Health Organization for Pudendal Education

I have been suffering from left perineal/scrotal pain for three years. I was referred by Dr. Dellon to Johns Hopkins with Dr. Fritz for an MRI and left pudendal block that helped for a short time, which seemed to confirm some sort of issue with the pudendal nerve.

The MRI didn't turn up anything noteworthy, but in the procedure report, Dr. Fritz reported the following:
"During the perineural injection of the left pudendal nerve and Alcock's canal, there was a suggestion of perineural left pudendal scarring at the entrance level of Alcock's canal, subjacent to the left sacrotuberous ligament."

In my follow-up with Dr. Dellon, he said one option short of surgery is to try botox to the obturator internus muscle, since that muscle runs adjacent to the pudendal nerve and might be putting pressure on it.

I asked my PT to work on that muscle specifically to see if that would give a hint if it was the problem. She said it didn't seem overly "spasmy," but it did flare me for about 2-3 hours and then I had a tad bit of relief for a day or so, for what that's worth.

So, would botox of the OI be a good idea for me? If there is indeed scarring in the Alcock's Canal area, would botox help at all?

RC

RC, I have not had botox, but I've discussed it briefly with doctors and I've read a little about it on here, and I think doctors tend to recommend it only when the muscles are spasming. So, if your muscles are spasming, I think it is supposed to help calm them down.

April

April, thanks. Yes, it seems as though most on here only recommend it if the muscle is in spasm.

I asked my PT to work on my Obturator Internus (she got at it both externally and internally), and it flared me for about 2 days. She said it wasn't overly spasmy, but the fact that I flared after working it directly suggest that the OI might be part of the issue. Has anybody else on here tried botox under these circumstances?

RC

Oh, yes, that does make sense.

April

I didn't try Botox but I wanted to respond to what you said about having a flare-up after the OI was worked on. I also had a flare-up after the PT worked on my OI muscle. I asked my gyn about trying Botox and she said it is just a temporary fix and discouraged me from trying it. But if it were to provide several months of pain relief I think it would be worth it.

Violet

Thanks. According to my workup, I have extreme tenderness at the exit of the Alcock's Canal, which is near where the obturator internus crosses over. So I think it is worth a try. I am scheduled for late October.

Well, it definitely helps some people so hopefully it will work for you.

Violet

Quick update...

I had a botox injection into the left Obturator Internus muscle by Dr. Fritz and his team at Johns Hopkins.

The doctors said that if I were to feel relief, I would feel it within a week. I am now a week and a half into it and have not had any relief so I doubt it will help for me. I haven't had any negative side effects.

I did have some short-lived relief on the day of the injection. They injected numbing medication with the botox so I'm assuming that had an effect, but just not sure what the mechanism was...

RC

I have had 3 rounds if Botox. 2 white awake 1 under anesthesia. It did nothing to help my pain.

So if there is no relief does that mean the muscle is not the problem?
What does the dr say if it did not work?