Health Organization for Pudendal Education

Has anyone ever had releif from PGAD with their nerve block? (If pgad is a symptom)?

Maybe slight relief for a few hours but not much. The 3rd nerve block that was done into alcock's canal gave a few hours of temporary partial relief but then it caused a month-long flare-up. I don't know of very many people who had permanent or long-term relief of pain or PGAD from nerve blocks.

Violet

Violet M wrote:Maybe slight relief for a few hours but not much. The 3rd nerve block that was done into alcock's canal gave a few hours of temporary partial relief but then it caused a month-long flare-up. I don't know of very many people who had permanent or long-term relief of pain or PGAD from nerve blocks.

Violet

Violate did you ever have one done vaginally? My dr. is talking bout doing one that way possibly. How is it even if a nerve block helps for a little while that the blocks can cause flares once it wares off? Is it because the injected medication can irritate or inflame the nerves?

Lindsey, many of the docs use an anesthetic like marcaine that gives a few hours of relief (for diagnostic purposes) and they also add a steroid to the injection. The marcaine wears off in a few hours but the steroid usually takes 3-4 days before it kicks in and my understanding is that the steroids (or the preservatives in them) can cause a flare-up in some people but steroids may also reduce inflammation and provide relief for some people. It's like most PN treatments -- you don't know until you try it -- which can be frustrating.

Nerve blocks given vaginally are not considered as precise as blocks done using some type of image guidance. Basically the gyn uses a finger to locate the ischial spine, a bone that protrudes inside the pelvis, and gives the injection there. The pudendal nerve runs near that bone so the medication blocks the pudendal nerve. I had one given that way. It helped a little bit but not much and not for long. Personally, the only reasons I would go for a nerve block would be for diagnostic purposes, or if I was considering surgery and the surgeon required a series of 3 nerve blocks before surgery like they typically do. If the first diagnostic block really helped a great deal for a long period of time I might consider another one. I don't know...that's just my opinion based on my own experience and reading the experience of others on the forums for 10 years. You might want to be evaluated by an experienced PT who specializes in PN before trying a nerve block because PT is less invasive. If PT doesn't help, then you go on to the next most invasive therapy -- conservative first, invasive last. But I wouldn't cross the invasive therapies off the list of options because I know plenty of people who have been helped by them.

Violet

What is the next step typically when pt isnt helping? Is it off for the dr. to suggest a block so soon?

Lindsey, it's really an individual decision. There are a lot of conservative treatments discussed on the forum such as restorative exercise, the mind-body approach, etc. You know your own body and history better than anyone else. Where you go next depends partly on your history such as is there stress, anxiety involved that might respond to a mindbody approach, do you have mechanical issues that might respond to manual therapy or something like restorative exercise, or is there an ongoing injury to the nerve from a possible nerve entrapment? What are your instincts telling you?

No, it's not off for the doctor to suggest a block so soon. Western medical doctors specialize in fixing diseases by prescribing medications or performing procedures. It's really a personal decision whether you want to go that route or not.

Violet

Violet M wrote:Lindsey, it's really an individual decision. There are a lot of conservative treatments discussed on the forum such as restorative exercise, the mind-body approach, etc. You know your own body and history better than anyone else. Where you go next depends partly on your history such as is there stress, anxiety involved that might respond to a mindbody approach, do you have mechanical issues that might respond to manual therapy or something like restorative exercise, or is there an ongoing injury to the nerve from a possible nerve entrapment? What are your instincts telling you?

No, it's not off for the doctor to suggest a block so soon. Western medical doctors specialize in fixing diseases by prescribing medications or performing procedures. It's really a personal decision whether you want to go that route or not.

Violet

You make great points,Violate. Its a hard decision to know what to.do.next Im sure for.most of.us when there r so many possibilities. Yes,I had anxiety when I got a bladder infection that started it all. Yes, I worked at a job where constant heavy lifting.was involved. Its hard to know what step when u dont know the source. For instance,did those that.have been.helped.from.restoratove excercise have a real nerve entrapment? They may or my not know. If I had an un known enjury from so much heavy lifting,that getting a bladder infection,and IC, that matbe inflamed it. If it were as simple as I fell on a hard fkoor,rode a bike or horse constantly,or pain suddenly started from heavy lifting, then you might have an easier guess that your nerve is entrapped. But when it started in your bladder,and your bladder is so close to.the PN, its truly hard to know what step to take.

It is always hard with this condition to make decisions on treatments and interventions. I agree with Violet that you know your body best and should try to figure out what to do accordingly. Sometimes a hard fall or other "trauma" can be a red herring, where you assume it is the cause of your pain but it is not. Do you still feel like your pain is getting worse or has it stabilized? How about your PGAD? Has anything about your condition improved from anything that you have done or not done? Sometimes time helps clarify the best approach. Your bladder is controlled by the PN so that may have been the first symptom of your nerve irritation which is now causing you multiple problems.

Stephanies

stephanies wrote:It is always hard with this condition to make decisions on treatments and interventions. I agree with Violet that you know your body best and should try to figure out what to do accordingly. Sometimes a hard fall or other "trauma" can be a red herring, where you assume it is the cause of your pain but it is not. Do you still feel like your pain is getting worse or has it stabilized? How about your PGAD? Has anything about your condition improved from anything that you have done or not done? Sometimes time helps clarify the best approach. Your bladder is controlled by the PN so that may have been the first symptom of your nerve irritation which is now causing you multiple problems.

Stephanies

It is definately getting worse. Having a weird buzzing feeling in lower back,along with horeible genital sensations,central sensitation,etc. It will be 7 month in March 9. I want to do restorative excercse but im afraid it will makw vaginal issues worse,uncluding pgad. Have constant tingling in there,object feelung in there,pressure on clitoris,some pulsing nd pgad,now pain on front of my legs not just back. So far ive only tried 4-5 weeks of physio,but then pgad started to stay. I truly cant make up my mind about this block and its this Thursday. If it wasnt for my genitals i wouldnt question RE. But im obviously doing something wrong if it continues to spiral. Wish it would just stableize.

Lindsey, I know it's hard. I went through a period of agonizing over what to do next too. Eventually I think I made a spread sheet that showed the pros and cons of each decision and it became more clear what to do next. You can also include on the spread sheet the pros and cons of doing nothing.

Violet