Health Organization for Pudendal Education

Hi, Returning here after around 12 months of self management & low dose amitryptyline. Hoped someone can shed some light on where to go next. In summary, had anal fissure 3 years ago, fissure healed pain remained. 6 botox injections and a lateral sphincterotomy later (docs thought it was due to spasming anal muscles from fissure). Seen Dr Greenslade twice in Bristol, first time ruled out pn second time thought it was. Seen numerous consultants/physios all see it as spasming/knots in muscle. Still pain only in and around anus. Despite prev fissure/scar tissue being at around 7 o clock position most of pain around 4 o clock position just around entrance to anus (sorry to be so graphic just dont know how best to describe). Does this position infer poss pudendal as may finally have to try blocks/sgy. Not really talking about this to anyone thesedays, just managing pain which to be honest has been manageable until recently. Can i continue to take amitryptyline indefinetly or is another pain med better to take long term? Just need little help at mo. Many thanks, Chris

Hi Chris,
I remember you, always nice to know how people are, although I wish it could be better news from you, of course.
I don't think that where the scar tissue is and where the nerve pain is can always be a help. For instance, if a certain part of my anatomy is touched I always have a shooting pain that skips 2 inches (no travelling pain at all there) and zooms along the back top of my thigh ?? It is always the same path just sometimes more ferocious than others . The fact that nerves are strange, is something that gets reported here a lot. Wanting more practical answers at one stage for my own problems I have tried to find some rhyme and reason for much of it. I have discovered a lot and it makes more sense to me now but I have to still go back to the fact that nerves are strange!
The pudendal nerve is definitely in that territory, I would think it highly likely that it is the culprit. The only way to find out more is to have a pudendal block done. This may even be therapeutic.
Let us know how you get on and what you decide to do.
take care,
Helen

Hi Chris,
From some earlier posts the consensus seems to be that Amitriptylene has been around for ages, well tested and safe. I did read in AARP (American Association of Retired People -I that is what it stands for) magazine some possible issues at older ages maybe 70 years old and may be possibly to do with dizziness. If you search on AARP you will find those other posts. Also may depend on what len,vel you are taking they say some at 300mg and I ham only on 20mg but taking it for 10+ years am 51 and have had no issues.
Janet

Chris, so I'm assuming the physios you've seen tried rectal/anal myofascial release. Did that or the Botox help at all?

Amitriptyline has side effects for some people but would be considered a more conservative therapy than some other forms of treatment such as surgery would be. With all PNE treatments it becomes a matter of weighing the risk/benefit. If you are tolerating it well and if it's working for you and giving adequate relief with minimal side effects, then it might make sense to continue with it especially if you are in good health otherwise. Many people take antidepressants long term with no problems but if you aren't sure, your pharmacist would probably be a very good resource as far as telling you the long-term risk.

Violet