I fear I have PN. It started with UTI and moved on to vulvar pain. That gradually subsided after 2 months. Unfortunately I then sat on my cushion but in pain for 2 hours and now have constant pain in anus 24/7. Have I permanently damaged nerve or is there hope it will heal in time?Pain 24/7
Pain 24/7
I fear I have PN. It started with UTI and moved on to vulvar pain. That gradually subsided after 2 months. Unfortunately I then sat on my cushion but in pain for 2 hours and now have constant pain in anus 24/7. Have I permanently damaged nerve or is there hope it will heal in time?-
helenlegs 11
- Posts: 1779
- Joined: Fri Sep 17, 2010 9:39 am
- Location: North East England
Re: Pain 24/7
It takes a lot to permanently damage a nerve in terms of pressure and time and even if damaged the nerve can grow again once any irritation or pressure is removed so I wouldn't worry on that score. Then, because your problem began with an infection and probable inflammation any nerve damage is unlikely, thankfully 
.
I hope I have put your mind at rest, and although I am not 'medical', I'm fairly sure others will agree on this too??
Sorry you are suffering in this way Alex. What treatments and/or medication have you tried for this problem?. I presume you have no UTI now?
If you take a look at the home pages it gives a lot of factual advice about PN including lists of doctors, physiotherapists and treatments for PN.
It could be the inferior rectal branch of the pudendal nerve is being irritated now perhaps. This could be due to postural problems, even very slight, almost unnoticeable ones and/or an added stress to your pelvic floor muscles. The latter could be due to hypertension in the pelvic area created by the previous UTI.
I would suggest physiotherapy, if you haven't tried this already. Take a look at the list on the home pages as you need someone who is PN aware. A good knowledgeable PT evaluation can help explain the problem as well as solve it
Take care,
Helen
.I hope I have put your mind at rest, and although I am not 'medical', I'm fairly sure others will agree on this too??
Sorry you are suffering in this way Alex. What treatments and/or medication have you tried for this problem?. I presume you have no UTI now?
If you take a look at the home pages it gives a lot of factual advice about PN including lists of doctors, physiotherapists and treatments for PN.
It could be the inferior rectal branch of the pudendal nerve is being irritated now perhaps. This could be due to postural problems, even very slight, almost unnoticeable ones and/or an added stress to your pelvic floor muscles. The latter could be due to hypertension in the pelvic area created by the previous UTI.
I would suggest physiotherapy, if you haven't tried this already. Take a look at the list on the home pages as you need someone who is PN aware. A good knowledgeable PT evaluation can help explain the problem as well as solve it
Take care,
Helen
Fall 2008. Misdiagnosed with lumber spine problem. MRN June 2010 indicated pudendal entrapment at Alcocks canal. Diagnosed with complex variant piriformis syndrome with sciatic, pudendal and gluteal entrapment's by Dr Filler 2010.Guided piriformis botox injection 2011 Bristol. 2013, Nerve conduction test positive; new spinal MRI scan negative, so diagnosed for the 4th time with pelvic nerve entrapment, now recognised as Sciatic, pudendal, PFCN and cluneal nerves at piriformis level.
Re: Pain 24/7
Helen,
Thank you for your kind and swift reply. I am having PT and have just started Gabapentin because the pain has been so great and it feels like there is a ball up inside me. I was in pain the whole time I sat (2 hours) and now it is constant. The UTI cleared up months ago. I have a history of constipation, cycling and working sitting down so whilst I'm glad you think it takes a lot to permanently damage the nerves I am very worried. With the earlier pain I always slept at night. I eventually got rid of the clitoral pain with baths and relaxation and acupuncture and time but nothing is shifting this even at night. Going to try Mindfulness next. I am completely stressed by all this which I know is not helping my chance of recovery so hopefully the therapist will help. Does PN happen in flares and it might decrease with time,drugs and care ie never sitting again!
Alex
Thank you for your kind and swift reply. I am having PT and have just started Gabapentin because the pain has been so great and it feels like there is a ball up inside me. I was in pain the whole time I sat (2 hours) and now it is constant. The UTI cleared up months ago. I have a history of constipation, cycling and working sitting down so whilst I'm glad you think it takes a lot to permanently damage the nerves I am very worried. With the earlier pain I always slept at night. I eventually got rid of the clitoral pain with baths and relaxation and acupuncture and time but nothing is shifting this even at night. Going to try Mindfulness next. I am completely stressed by all this which I know is not helping my chance of recovery so hopefully the therapist will help. Does PN happen in flares and it might decrease with time,drugs and care ie never sitting again!
Alex
-
helenlegs 11
- Posts: 1779
- Joined: Fri Sep 17, 2010 9:39 am
- Location: North East England
Re: Pain 24/7
The theory is that if the problem is from hypertension of the pelvic floor muscles then yes to your last sentence except the never sitting again.
The best way forward for you is physiotherapy with someone who is PN aware (so you can tick that box)
Medication. . . I would also try combining the gabapentin with an anti depressant like cymbalta. This only needs to be taken at a low dose although you can always titrate up and see if there is any benefit, however it is usually thought that more anti depressant doesn't always mean more pain relief and the lower dose is as effective as as higher one with neuro pain. The gabapentin dose can be increased to good effect, but that should be discussed with your doctor of course. The combination of the anti seizure and anti depressant can be effective although it is often a bit of trial and error to see what works individually. You already know how you are with the gabapentin, so introducing another drug separately will be easier evaluating any benefits.
You have already found relief from the clitoral pain, which would be the dorsal pudendal nerve branch, with conservative therapies so there is no reason why conservative treatments shouldn't work this time. I know it is probably the hardest thing to do but try not to worry as this will only exacerbate the problem. . . . . .then you worry about how to stop worrying
Having mindfulness training is also a great idea, as it can help enormously, any cognitive therapies can be extremely therapeutic and help with coping strategies and hopefully lessen the worry factor.
I did see a comment by David Butler (Co-Author of explain pain http://www.bodyinmind.org/resources/books/) that you can stand on a nerve and it will survive. Sorry I can't find the reference now.
It probably says something similar in his book (above) but it is expensive and I haven't read it (yet).
Much of the pain management treatment available now is based on this 'pain in the brain' concept. A synopsis of the book is detailed below.
EXPLAIN PAIN.
A ground-breaking concept in its content and presentation, Explain Pain demystifies the process of understanding and managing pain. It brings the body to life in a way that makes an interesting read for therapists and pain sufferers alike. All pain is real, and for many people it is a debilitating part of everyday life. It is now known that understanding more about why things hurt can actually help people to understand their pain. Recent advances in fields such as neurophysiology, brain imaging, immunology, psychology and cellular biology have provided an explanatory platform from which to explore pain. In everyday language accompanied by quirky illustrations, Explain Pain discusses how pain responses are produced by the brain: how responses to injury from the autonomic motor and immune systems in your body contribute to pain, and why pain can persist after tissues have had plenty of time to heal. Explain Pain aims to give clinicians and people in pain the power to challenge pain and to consider new models for viewing what happens during pain. Once they have learnt about the processes involved they can follow a scientific route to recovery..
Take care,
Helen
except the never sitting again.The best way forward for you is physiotherapy with someone who is PN aware (so you can tick that box)
Medication. . . I would also try combining the gabapentin with an anti depressant like cymbalta. This only needs to be taken at a low dose although you can always titrate up and see if there is any benefit, however it is usually thought that more anti depressant doesn't always mean more pain relief and the lower dose is as effective as as higher one with neuro pain. The gabapentin dose can be increased to good effect, but that should be discussed with your doctor of course. The combination of the anti seizure and anti depressant can be effective although it is often a bit of trial and error to see what works individually. You already know how you are with the gabapentin, so introducing another drug separately will be easier evaluating any benefits.
You have already found relief from the clitoral pain, which would be the dorsal pudendal nerve branch, with conservative therapies so there is no reason why conservative treatments shouldn't work this time. I know it is probably the hardest thing to do but try not to worry as this will only exacerbate the problem. . . . . .then you worry about how to stop worrying
Having mindfulness training is also a great idea, as it can help enormously, any cognitive therapies can be extremely therapeutic and help with coping strategies and hopefully lessen the worry factor.I did see a comment by David Butler (Co-Author of explain pain http://www.bodyinmind.org/resources/books/) that you can stand on a nerve and it will survive. Sorry I can't find the reference now.
It probably says something similar in his book (above) but it is expensive and I haven't read it (yet).Much of the pain management treatment available now is based on this 'pain in the brain' concept. A synopsis of the book is detailed below.
EXPLAIN PAIN.
A ground-breaking concept in its content and presentation, Explain Pain demystifies the process of understanding and managing pain. It brings the body to life in a way that makes an interesting read for therapists and pain sufferers alike. All pain is real, and for many people it is a debilitating part of everyday life. It is now known that understanding more about why things hurt can actually help people to understand their pain. Recent advances in fields such as neurophysiology, brain imaging, immunology, psychology and cellular biology have provided an explanatory platform from which to explore pain. In everyday language accompanied by quirky illustrations, Explain Pain discusses how pain responses are produced by the brain: how responses to injury from the autonomic motor and immune systems in your body contribute to pain, and why pain can persist after tissues have had plenty of time to heal. Explain Pain aims to give clinicians and people in pain the power to challenge pain and to consider new models for viewing what happens during pain. Once they have learnt about the processes involved they can follow a scientific route to recovery..
Take care,
Helen
Fall 2008. Misdiagnosed with lumber spine problem. MRN June 2010 indicated pudendal entrapment at Alcocks canal. Diagnosed with complex variant piriformis syndrome with sciatic, pudendal and gluteal entrapment's by Dr Filler 2010.Guided piriformis botox injection 2011 Bristol. 2013, Nerve conduction test positive; new spinal MRI scan negative, so diagnosed for the 4th time with pelvic nerve entrapment, now recognised as Sciatic, pudendal, PFCN and cluneal nerves at piriformis level.
Re: Pain 24/7
Alex,
Helen is correct in not worrying both in making things worse ( well maybe not possible given the title of the thread!) Also the nerve can heal. I sat on a hard chair when in pain and that started the continual pain that I have been working to relieve, rectal pain and I had years of constipation and sitting like you. I did end up diagnosed with PNE however this may not be the same for yoou so do not panic. I had decompression surgery May 2011. I am now getting Sacroilliac(SI) shots for SI joint dysfunction after surgery.and new acupuncture treatment that eliminated my pain for a short period( I still cannot believe it) and am continuing in the next weeks to see if this can take hold for longer times. There really is hope, please keep the faith.
Janet
Helen is correct in not worrying both in making things worse ( well maybe not possible given the title of the thread!) Also the nerve can heal. I sat on a hard chair when in pain and that started the continual pain that I have been working to relieve, rectal pain and I had years of constipation and sitting like you. I did end up diagnosed with PNE however this may not be the same for yoou so do not panic. I had decompression surgery May 2011. I am now getting Sacroilliac(SI) shots for SI joint dysfunction after surgery.and new acupuncture treatment that eliminated my pain for a short period( I still cannot believe it) and am continuing in the next weeks to see if this can take hold for longer times. There really is hope, please keep the faith.
Janet
2007-08 pelvic muscles spasms treated by EGS. 6/27/10 sat too long on hard chair- spasms, EGS not work Botox help, cortisone shots in coccyx help, still pain, PT found PNE & sent me to Dr Marvel nerve blocks & MRN, TG left surgery 5/9/11. I have chronic bunion pain surgery at age 21. TG gave me back enough sitting to keep my job & join in some social activities. I wish the best to everyone! 2019 luck with orthotics from pedorthist & great PT allowing me to get off oxycodone.