Health Organization for Pudendal Education

Hi--

I was diagnosed a couple of days ago with pudential neuralgia. I also have interstitial cystitis. The pelvic pain specialist I saw said to do monthly CT guided pudential nerve blocks under sedation with a interventional radiologist. The urogyn that I have been seeing before this most recent visit said she can do in-office pudential blocks going through the vagina. I did one Friday and also had another bladder instillation. It didn't help the itching in my buttock and numbness/pain in my buttock I was having but after the block wore off I had a lot of bladder symptoms. The specialist had said that my IC isn't typical in that I get relief from the instillations a couple of days later and not right away. And that the instillations could be irritating the PN. I have been having less bladder pain lately overall and I think that's why I was able to notice the worsening now with the instillation. And I think the pudential block did block the bladder symptoms. But I don't know what to make of how the itching and numbness sensations didn't go away. I think she did correctly block the pudential nerve. Any thoughts? My sensations have some variability from day to day (other sensations include itching above the vagina up to the clit, burning in the pelvis, pain in the whole pelvic area, pain on the left side of the vulva). Also, why is the CT guided one superior? Do I have to do it under sedation? Lastly, I have to find out from my eye doctor if I can have steroids injected. The specialist said it was fine but my urogyn that I have been seeing said she was concerned about it and only used lidocaine in the block.

Thanks so much for your help.

Hi Marissa,
For me the big difference was that the CT guided fully blocked my nerve. With the others it was hit or miss and only partially blocked the nerve.
Janet

Welcome Marissa,

Pudendal nerve blocks never took all of my symptoms away. I saw from one of your other posts that you think your neuralgia is related to weaning off an SSRI. It seems like treatment for that type of neuropathy would be different than treatment related to a mechanical pelvic concern. Have you had an MRI to rule out any problems in the spinal area such as tarlov cysts or other impingements on the nerve roots?

Violet

I had an MRI with and without contrast of the lumber sacral spines and the pelvis--which was normal. I wasn't able to get off the SSRI completely because of the withdrawal nightmare. But I am convinced that's what started it all. I also cannot re-state back to the original does because it affects me badly. The doctor's don't believe me or take this into account with my treatment.

I have another question--is there something healing about doing a bunch of nerve blocks in series? My urogyn said we can do weekly un-guided pundential blocks and the pelvic pain specialists said to do monthly ct-guided ones. What is the reason for this frequency? If the nerve blocks only potentially last a few hours?....I don't really see the point of doing them...

Thanks so much for your help.

Also--another question--is it safe to do pudendial blocks weekly in the doctor's office (unguided)? Or is there some limit on the number you can do in series?

Thanks.

Marissa, do the nerve blocks in the physician's office contain steroids? Some people attribute their long-term worsening of symptoms after nerve blocks to a reaction to the steroid.

You might want to read my article in one of the previous HOPE newsletters. http://www.pudendalhope.info/sites/defa ... 202014.pdf

There are a number of people who have posted that they had a long-term worsening of symptoms after nerve blocks. I have not seen any articles that provide evidence for what might cause this worsening of symptoms. The speculation I've heard is that some people may be sensitive to the steroid or the preservative in the steroid, the needle may nick the nerve, or repeated needle injections may cause scar tissue to form. Professor Robert recommends not having more than 3 nerve blocks.

I can't remember many people who have had permanent success with nerve blocks. I can't say for sure what is best for you but from my own experience, nerve blocks were not very helpful and I would be leery of having very many of them.

Violet