissue or some other obvious problem causing your pain. You could try seeing a pelvic floor physical therapist for an evaluation of the pelvic floor muscles to see if they are in tension. You might consider a pudendal nerve block for diagnostic purposes, especially if the pain is severe but once you start doing invasive things, there is a slight risk involved.
Some major medical organizations just came out with guidelines that say there is no evidence for steroids in pudendal nerve blocks, so I see them as primarily having diagnostic value with the use an anesthetic like marcaine to see if it gives several hours of temporary pain relief.

You could consider some topical rectal ointments for rectal pain relief if your physician says you are allowed to use them since having surgery.

Violet

[harrydone]

Hello Violet,

thank you very much for your very detailed message!

I hope that your assumption is correct and that it is just a nerve irritation. I will do a pelvic MRI.
I will try to avoid a nerve block for diagnostic purposes for the time being. In addition, I am currently using an amitriptyline 4% ointment and I am now taking pregabalin.

I am still wondering whether there is a technical term for my recurring discomfort (beside my pain)? It mainly occurs at rest and feels like an internal movement that occurs at intervals of seconds (if present).

[Violet M]

I hope that your assumption is correct and that it is just a nerve irritation.

Sorry, I didn't mean to say I am assuming it is just nerve irritation. I meant to say that is a potential possibility, but the location of your symptoms indicate that it could potentially be the pudendal nerve.

I don't know what you would call the discomfort you are experiencing -- maybe neuralgia? Would you describe the discomfort as shooting pain, or just a feeling of something moving with no pain? Either way, it could be a nerve misfiring.

This article, written by a neurologist (MD) explains what neuralgia is. If you scroll down a bit to the symptoms of neuralgia, it describes the different symptoms that can be associated with neuralgia.

https://www.verywellhealth.com/neuralgia-8671886

A lot of websites describe neuralgia as severe shooting pain, but really it can present in many different ways as described in the article, including numbness, tingling, or electric shocks, pain, weakness, and hypersensitivity.

Regarding nerve blocks, there can also be a risk of waiting too long to get treatment if something like a decompression is needed, so you have to weigh the risks and benefits of taking a wait and see attitude vs. pursuing treatment aggressively. It is always a difficult choice. Praying for you to have wisdom as you figure all of this out.

Violet