Health Organization for Pudendal Education

Can anyone explain to me the process of how one might become entrapped following a vaginal birth?
My pain started 6 months after the birth of my second child. He was large, he came out very fast.

For many of us this started after childbirth.
I also had a fast birth with my 2nd child, which is when this started.
There are so many ways this could affect you; it is a major disruption to the pelvis.
During pregnancy the hormones cause the pelvic ligaments to soften and become more flexible so that the baby will be able to pass through the pelvis. This increases risk of SIJD when the pelvic joints actually have to open up a bit to accomodate birth. I had pre-existing SIJD before childbirth but without PN; I don't know if the birth further changed the pattern of pelvic dysfunction, but I kind of assume so since I got some relief from PN by having the SIJD corrected.
My other problem was tarlov cysts in the sacrum, and as nobody knows what causes these I don't know how they would be related to traumatic birth; I only know they were a primary contributor to my PN and my PN did not begin until after that childbirth.
Some of the women who got PN after childbirth on this board, did have PN surgery and various entrapments were found, so I think that pretty much nothing can be ruled out post birth because it can be a major trauma to the pelvis in many ways. If you go to "success stories", you can read Celeste's post about how her symptoms started after childbirth and during surgery they found that her ligaments were entirely fused together with the nerve compressed in between: I don't think childbirth could cause this, but more that it was the straw that broke the camel's back in creating symptoms out of a previously asymptomatic abnormality.
I guess to sum it up, I would have to say that you can't really rule anything out in investigating what is causing your PN. Giving birth to a big baby fast has enough potential to cause pelvic trauma, that almost any pathology would be possible.
I wish you the best; and I have to say if one must pick a way to get PN this is the best one: To everybody else it is just a curse, but to us Mommies it is also a blessing because we got a child out of the deal

Wow, reading your posts sounds a bit like my story! To sum up, my pain started exactly 6 months post-partum as well. I too was diagnosed with osteitis pubis through radiographs (stork) almost 1 year post-partum. I had a bone scan 1.5 years after that to prove to my gp and insurance company that I was STILL in pain! The pn started at the same time. So yes, osteitis pubis can cause this, now only if I could get a doctor to listen to me!!!! Have you found any relief? Can I ask what your symptoms feel like (I wonder if ours would be similar....)

desperatehousewife,
personally because of multiple pathologies I had very global below-the-waist symptoms and doubt there would be much similarity. But you might have better luck going to a PT with experience treating the pubic symphysis, than you would trying to get a doctor to listen to you. I just read briefly about osteitis pubis and stork position imaging; and I am having trouble figuring out how they would even be able to tell it is this particular diagnosis vs. pubic symphysis diastasis, which can also be caused by traumatic birth. Are they able to see anything aside from a widened pubic symphysis? If not, it could be either one. I was never able to find a physician who was any use in helping me with structural abnormalities of the pelvic girdle. That is more along the lines of what a PT is trained for.

I am at my wits end with the pain, and trying the best I can to come up with all possible reasons for pn or pne post childbirth, hoping you all can help. Is it really so varied. I too had a quick birth. 8 cm fibroid left side. Numbness in labia, vulva, perineum, (left side only), until numbness started wearing off and giving way to pain (4 months) later.

I have been to so many doctors, had the fibroid removed, pt for 2 years ( 2 different therapists, but steady, weekly), exercise, yoga, swim, try not to sit. Am currently trying trigger point injections. It's round to my pudendal (clitoral branch) and ilioinguinalhypogastric) next to Alcock's canal, and I go tomorrow for another. The treatments have really taken their toll. I feel I've been run over by a Mack truck. And like I told my husband tonight, ever have a competition with friends S kids to see who can hold breath longest underwater? Well I feel like I need to come up for air now ( I.e. take a risk to get better). I know surgery is risky, but I have tried so much. Reiki, reflexology, naturopath, acupuncture, pt for 2 years, massage, surgery once with dr. Marvel ( perineal branch dissection) and the myomectomy (fibroid removal), meds of all kinds steroid injections, and now trigger point injections.

So, tell me what are the possible ways 1. My nerve is entrapped and 2. The nerve is damaged or irritated? Please and thank you so very much.

My kids are growing up much too fast and I need to get the ball rolling in the right direction. Life is to short to waste time!!

). Hugs peace and blessings to you all. You have all been so wonderful through these trying years.

Kara

Kara, is your pain on one or both sides? Did you have an epsiotomy with stitches?

During childbirth the baby passes between the 2 ischial spines in the pelvis which is near the location of the pudendal nerve on either side . The pressure of the baby on the nerve can damage the nerve. Some people have a musculoskeletal predisposition to developing PNE such as a nerve branch that pierces through one of the ligaments and a traumatic event such as childbirth can be what triggers PN or PNE. My understanding is that once the nerve becomes inflammed from a traumatic event it continues to be irritated by the ligaments, especially if you have a tight ligamental grip and the inflammation may not go down until the nerve is released from between the ligaments.

Violet

Have you had pelvic floor physiotherapy Kara, what did they say if so, could any trigger points be detected and did any work on them have an effect?
It's far too simplistic to say 'it's your pelvic floor' even if they did find trigger points and/or tight muscles as they could just be 'firing' in response to irritated nerve signals and/or some other pathology. But if they do tense again if relaxed thru' PT or don't relax at all it could be due to this?
What about a 3 T MRI or MRN?
Sorry if you have already posted about these before.
Good luck in your quest.

Take care,

Helen

Yes, pain is left side only. Yes had mrn hopkins, havent yried for potter, as insurance wontcover and seems doctors discount it anyway. Have had pf pt 2 + yrs now. So, who is best surgeon. Called Ansell and because I had perineal branch sugery alteady he wouldnt do surgery, even thouvh different approach and part of nerve. Ugh! Frustratung. Is there anyone in USA getting great results? Violet, who would I see in France? Thanks, ladies, sorry for the typos, using phone.

Thanks. Love you all for responding andcaring

Kara

Kara, Hibner is one of the few docs who does redo's and to my knowledge he is the only one with published results on redo's. My understanding is he uses electrical stimulation on the nerve during surgery to make sure he is locating it and protecting it during surgery. It can be harder to locate the nerve the 2nd time around due to scar tissue.

I know that Robert offered to consider a redo on a patient recently but that person chose to go to Hibner in the end. I don't know if any of the other French docs do redo's. I know of at least one patient who had a redo from Beco but she has not posted since just after surgery so I don't know what the results were. It was Mahzi if you want to PM her.

Violet

Kara, your situation sounds just like mine. Have you learned any new information? I had a fast birth (#4) in March 2012, followed by numbness, then pain. I am at my wits end, too. Surgery has been suggested to clear out a lot of fibrotic tissue left over from a hematoma in my left labia. I'm just so scared to get surgery if they can't tell my for sure it will help. I'm scared it may make things worse. I have clitoral nerve damage as well.
Caroline