Health Organization for Pudendal Education

Hi, hoping you can help. Clearly I have very tight pelvic floor muscles. Does this confirm or dismiss pn. Does tight pf muscles cause pn or other way around. How many PN sufferers DONT have tight muscles. Just lots of recommendations for physio on here which assume all they can do is work on these tight muscles and little else? Many thanks, Chris

Chris, as I understand it, having tight pelvic floor muscles does not confirm or rule out PN. Dr. Hibner states in his article http://www.pudendalhope.info/sites/defa ... Hibner.pdf that "entrapment" may be caused by pelvic floor muscle spasms. He typically has patients try Botox before surgery to see if that will relax the pelvic floor and relieve the pain.

From my own experience an entrapment of the nerve between the ligaments can cause a tight pelvic floor but I have known several people with PN who told me they were told by their physician or PT that they didn't have a tight pelvic floor so I guess the answer to your question is that each person is different and since PT is less invasive than surgery it's good to try it. If it works then maybe you can conclude that you just had tight muscles but not an entrapment between the ligaments.

Violet

Many thanks violet, helpful and inciteful as always. I will read hibners article. I was just struggling to understand if entrapment or neuralgia is inevitable if muscle spasm that tight. My limited knowledge of biology tells me if whole pelvic floor is rock solid then surely there has to be entrapment? Where else can it go?

I think the thing with tight muscles is if they are tight or are so tight they are in spasm (there must be degrees of tightness) those muscles can always be relaxed with treatment. Whether that is physiotherapy treatment alone or a next step which may be botox, they will eventually relax. Then then have to stay relaxed of course!
Once relaxed however any nerve caught in the formerly tight muscle will then be freed. This is why Physiotherapy can have a great lasting effect for some with tight pelvic floor muscles or tight piriformis with pudendal involvement too.
However, in PN, sometimes the muscles are tight as a reaction to the nerve being physically entrapped somewhere other than in the tight muscle tissue. This type of entrapment can only be freed with surgery, like in Violets case where the the nerve was caught between the ss and st ligaments.
All the physio in the world would not fix this type of entrapment. Botox would only help any tight muscles targeted; not the entrapped nerve. AND because that nerve would still be trapped the muscles would probably just tighten up again once the botox had worn off. In this case the tight muscles are secondary to an actual physical entrapment; caused by it (this usually happens in cases of trauma onset) The other (tight muscle) way, occurs when tight muscles are the cause of the problem (which can also escalate with 'windup') This could be due to holding tension in the pelvic area, body misalignment requiring postural changes, well all sorts of reasons but reasons that can be overcome conservatively.
Pudendal neuralgia can also be secondary to some hip pathology, like labral tears and inguinal hernias too, once the initial problem is fixed (again surgically) the PN is usually resolved.

Thanks for info Helen. I have had 6 sep botox treatments, 5 to sphincter, the 6th was a massive dose to pelvic floor with only mild relief from pain. My physio has told me that unusually I have ultra tight pelvic floor& sphincter ( my probs started from a fissure) so was thinking only success could be to have both at same time.

I liked your explanation, Helen. That's what I was trying to say. So Chris, since Botox didn't take your pain away then it seems you will have to search for a cause other than just pelvic floor tension by itself that is causing the problem.

Violet