Pudendal Nerve Entrapment (PNE): Your Questions Answered Part II

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This week’s post is the second half of a Q&A on the controversial diagnosis of pudendal nerve entrapment and the decompression surgery associated with it.

For this post, we chatted with two of the leading experts on the topic: Michael Hibner, M.D., a gynecologic surgeon at St. Joseph’s Hospital and Medical Center in Phoenix, Ariz. and Mark Conway, M.D., a gynecologic surgeon at St. Joseph’s Hospital in Nashua, New Hampshire. (See full bios below.)

Q: Can you give a brief rundown of the pudendal nerve decompression surgery?

Dr. Hibner:

There are  four different procedures described for decompressing an entrapped

Dr. Michael Hibner

Dr. Michael Hibner

pudendal nerve: transgluteal, transischiorectal, transperineal, and endoscopic.

The two biggest competing approaches for the decompression surgery are the transgluteal, which is the one I mainly perform, and the transischiorectal.

In my opinion, the transgluteal approach appears to be the most effective technique, allowing the best visualization of the pudendal nerve and the greatest extent of decompression along the length of the nerve. The surgery that I do is very different from the original France surgery. Back then it used to take 45 minutes to an hour to complete the procedure. Today, we spend three or four hours minimum using a high powered microscope, and very precise scissors we cut every little piece of scar tissue around the nerve.

The main concern with this approach that was originally described by Professor Roger Robert in Nantes, France, was that it requires the cutting of the sacrotuberous ligament in order to get to the nerve. As a result, PTs would see a lot of sacroiliac joint instability after cutting that ligament and not repairing it. When I began doing the procedure, I started repairing the ligament. PTs around the county started noticing that when you repair the ligament you actually prevent instability of the joint, so again this surgery has gotten better and I think since we are repairing the ligament the negatives are minimized.

Click this article by Dr. Hibner in OBGyn News for a more detailed and in depth description of the nerve decompression surgery see:

http://www.obgynnews.com/index.php?id=11146&tx_ttnews%5Btt_news%5D=126789&tx_ttnews%5BsViewPointer%5D=3&cHash=91e34fe95b0699a7a963b225f62bce1a

Dr. Conway, you stopped using the TIR approach and now use the TG. Can you tell us why?

Dr. Conway:

Firstly the decision to do the TIR was based on published case series data that showed marginally better outcomes than the classic TG approach. However, no head

Dr. Mark Conway

Dr. Mark Conway

to head trial was ever done so it’s impossible to state which is more effective. Also the TIR preserves the ST ligament which I felt was a big advantage compared to the classic TG approach where both the ST ligament and the SS ligament are transected.

I felt these advantages outweighed the lack of exposure of the nerve; however, with the modification of the TG approach with longitudinal spreading of the ST ligament and it’s preservation that changed. Now the superior visualization of the nerve with the modified TG approach becomes a big advantage.

Also I have done at least 20 redo operations on failed TIR surgeries with the modified TG approach and have invariably found the nerve entrapped by scar tissue at the level of remnants of the SS ligament. This is because often only a portion of the SS ligament is severed during the TIR approach.

Plus the TG approach allows the operator to do more precise nerve monitoring during the procedure using the NIMS system. Also we often find very complex anatomical situations where there is a branched nerve traversing the area, and the nerve may be perforating one of the ligaments. The TIR approach can’t really address these issues. Also I feel there is definitely less bleeding and probably fewer infections as well with the modified TG.

Q: What are other negatives of the surgery?

Dr. HIbner:

The postoperative course and recovery can be difficult. Cutting through muscle is painful. We try to minimize this by giving patients a pain pump after surgery, which helps with the pain for the first two to three weeks after surgery by bathing the pudendal nerve in the anesthetic, Marcaine. Besides pain control, another reason to do this is that it may help to desensitize the nerve.

Q: What are the risks of the surgery?

Dr. Hibner:

One risk is that the pain will not get better. The second is a one percent chance that the pain will get worse. I’ve done about 200 to 250 cases, and have never had any significant negative outcome from surgery.

Also, there used to be a risk of wound infection because the incision was so close to the rectum, but two years ago we started using something called a wound vac, which is a suction dressing on the wound that provides negative suction to the wound for five days. Since then we have had zero infections.

Dr. Conway:

The greatest risk is that the surgery won’t help. I always tell patients that there is a 20 percent to 30 percent failure rate where the surgery will not help the patient at all. In addition, patients are always concerned that the surgery will make their symptoms worse. However, in my experience this hasn’t happened. But I have seen patients three years after surgery who have gotten worse, but not because of the surgery, but because the surgery didn’t help, and their condition got worse over time.

Q: What is the follow up protocol for patients who do the surgery?

Dr. Conway:

Patients are in the hospital for two or three days. Many of our surgical patients are from out of town, and therefore, they stay in a local hotel for another seven to ten days. We then see them in the office to give them the okay to go home. From there, we recommend follow up with their local physician once they get home to have their incisions checked and refill pain medication. In addition, we do leave stitches in that have to be removed.

The majority of out-of-town patients do not keep in touch. We tend to hear either good news or bad news from the ones that do.

Then after that if patients do live locally, we will see them in two to three months, then every few months until they get to where they need to be.

Adds Dr. Hibner:

In addition, while surgical incisions are healing, and operative pain runs it’s course for four to six weeks, during that time we recommend only light activity avoiding sitting and minimal activity. And somewhere between eight to twelve weeks after surgery we recommend that patients reconnect with their local PT to further help heal musculoskeletal issues. Overall, we encourage patients to view recovery from surgery as their career at that time taking at least six weeks off from work if they are working. Many patients are not due to their pain.

(Stephanie:

Patients having any surgery – rotator cuff repairs, knee replacements, back surgery, all require post-operative physical therapy. It is important for patients to understand that  surgery alone will never be as successful as surgery and post-operative physical therapy combined.

Over the past 13 years, I cannot count how many PN post-operative patients have called our office concerned that they were ‘re-entrapped’. While this is possible, many of these patients were not told to go PT or they unfortunately did not have access to it. When I evaluate these patients we often find myofascial impairments that are causing at least some of, if not all of, their pain. The take home message is in almost all cases physical therapy can help a patient dealing with PNE function better. And I am not just saying that because I am a PT. : )

Q: At which point is the surgery considered a success?

Dr. Hibner:

Usually we expect the first improvement to occur between about four or five months with a maximum of 18 months. In my view, success is what the patient considers success.

Q: When is the surgery considered a failure?

Dr. Hibner:

From a research perspective what is considered a positive outcome, and I’m not saying this is good for the patient, but just for research purposes an improvement of pain of 20 percent is a positive outcome. Looking at our patients, 70 percent of our patients have an at least 20 percent positive outcome.

Q: What is the goal or the expectation of the surgery?

Dr. Hibner:

That is a great question. It is crucial to set realistic expectations with patients. So number one what I tell patients is that you have developed PNE because you have a predisposition, and we don’t know what that predisposition is.  The surgery can’t take that predisposition away.

Number two I tell them it is very unlikely the surgery will be able to make you 100 percent pain-free. There are some people who get 100%, but it is uncommon. Number three I tell them if an activity caused  PNE, like biking, surgery will not likely result in the ability  go back to biking. Number four I tell patients that PNE affects multiple things: pain, sexuality, sexual arousal, ability to sit, etc., and  some symptoms may improve and not the others.

The ultimate goal of the surgery is to improve patients’ quality of life.

Dr. Conway:

We’re trying to get these patients to have as normal life as possible, the highest level of normal function they can achieve using a continuum of treatments. You have to keep trying modalities until you get maximum result for the patient. I always tell my patients not to think of surgery as the end of their treatment.

For instance, they may need more PT after surgery or more nerve blocks. They might even respond better to a block now that the nerve has been freed up because there’s much more room around the nerve for the medication to diffuse and have a positive effect. In addition, PT may be much more helpful because the nerve is behaving better, so the effect of PT may be more profound for these patients.

Dr. Michael Hibner is director of the Arizona Center for Chronic Pelvic Pain, St. Joseph’s Hospital and Medical Center, Phoenix. He is a former fellow in advanced gynecologic surgery at Mayo Clinic, Scottsdale, Ariz., and is now professor of obstetrics and gynecology, Creighton University, Omaha, Neb., and associate clinical professor of obstetrics and gynecology, University of Arizona, Tucson.

Dr. Mark Conway is the head of the obstetrics and gynecology department at St. Joseph’s Hospital in Nashua, New Hampshire. Dr. Conway, a Fellow of The American Congress of Obstetricians and Gynecologists, heads a comprehensive pudendal neuralgia treatment center offering conservative therapies, medication management, a surgical solution to treat pudendal nerve entrapment as well as comprehensive post-operative care.

If you have any questions about either the diagnosis of PNE or the decompression surgery, please leave them in the comment section below!

 


37 thoughts on “Pudendal Nerve Entrapment (PNE): Your Questions Answered Part II

  1. Great post, as always. So informative, thank you so much for all the hard work in putting these together. And thanks to you both, Dr. Hibner and Dr. Conway for sharing your experiences giving us more insight into the intricacies of the surgeries for PNE.

    Recently, I’ve been looking at my diagnosis of almost five years, Pudendal Neuralgia or possible PNE, differently. I’ve been told by a neurosurgeon that PN is a “symptom” and not really a diagnosis. It could be that my Tarlov Cysts at S2 and S3 are causing the Pudendal Neuralgia. Wondering if you’d consider a post that looks at all of the varied “causes” of Pudendal Neuralgia. If my block is positive for the TCs being the cause of my PN, then I will have surgery at the Tarlov Cyst Institute in Dallas, TX. This surgery has very very high success rates. So it seems possible there are other little known causes out there that patients should be aware of. It’s taken almost five years to get my TC diagnosis, which had I gotten it earlier I would have been spared one Perineal branch dissection surgery and two years of PT once weekly, in addition to thousands of dollars and years of suffering. Obviously the surgery didn’t work, PT was relaxing but did not prove helpful in the long run. Please, if we could get the doctors to talk about all of the potential causes of PN, we might save others some suffering, money, and time. And by others I absolutely include Doctors and Physical Therapists, as they spend countless hours working to help the patients with PN, and I do believe it hurts them too when the patient does not improve after therapy, treatment, or surgery.

    Thank you so much! I look forward to the next post. 🙂

    Kara

    • I had TC surgery 9/2011 on s2 and s3, and am worse now. I have heard 50% success rate. Just encourage you to make sure pain is coming from the cysts. Take care.

  2. These posts are absolute heavenly gifts to those of us suffering pelvic pain in isolation. Thank you SO much for shedding light on surgery and treatment options!

    Is there any source on the mainland that can help diagnose the vascular wellness of the pelvic arteries beginning with the iliac artery, which feeds the pudendal artery? I believe there could be a vascular component/source to my misery. i.e. When I’m upside down (various yogic inversions/sling), the pressure/burning is drastically diminished; however when standing, the blood in my legs pool and the new pelvic/rectal pressure increases and feels like it is coming outside my body. Before “pudendal piriformis syndrome in NOV 2012, I had major circulation issues for 30 years, requiring me not to stand for very long. The sudden new pelvic issue began due to taking a Queen’s Hospital study constrictive calcium lactate for restless legs in NOV 2012 w/o my usual relaxing magnesium powder, not doing usual daily yoga for circulation, and extreme long days of sitting lotus/Padmasana due to prolonged 2.5 years of litigation. Since learning lotus in 2002 I always sit like this (legs closer to heart), which helps me from regressing from CEBV/CFS/Fibromyalgia/Toxic encephalopathy/Insomnia. So this new pelvic condition is exacerbated by my previous chronic circulation issue.
    aloha, audrey

  3. Hi,

    Thank you for the article. I currently have been diagnosed with PN, but am concerned that it is PNE. I believe my injury would more be the “stretching” injury due to years of straining for bowel movements. Two recent PN nerve blocks did little to nothing other than increase pain levels and add new areas of pain, but I am not sure they got close enough to the nerve. I have symptoms in all 3 branches. If this is a “stretching” injury of how would decompression surgery help? Medicine, PT and hyper-avoidance/life-style changes have helped to decrease pain levels, but I worry that if it is a true compression that the nerve will just get more and more damaged. How would I know know if it is getting worse.

    • Hi Dee,

      A nerve block is ‘technically successful’ if you are numb in the distribution of the nerve in the couple hours following the nerve block. The distribution of the nerve is the lower portion of the vagina, the perineum, the clitoris, the peri-anal tissue, anus and the lower part of the rectum. If you were not numb in these areas, the block was not done correctly. Regarding PNE, it is virtually impossible to definitively diagnose PNE until you surgically open up the patient and can see what’s happening to the nerve. A person who actually has PNE will likely have constant pain that is progressively getting worse. If your pain has improved with conservative therapies (medicine, PT, changing lifestyle), I would continue with those things. There is a good chance that those conservative treatments can help you to fully recover without surgery. Regarding the ‘stretching’ injury, if your nerve became irritated via a stretching injury and if you don’t stop the activity/behavior that caused the stretching in the first place (straining in your case), then the nerve will continue to be irritated regardless of having it surgically decompressed. You must change that behavior. If you begin to feel more and more neuropathic pain and/or numbness and/or motor loss (incontinence), then that is a sign that the nerve is becoming more and more irritated, however, it does not mean that it’s entrapped, it just may mean that the muscle/tissue/behavior, etc, impairments are not being properly addressed with conservative therapies. Hope that helps. Good luck!

      Best,

      Liz

      • Liz and Stephanie,

        A nerve block is successfully diagnostic for one if you had two hour numbness in the distribution of the pudendal nerve? I think I misunderstood the parameters for success.

        Thank you,
        Judith Vance

        • Hello Judith,

          Thank you for sharing your story! I encourage you to speak with Dr. Hibner regarding nerve blocks. It sounds like you’ve already established care with him, thus he can shed light on your specific situation.

          All my best,

          Stephanie

          • My Brother suffers from PNE after having rectal cancer surgery. He has not found a Doctor in the Omaha, NE area to help him with the options past finding out that he does have the PNE, has tried the Block, but it has not helped, he tried PT, but is not always able to go, or do what they have taught him to do when the pain is so severe he cannot tolerate it.
            He has had to take time off work because it was to much stress on the nerve itself …..
            Do you know of a Doctor in the Omaha area that he can go to for help??
            I appreciate your help in any way !!
            Thank You, Renee’

          • Hello Renee,

            Many of our patients who cannot tolerate treatment have botox injections in order to allow a physical therapist to treat their impairments. Here are our recommendations for Nebraska:

            Kelly Behney, PT
            Nebraska Methodist Hospital
            Gretna, NE
            (402) 815-1689
            kelly.behney@nmhs.org

            Michelle Shellhaas, PT
            Nebraska Methodist Hospital
            Lincoln NE
            (402) 815-2061
            michelle.shellhaas@nmhs.org

            Regards,

            Stephanie

  4. I developed PN after pelvic surgery(vag hyst and rectocele repair and TVT insert- since removed). I have had EVERYTHING done, including decompression surgery 1 year ago by Dr. Hibner. I am still suffering every day. I probably would be suicidal if it wasn’t for Norco that gets me through hour by hour. I have to work- single mom.
    What options are left? What do you thing of the neurostimulator at the pudendal nerve? I had a trial of the sacral stimulator, but am hesitant to have material permanently implanted.
    Thanks.
    Cyndi in Chicago
    What do you or others think?

    • Hello Cyndi,

      Please contact our office to schedule a complimentary phone consultation. Our staff will be able to assit you.

      All my best,

      Liz

  5. I had decompression surgery, TG approach in 3/12 by Dr. Hibner. I am functioning in day to day activities/exercise, am back to work since 7/12 and am relatively pain free (~90%). Thank you Dr. Hibner!
    My question is: I have had a problem staying in pelvic alignment since surgery. I see a PT every 7-14 days for manual alignment. If I do not get aligned, my pelvis get worse and worse and I end up in pain. This may sound petty but is an issue with my insurance paying to continue therapy. I need advice. Is there an article or some kind of literature stating that pelvic instability may be an inherent issue after surgery? Or am I the only one with this problem???

    • Hello Hilary,

      We do not have any articles that discuss Dr. Hibner’s patient population post surgery. Your presentation of pelivc misalignment depends on several factors. Whether you had a history of pelvic misalignment prior to surgery, and what happened during surgery are variables which may be contributing to your current issue. I would recommend that you follow up with Dr. Hibner’s office, and also consider seeing a pelvic floor therapist for an evaluation. Your symptoms may be more orthopedic in nature, but it is always a good idea to rule out any PFD as causes to your problems with alignment.

      Best,

      Liz

  6. Hello,

    I think I might be suffering from PN. For the last several years (maybe 7-8 years) I have had chronic constipation, frequently resisted the urge to defecate, would produce very large stools which required much strain frequently, and also dealt with excessive masturbation. I am 27 year old male if you couldn’t tell by that last bit. I also have a job which requires long periods of sitting throughout the day and I would sit mainly at home and play video games. All of this is my fault for not eating properly, drinking enough fluids, defecating when need be, exercising, and losing to temptation.

    A little under 2 months ago the sensation started. It began as a tightness in perineum on my left side whenever I would get an erection. If I ejaculated the sensation would get much stronger and produce a pain. Pain would be maybe 4/10 on the scale. This stayed like this for about a month. I then began to feel a pain in my the upper portion of my testicles so I went to my general doctor. He believed I was suffering from prostatitis and gave me an antibiotic. I also then began having to urinate frequently as well. A few days on the antibiotic I felt fine again, but I still felt that tightness on my perineum with arousal and ejaculation.

    A week or so later the bigger symptoms began. I felt pain with just sitting down. Up until then I had no pain with sitting. The pain was where the ischial tuberosity is. It was not burning, but just uncomfortableness type pain. I also feel weakness in my perineum or pelvic floor muscle and also in my mon pubis area. The pain in the top of testicles also returned. I have not ejaculated nor even been aroused more than once in this week’s time nor felt the urge to even get aroused as well.

    I went to see my doctor again and he asked if I had a hemorrhoid. I said yes. He checked me and felt a small internal hemorrhoid. He said that if took care of this that it should relieve any pressure on the pudendal nerve and stop irritating it.

    For the last 5 days I have now been using metamucil, colace, drinking lots of water, and using a suppository he prescribed to help shrink the hemorrhoid. I have also been sitting on a donut cushion at work (I have an office job). I have also been walking on breaks at work. I have now been defecating once a day, but instead of a snakelike stool it is just globs or pieces stuck together but much softer than ever before and only require slight strain to start the movement. The stool are also slightly green sometimes if that’s anything.

    Do you believe this situation will resolve itself once I get my bowels back in order or is this something that I will need Physical Therapy to resolve? I think my pelvic floor muscles have become very tight from the years of constipation, straining, and excessive ejaculation.

    Please help, I am only 27 and would not like to have to sit on a donut cushion for the rest of my life. Thank you.

    • Hello Chris,

      Your pelvic floor muscles may now be involved, and will need to be addressed along with the managment of your bowel habits. Where are you located? I may be able to recommend a physical therapist in your area.

      Best,

      Allison

  7. My mother has been suffering with what has been diagnosed as PN or PNE– not sure which. In her case however it does not hurt her to sit, but instead it hurts to stand. In fact this is one of the reasons for mis-diagnosis in the early years. Is it true/possible that it could be PN/PNE even though its not painful to sit? In other words, is pain while sitting always part of PNE or do some people have pain while standing instead or at other times?

    thank you for your help

    • Hello Daniel,

      It doesn’t sound like your mother has PN/PNE if her only issue is pain with standing, but without first evaluating her it is impossible to tell. I would suggest that she see a local physical therapist who specializes in pelvic floor dysfunctions. The therapist will be able to conduct an assessment to determine the exact causes of your mother’s symptoms. Where is she located? I may be able to recommend a therapist.

      All my best,

      Malinda

      • Hi Malinda, thank you very much for the fast response. I dont think I was very clear in my previous post. Its not that pain when standing is my mom’s only issue. She has a lot of pain, but its not just when sitting or particularly aggravated by sitting. She has been suffering with this problem for the past 5 years and it has progressively gotten worse. Its to the point where she can barely walk and spends a lot of time in bed or on the couch. Its a burning piercing pain in her pelvic areas. She has seen many doctors for the first few years with no diagnosis. She is in Florida and recently she has seen specialists in Boston and New York as no one in Florida is familiar with her condition. She was originally thought to have Vulvodynia but now the latest specialist thinks its PN/PNE.

        • My comment is for Daniel. My name is Hilary, I had similar symptoms that your mom is having. The standing felt like I was carrying.a bowling ball between my legs. Some shooting pain but more nagging awful pain in my groins, buttbones bilaterally, my sacrum, vulva and coccyx ,. When the Dr finally got my pain under control and pinpointed where the pain was coming from (after years of internal and external PT). It was coming from the Pudendal nerve. This neeve services the perineum, vulva, etc, when she would press on the area in between my vagina and rectum and to side a little.

        • I got cut off. Sorry. It hurt really bad when I was touched there. The dr tried site injections, I had 6 pudendal nerve blocks, Botox injected into the muscle to see if that’s what was entrapping the nerve. Nope. So we moved on to surgery. Very tough surgery. I’m 3 years post op and can say I’m about 90% cured!!!!!! I saw Dr Hibner in Phoenix, AZ. When I first visitedhis office, I met people from all over the U.S. and Broad that we’re having the same pain.
          Good luck to your mom!
          I hope my story helped

        • Hello Daniel,

          Boston and New York have excellent medical providers and physical therapists that may be able to help your mother. Below are the PF physical therapists we recommend in New York.

          Regards,

          Malinda

          Carolyn Vandyken, PT
          Physiotherapy Association of Cambridge
          Cambridge, (Toronto) Ontario Canada
          (519)624-8798

          Stacey Futterman, PT
          Five Points Physical Therapy
          New York, NY
          212 226-2066

          Diana Kafka, DPT
          Beyond Basics Physical Therapy
          New York NY
          (212)354-2622

  8. hi Hilary,

    Thank you very much for your story. It sounds like you were able to get the pain under ‘control’ prior to the surgery. How did you do that and how do you define under ‘control’? Also how long did it take you to recover after surgery?

    thank you very much, Edwin

    • Edwin,
      Sorry it took me so long to respond. To get my pain under control while I figured out if I was entrapped, I had pudendal nerve blocks, tried Botox injected into the muscles surrounding the nerve, medication (lyrica and Cymbalta and occasionally Lortab 7.5 (when I ciuldnt control pain) and the best way was PT- internal and external. 2-3 times a week. Please ask more questions if u would like detail on any of my info.
      Hilary

  9. Who are the other experts for pudendal entrapment surgery? I live in Louisiana and am looking for someone closer than Phoenix or New Hampshire.
    I’ve already tried PFPT, nerve blocks, PRF ablation and botox.

    • Hello Lou,

      Dr. Michael Hibner and Dr. Mark Conway are both experts in their field. Please find their information below.

      Best,

      Rachel

      Michael Hibner, MD
      St. Joseph’s Hospital and Medical Center
      350 West Thomas Rd
      Phoenix AZ 85013
      602-406-7564.

      Mark Conway, MD
      OB/GYN Associates of Southern NH
      30 Daniel Webster Highway Suite 11
      Merrimack, NH 03054
      Phone: 603-883-3365

  10. Hi, I apologize in advance for the long post and question.

    Roughly two years ago I felt a shock near my testicles while having sex with my wife. It felt as though one of my testicles had gone inside of my body. The pain went away within a few minutes and I though nothing of it.

    About a month later I started to feel as though I was going to ejaculate at any given moment. I got checked out by a urologist who said there was no testicular torsion or other injury.

    I continued to have the problem, though to a lesser degree. I started taking Zoloft, which did not take away the feeling completely but did make me last as long as I want.

    I recently went off the Zoloft since my wife and I are going to try to start a family soon. I still feel a tightness in my pelvis and pressure on my prostate. I’ve started to research male PGAD and pudendal nerve entrapment, and I have convinced myself I have many of the same symptoms. I also have trigger points in the area and flat feet, which affect my gait.

    Other than a constant sense of annoyance, there is no pain.

    Advice on treatment, meds, vitamin, things to help, etc? I’m in central Virginia.

    Thanks

  11. Hello,
    Hope this site is still being used.
    I started having ALL symptoms of PN or PNE 9 months ago and have had 2 family doctors and a neurologist basically shrug their shoulders. Seeing another nuerologist soon, but I am not holding my breath. Can’t even get an MRI done..I am very frustrated, isolated, depressed and in pain. I am also in Canada, in the middle of nowhere it seems. Do you have any names of doctors or PTs in Canada that can help me. Preferably western Canada but I am desperate, so will travel. Thanks, Alison

  12. Good morning,

    Have you heard of pudendal nerve irritation causing problems in the lower abdomen? I have pain with sitting and normally have vulvar pain. The pain has now reproduced in my abdomen.

    Thanks,
    Elizabeth

    • Author Stephanie Prendergast says:

      People with PN symptoms often have pelvic floor and girdle muscle function also, which can cause symptoms in the lower abdomen. The pudendal nerve does not innervate the abdomen in most people, however, anatomic variances can exist and there may be branches into the suprapubic region.

  13. I had the TG approach done and was told it was okay to go back to work after 2 weeks,but am finding that it is advised that you not go back to work after 6 weeks on this site. I am in pain and have severe frequency now. Is that from going back to work too soon? Why would these docs have told me it was alright?

  14. Are thee any doctors in the Houston area that treat pudenadal nerve issues? I have had many blocks that don’t help for long or don’t help at all. I have been having pain for about 3 1/2 years. The burning and pain is so depressing.

  15. My husband has had PN or PNE for 2 years. Nerve block injections do not work. He’s seen 2 PT’s, one that was trained in pelvic pain. Nothing seems to help. He’s been unable to work since September and we are currently fighting the insurance company to reinstate his short term disability. Are there any surgeons or PTs that can help in the Minnesota area?

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