Health Organization for Pudendal Education

Had my first bilateral pudendal block today. They only used anesthetic (bupivacaine, which is supposed to be a little longer acting) since I responded badly to steriods in another injection I had. The block was injected posteriorly to alcock's canal under ultrasound and xray. After about 10 hours the anesthetic is pretty much gone. But afterwards I had no pain with sitting (and I had a 3 hour drive home) in the ischial/perineal area. So I feel I do have PN. I did however start to have sacral pain (which is normal for me) after sitting for a good while. I have been told I have SIJD by some, but I don't have pain in that region, rather it is on the left side right where I think the ST ligament connects to the sacrum. Sometimes I am positive for the little tests the do for SIJD and sometimes I am not. (side not I am on my menstrual cycle and I always have increased pain with that so maybe the sacral pain is hormonal). But while I had the left sacral pain, the ishcial tuberosity pain bilaterally was gone/numb. Should the PN block have completely taken away the sacral pain if it is coming from the PN? The doctor has discussed the possibility of an SI injection in the future so maybe this would diagnose the sacral pain. Just wondering if anyone had any insight into my response to the block.

Faith, it's good to hear that you got some relief. Dr Potter suggested that I have a nerve block done in the Alcock's canal so I'm wondering if you were awake when they injected you? How painful was it?

for me, the longer I sit, then the pain spreads to the sacrum. maybe since you didn't feel the pain in your sitting area, over time you flared your nerve till your sacrum felt it, and the sacrum wasn't numb. just theorizing here... totally theoretical

pianogal wrote: maybe since you didn't feel the pain in your sitting area, over time you flared your nerve till your sacrum felt it, and the sacrum wasn't numb. just theorizing here... totally theoretical

Good point pianogal. I wondered that as well. I wonder if a block higher up at the ischial spine would have numbed me higher up.

Griff522 wrote:Dr Potter suggested that I have a nerve block done in the Alcock's canal so I'm wondering if you were awake when they injected you? How painful was it?

I was awake for the block and it wasn't horrible. The left was more painful than the right for me, but that is the more painful side normally for me too. My muscles are really tight on that side all the time and I could feel the needle kind of poking through the muscle (just a pressure), but it was definitely doable for me without sedation. I saw that you have had injections before...where were your injections? What did your MRI say? i have been wondering about how that went. I too have thought about going to Dr. Potter.

Faith wrote:Should the PN block have completely taken away the sacral pain if it is coming from the PN?

My understanding is that a nerve block only numbs what is distal (farther from the spine) than the block. So I don't think a PN block would take away sacral pain.

Thanks violet. I wish I could figure out if the sacral pain was caused by the pudendal nerve or something else like SIJD (even though it's not at the SIJ level). I know others on this forum have sacral pain but many dont. I think for me the sacral pain causes me as much grief as the PN pain.

Faith, I get sacral pain too -- in the SI area. I'm not sure if it's from the strained ligaments or the joint itself. Prolotherapy sometimes helps this type of pain but unfortunately it's not usually covered by insurance.