Health Organization for Pudendal Education

Hello all,

All this coming to light about hip pain causing pelvic floor pain is amazing to me. I mean, we knew there were some missing pieces in the PN story, and this certainly seems like it might be one of them.

Did anyone see Dr. Deborah Coady (GYN in New York City) in your hip journey? Would that be a good place to start? My pudendal neuralgia started in the setting of what I thought was a groin strain. (I posted about this a while ago.) I still get groin tightness and discomfort from time to time. But otherwise I don't really identify as having "hip pain." I don't know... I think I would feel funny going to a hip specialist (orthopedist) when I'm not even sure if I have a hip problem. Do you think Dr. Coady, for example, would order a hip MRI for me, assuming she felt there were enough suspicion for hip pathology? Then if something came up on the MRI I could go to an orthopedist.

Thank you for any advice you can offer.

Wishing everyone here reduced pain and much happiness.

Susibee,

The problem with we PNers is that the PN pain is often so overwhelming that we ignore other pain symptoms -- e.g. groin pain, lateral hip pain, difficulty sleeping on one side -- that would send other people straight to a hip doctor! In actual fact, the PN pain could actually be a mere symptom of something else going on, namely, hip pathology or tight pelvic floor muscles. So we neglect our other aches and pains and instead hone in on "fixing" the pudendal nerve. This may explain why pudendal decompression surgery sometimes fails. Although the nerve may be successfully decompressed during surgery, it may quickly become recompressed by spasming hip rotator muscles (e.g. obturator internus) or other pelvic floor muscles which are trying to compensate for the unstable hip.

So if you are having hip symptoms such as groin pain, clicking, catching or clunking, and even buttock pain when sitting or walking, I think the possibility of hip pathology should be explored.

Personally I think that a trip to a gynecologist would be a waste of time if you want to explore hip pathology. Instead, I would go directly to a hip preservation specialist and take with you some articles indicating that there may be a link between hip pathology and pelvic pain. You may still face an uphill battle. So probably the safest bet for someone living close to NYC would be to see the hip preservation specialist Dr. Stuart Coleman, who has co-authored some papers with Dr. Coady about the relationship between hip and pelvic pain.

Best of luck in pursuing this angle and please keep us posted on your progress.

P.S. What is it about the left side and PN?? My pain is all left-sided, as is PNDownUnder's and Susibee's. And according to Dr. Andrew, all his PN patients have left-sided symptoms.

Is it because the colon descends on the left side? Is it because the sigmoid colon is also located there? I dunno. Anyone have a theory?

Thanks for the great reply Lernica! I was not a runner per se, but definitely did a lot of running incidental to playing and training for soccer, and also triathlons.
Although I think it is a long shot as being causal to my PN, at the very least I want to make sure I don't end up with PN & hip pain!

Cheers

Nathan

Lernica wrote:P.S. What is it about the left side and PN?? My pain is all left-sided, as is PNDownUnder's and Susibee's. And according to Dr. Andrew, all his PN patients have left-sided symptoms.

Is it because the colon descends on the left side? Is it because the sigmoid colon is also located there? I dunno. Anyone have a theory?

Hi Lernica,

Could be. The medical advice I've been given is to avoid constipation as it can irritate the pudendal nerve. Oh, that's not a theory, sorry, just a statment.

Cheers Jackson.

FYI, aside from Dr. Coleman, here are two more PN-aware hip scope surgeons, both in Minnesota: Dr. Trousdale (Rochester) and Dr. Larson (Minneapolis).

Lernica wrote:FYI, aside from Dr. Coleman, here are two more PN-aware hip scope surgeons, both in Minnesota: Dr. Trousdale (Rochester) and Dr. Larson (Minneapolis).

I'm not sure Dr. Trousdale is PN aware, and he isn't a scope dr - he does PAOs and, I think, open dislocations. I know he was mentioned on a recent Hip Chicks forum discussion (I'm Jess over at that site), but I've never heard that he knows about pudendal issues. Dr. Larson does, but I wouldn't recommend that pudendal patients (esp newbies) go to him primarily complaining of pudendal/pelvic pain. His criteria seems to be more strict (and not correct in my opinion) than Dr. Coleman who has studying the connection between pudendal/pelvic floor disorders and hip pathology. For instance, Dr. Larson decided that my hip(s) weren't related to my pudendal pain because, when bending my legs up towards my chest, I didn't have sharp pudendal pain right then. Well, right....but I did have a nice flare for a few days, and I have two sets of Xrays, 1 MR arthrogram, 1 3T MRI, 1 CT scan, and 1 successful steriod hip injection that show I do have hip pathology. As most of us and those drs who treat pudendal neuralgia everyday know, pudendal pain can often be delayed. Furthermore, if someone has pelvic pain during that test (of bringing the leg up past 90 degrees flexion - which of course is a big no-no for PNers), it doesn't mean that they def have hip issues causing pudendal neuralgia. They could have an entrapped/irritated pudendal nerve absent hip pathology. That test can't be the sole deciding factor.

I just want to add that Dr. Coady's partner, Dr. Harris, was the one who gave me the prescription to get my hips MRIs at HSS. I'm not sure how easy it is to get an appointment with a hip doctor if you don't already have the proven hip pathology. I was able to call and say that I already had the MRIs at their hospital that showed labral tears. So, it might be worth it to see someone like Dr. Coady first if you are planning to work with Dr. Coleman since he would definitely take her opinion seriously. Just a thought.

Thank god I had access to my MRI report.
My PN doctor mentioned nothing to me about the fact that there was "focal fissuring and possible paralabral cyst formation in the anterosuperior hip labrum on the right" which the radiologist recommended follow up MRI for.
Apparently there is no evidence of cartilage loss and my hips outline normally.
BUT my MRI did show entrapment on the LEFT and markedly narrow interligamentous space on the RIGHT, but no definite entrapment.
What I would like to know is if this right hip issue can cause left pudendal entrapment? Or are they two separate issues?
I don't have hip pain or anything like that...
What are your thoughts on this, folks? I know absolutely nothing about the hips and PNE...

Hip pathology on either side can misalign your pelvis, result in overcompensating muscles on the opposite side, and put pressure on your pudendal nerve. My hip pathology was on both sides but PN developed on the left side only.

I definitely think you should investigate this angle further. Whether or not you have hip scope surgery can be decided later, depending on whether or not you have hip pain. Do you have any symptoms of hip pathology?

Please make sure that you go to the right orthopaedic surgeon to follow up on this. NOT a general orthopaedic surgeon. Also, you want a hip preservation surgeon, not a hip replacement surgeon.

Good luck, and please let us know how it goes!