Bautrant_MRI 3TTesla

[Alessandro76]

Hy guys,
,
I made the famous MRI 3T tesla, where it was highlighted, strong contractions the muscles involved are transverse muscle and all coccyges muscles, fortunately the nerve was not damaged and / or compressed.
I have done the visit with Dr. Bautrant in Aix this April, and he totally excluded, a neuropathy, indeed, confirmed a syndrome myofascial the muscles involved are the bulbocavernosus , transverse and coccyx muscles

I noticed that after an intense sexual activity I feel pains exactly to the bulbocavernosus / perineum area and I feel pain /tension for days ( bulbocavernosus muscle innervated by the pudendal) and this makes me go in paranoia.

is there anyone who has the same symptomatology? andcan give me some advice?
is there anyone lives in London recommend a good physiotherapist?

thank in advance for any kindly reply

Ale

[April]

Hi Ale,

That's great that Dr. Bauntrant could rule out pn. There are some London physical therapists listed under the UK and Ireland link for PTs on the home page: http://www.pudendalhope.info/node/60#UK_and_Ireland. There are also London doctors: http://www.pudendalhope.info/node/57#UK.

April

[Violet M]

Some guys use a therawand to do self myofascial release of the muscles. You might want to read David Wise's book A Headache in the Pelvis. You could also try a TENS unit. You would need your PT to show you how to use it. I found a TENS unit to be really helpful in getting the pelvic floor muscles to relax. My PT recommended using it 2 hours a day.

So, I wonder what is causing those muscles to be in spasm. Hopefully you can find a PT or manual therapist who can do an evaluation of your posture, pelvic alignment, and sacroiliac joint function. You could also try alternating hot/cold sitz baths to relax the muscles, especially after having sex since that is what flares it up for you. Here is the link to how you do that. http://www.pudendalhope.info/forum/view ... =25&t=5267
Some people have had success with Restorative Exercise by David McCoid. You can google it.

You could also do a search on this forum on Ezer's posts about the mindbody approach. Just trying to brainstorm ideas.

Take care,

Violet

[Alessandro76]

Hi Violet,

Thank you for your reply, you are really precious for this forum
I must say that my physiotherapist uses the stanford protocol.
I have started again to have long sessions of hydro massage in a hot poll, practically I put the perineum in contact with the jet of water ( 5/8 minutes )and this has always given me great benefits.

I can not tell you if my issue is generated by having sex for long time or muscle spasm due to it,( Bautraunt says that the muscles contracted in my situation are the sexual muscles) or doing fitness (without absolutely training the legs).
I usually feel the perineal tension after a long sexual intercourse, not only, I can not even reach orgasm and I have to stop me because I'm tired, (and not after doing gym, quite strange).


I definitely have a myofascial syndrome, confirmed by a 3Tesla MRI, Bautrant and 2 physiotherapists very well known in Italy (Mirko Croci and donatella giraudo)
Fortunately, the pudendal nerve is not involved even if I know very well that in the perineal areas the pundeal nerves innervates all muscles.

guys,
believe me I have been asymptomatic for years, and I had resumed my life like everyone, in last year thinking of being superman I did something that has reactivated the spam in the perineal muscles, now by months.

does anyone of you a symptomatology similar to mine?

one of my main symptom is as if I wanted to massage the bulbospongiosus area, the feeling is like to try to push it out
at the moment this is the main symptom. I find pleasure in massaging the painful part

any advice are welcome

best,
Ale

[Violet M]

I'm not a guy so it's hard to say if my symptoms were the same but I had a lot of tension in the coccygeal muscles and the perineum muscles. Are you still working out in the gym? If so, maybe you need to give that a rest and let the muscles recover. You could be straining your ligaments which then puts a strain on your muscles. It doesn't matter whether you feel pain during the actual gym workout -- the nerves and muscles can complain later. At least that's how it worked for me.

Does it help to take a muscle relaxant -- like valium? Or maybe some vino?

I should just add that my understanding is that a 3T MRI is not 100% accurate in the diagnosis of PNE. But knowing Bautrant, he probably did a rectal exam and pressed along the course of the pudendal nerve at the ischial spine and Alcock's canal to see if it was tender, right?

Violet

[Alessandro76]

Dear Violet,
thanks again for yor reply, please below

to all/ i have traslate from french to english

EXAM: PELVIC AND ENDO-CAVITARY (vaginal touch + digital rectal examination)
piriform trigger: YES

contracture of elevators YES
trigger beams of the elevators: YES BULBO-CAVERNEUX AND TRANSVERSE

pudendal trigger / tinel channel NO
urethral / vesical trigger / prostate trigger NO
Pudendal bone trigger NO
statistic perineale RAS

DIAGNOSTIC CRITERIA FOR NEVRALGIA PUNDEDALE (AIX) NO
CANALAR SYNDROME CRITERIA (NANTES) NO
PLEVI - PERINEAL HYPERSENSITIVITY CRITERIA (PP CONVERGENCES) NO
MYO - FASCIAL SINDROME CRITERIA WHO

PHYSIO - PATHOLOGICAL AND DIAGNOSTIC HYPOTHESES:

CRITERIA of pudendal neuralgia NO
SYNDROME DIAGNOSIS OF CANAL ALCOCK DUTY WE SEEM TO BE REJECTED

CRITERIA OF MYO-FASCIAL SYNDROME OF SUPERFICIAL PERINEAL MUSCLES ( BULBO-CAVERNEOUS AND TRASVERSES) + (ISCHIO-COCCYGIAN MUSCLES WITH COCCYGODYNIA)

aix 24 April 2018
Eric Bautrant


Dear Violet/all,
I have not been in the gym for a week and I do not do any more physical activity,

current symptoms
general tension at the perineum
and flow of urination a little weak
sitting up does not seem to me to have big problems. 3 days ago I flew from London to Milan 2 hours without any problem. and now I'm writing you without any particular problems.
anxiety and fear ( A LOT)

I booked another visit with bautrant at the beginning of October 2018, following my physiotherapist, I do not need another visit. I had my diagnosis, which is the same as the physiotherapist and not only last FridayI asked him to perform the same bautrant's maneuver on ischial fossa ( i think)
practically, I felt his finger on the bone but I did not feel any pain either on the right side and on the left side, he told me that with this maneuver if I was positive, I would have jumped out of bed.

what scared me a lot is that an intense masturbatory activity ( i read) can cause neuropathic problems, and this may have been the only thing I did after the bautrant visit.

[Alessandro76]

no one answers?

[Violet M]

Sorry, for some reason I thought Alessandro was a guy's name but from your translation I guess you are female? It is not a common name here so maybe I was mixed up.

So it looks like you don't fit the criteria for pudendal nerve entrapment but since the bulbocavernosus muscle is innervated by the pudendal nerve there is apparently some pudendal nerve irritation since that muscle is painful -- just not due to PNE at the typical places like the ischial spine and alcock's canal. If you have coccygeal involvement the bulbocavernosus pain could possibly be referred from there. If you think the coccyx area is a problem you could try a ganglion impar block and see if that helps.

MrPK on the forum recently posted some interesting information about fascia. You might want to look at his post. In addition to fascia being a potential issue, ligament problems can potentially cause pain. I did some prolotherapy to strengthen my ligaments due to chronic ligament strain. Has your PT said anything about the ligaments being a problem? There has to be some underlying problem as to why the muscles are in pain. I know some people say that anxiety causes their muscles to be tense. For me it was the other way around -- the muscular pain caused me to be anxious. I was fine before so I know it wasn't from anxiety -- it was from musculoskeletal problems. I guess you have to be a Sherlock Holmes to get this figured out.

Violet

[Alessandro76]

Thanks Violet

Alessandro is a male name
Ale is my short or nick name, if you want ( like Robert = Rob/ bob etc etc )
In Europe Alexander is a common name I think.
I agree with you in my case, following all my clinics test I don’t think to have a PNE, also because my symptoms were
Probably different. But I think as Normal, part of nerve on the bulbospiungos muscle probably is a bit irritate, that’s, I think are the reasons of some my issues.

Following Bautrant, but in this I need yours opinion, there a few points Unserstand if you have some bad issue with the nerve and based on his test it seems that I’m fine, but as I said the superficial muscle are innevated by the nerve.

Now probably what I should understand with my PT is try to relax the muscle in spasm and see if the nerve respond on the right way.
I booked another visit with bautrant, but as you know, the waiting list is quite long.
In the main time I hope doing phisio I will find some answers,
This probably will helps a lot.

[Alessandro76]

Hi all

an update,
This morning I' get back in London from Milan, and I've been sitting on the plane 2h without ever getting up, and I did not have any kind of problem.
and even now I'm sitting on my chair in the office without particular problems.

current drugs:
Physiotherapy. twice per month 1h each
and since yesterday I started taking lyrica 75mg 1 tablet a day
and Tramadol 100 mg 1 tablet a day

maybe tramadol is helping me.
but many disorders seem to have disappeared.
the only collateral effect I noticed, is the urine flow has reduced a lot, (I look like a 90-year-old) but despite this, I no feel ( at the moment) any pain or burning or feeling of incomplete emptying.

i will keep you posted