Health Organization for Pudendal Education

Great report, Beverley! I'm so happy for you! You must be so happy to see the light at the end of your PN tunnel.

Brief update from me: I'm 3.5 weeks post arthroscope hip surgery on my PN side. Post-op recovery was really really rough but finally I'm beginning to feel better. PN pain is much better, and I too am feeling very optimistic that I'm nearing the end of my PN road. I'm going to have to learn to walk again as four months ago I had surgery on my other side and so it's been about that length of time that I haven't been walking outside the house.

As for the post-op perineum pain, I am still suffering from that. In order to "distract" the hip joint, they put your foot into traction and pull it until the hip pops out about 1 cm. (This is how they get into the joint to clean it up.) While they pull on the leg, they brace your perineum against a perineal post. Although I'm told the post is "well padded", your genitals can still suffer, especially if they are already pain-sensitized. So I have developed a bad case of vulvodynia post-op, something I've never had before. I've had to figure out how to deal with it by researching the internet. And it's getting under control, but it is still my most bothersome post-op complication.

Like PregMom and Beverley, I also have a stubborn O.I. muscle on the PN side that spasms and acts up in the afternoon (when my hips are tired). I start pelvic PT next week (couldn't book her before then) and in the meantime rectal valium suppositories bring the spasms under control until bedtime, when I take a bit of Klonipin (clonazepam), again for the O.I. muscle. If the muscle doesn't settle down in a couple of months, I'll make a final pilgrimage to Dr. Andrew in Cornwall for a final session of ESWT. The treatment seems to settle down the spasms for up to a month, but in my case they acted up again because of the wonky hips. I'm hopeful, though, that after a final treatment the spasms will settle down for good now that the hips are fixed.

PregMom, please don't hesitate to get your hip fixed! It could be a piece of the puzzle to end your PN pain. Also, please don't hesitate to PM me if you have any questions about the surgery. In Canada, it's done on an outpatient basis.

Wow Lernica, I can almost see that wonderful horizon of 'yes lernica can, just watch!!' coming into view. You have certainly earned it. Loving it and will be happier still when there is more good news to report. Keep it coming.
(((hugs)))
Helen

This excellent website, called Hip Chicks Unite, has a subgroup where members discuss the link between pelvic pain and hip pathology:

http://hipchicksunite.ning.com/group/pe ... n-hipsters

Viewing the site is free, but there is a small annual fee to become a member.

Lernica I can't view that site at all. It only gives me the option to pay to join.

Oh dear, maybe the subgroups are only available for members. Can you access the general Hip Chicks Unite forum?

You can take a look at what is going on there before joining. http://hipchicksunite.ning.com/
You do have to pay to become a member tho'.
Take care,
Helen

Here's an interesting article linking pelvic floor pain to hip pathology:

Hunt, Clohisy and Prather, Acetabular Labral Tears of the Hip in Women, Phys Med Rehabil Clin N Am 18 (2007) 497 - 520, at 503 (not available online unless subscribed to PubMed):

"Unique in women is the possible concomitant pelvic-floor pain that may occur in association with labral tears, hip impingement, dysplasia, and early and late arthritis. Because these hip disorders are more common in women, a thorough history should include the discussion of pelvic-floor symptoms. The obturator internus is considered one of the primary musculature sources of pelvic-floor pain that often presents with the complaint of deep vaginal pain. Because the obturator internus is a primary hip rotator, a hip-related cause of pelvic pain should be considered in the differential diagnosis when the pain is determined to be originating from this muscle and when other causes have been excluded."

My hips are feeling great but my OI continues to be a major "pain in the butt". I am still hopeful that it will settle over time now that my hips are fixed.

If you would like a copy of the article, please PM me.

That sounds like a really interesting article Lernica, I may ask you for a copy later. Today I went to HSS and saw Dr. Kelly to talk to him about my hip MRI. I had a CT scan and an x-ray. He showed me the images, which were really amazing to see. He sent me for a hip injection (steroid) into the joint and wants to check back with me in 2 weeks to find out if it has helped the hip or pelvic floor pain. He wants to be sure there is some connection between the labral tears and vulvodynia in my case before we do surgery. I am happy that he is cautious, but I am also concerned that the hip injection might not work. Anyone on here who has had the same thing, what happened when you got the injection? Did it help? I had the injection, and my hip feels better, but the radiologist said it may take time for the pelvic floor to relax. If it doesn't help and he won't do the surgery, I want to get a second opinion from Dr. Coleman just to be sure.

I really liked the PT who works with him, Ben. He examined me and decided that my right hip is definitely the pain generator of the whole thing and causing me to tense my muscles. He suggested some orthopedic PT and possibly ART instead of or in addition to pelvic floor physical therapy. Overall, I feel like I am in good hands with the HSS team, I just wish Dr. Kelly were more knowledgeable about the connection between the pelvic pain and hip pain like Dr. Coleman. That said, I have my fingers crossed that the injection will help my pelvic floor.

Thank you all for your support,
Jackie

Jackie,

In my case the hip steroid injection on my PN side relieved neither my hip pain nor my pelvic floor spasms. But my OS (orthopedic surgeon) was willing to go ahead with the surgery anyway because of the obvious pathology in the hip as evidenced in the pictures. I had a pincer impingement that was eroding the cartilage in the hip joint. If you have FAI, you pretty much should get it shaved off during a scope procedure because an uncorrected impingement can result in early onset osteoarthritis and the need for an eventual total hip replacement.

You also have hip dysplasia, right? What did Dr. Kelly say about that? Usually women with dysplasia need more than a scope; they also need a more major surgery known as periacetabular osteotomy in order to correct the dysplasia which caused the tear to begin with. There are very good discussions about hip surgery options on the Hip Chicks Unite website referred to above.

I should also warn you that, just like a pudendal nerve steroid injection, you may have a pain flare over the next few days as the steroid "chrystalizes" in the hip joint. After about a week the pain flare will settle down. Funny how doctors don't tell you about that.

Good luck with the injection and let me know how it goes.

Thanks Lernica, your experience with the steroid not working is exactly what I'm worried about. I'm almost tempted to tell him it helps just to get the surgery! He needs to take a further look at my measurements, but he said that I don't have dysplasia on the right and the MRI was only showing dysplasia based on the condition of my labrum. He said he will look at my CT scan more closely for more measurements. We will see.