His and Her Health

I have been treating PFD resulting in urinary frequency, urgency and retention, as well as painful intercourse, muscle spasm etc. I have been having PT using connective tissue massage, trigger point release, and several rounds of pelvic floor injections of Marcaine before internal Tpt work.

I've had reduction of pain and can tolerate penetration now, but I still have to have an indwelling supra-pubic catheter as the retention issue is unresolved.

My provider that has been doing the Marcaine injections has been studying recent literature and is willing to do Botox injections if I want to try it.

What has been your personal PT experience with PT after Botox injections? And, Dr. Goldstein if you see this and do the injections, do you have any feedback for success?

Thanks!

Tacy
It sounds like you are in good hands with the PT. Where are the proposed Botox injections going to be: PF muscles or Bladder? I have worked with several patients now using Botox as an adjunct, but mostly for pain not urinary symptoms. These injections were to the muscles though.
I am currently working with a patient who just had Botox and her PF muscles are much les taut, less trigger points and she is in less pain. Of course this was the 3rd try of Botox, but 3rd time a charm.
Have you tried biofeedback at all and maybe while on the toilet? Have you done any bladder retraining?
niva

No bladder injections. I've done lots of bladder retraining and biofeedback. My external sphincter spasms shut before I've emptied. I would have a urethral cath. placed when my bladder would be soo distended the pain would just shut my whole PF down. The spasms would stop the flow of urine through a 16 fr catheter. YOUCH!

Is there a "go to" person in your area that is really working with the Botox injections?

PT has saved my life. I want to improve it now.

tacy99
I am not sure what you mean by "go to" but I do know some Mds that will do these injections.
niva

why would she need 3 shots of botox for it to be effective?

see trp injection heading

sarah1:
I did not meant to make 3 sound like the amount needed, but giving an example of a certain patient. Some patients have Botox once others need it to be repeated.

Niva

Which muscles are normally botoxed for vestibulodynia?

I usually let the MD know which muscles feel tight and tender. Pubococcygeus/Puborectalis, Iliococcygeus, Obturator Internus, Transvers Perieneal, Ischiocavernosus are usually the culprits...

<small>[ 03-17-2009, 01:31 PM: Message edited by: Moderator ]</small>

does the vestibule pain go away when these muscles are botoxed?
thanks

does an md need a pt to tell them which ones to botox or can they decipher without a pt's assistance?

I know you said on the one post that there are risks, I am really thinking of going this route and was wondering how risky it is? I don't want to end up with incontinence in addition to this!

I don't know the stats off the top of my head, but fortunatley, non of my patients have reported incontinence.
A doctor who is going to perform this should be able to decipher on their own.

Niva

Do the women that have the muscles botoxed experience any decrease in the vestibule pain

Dr G, I have read about botox right into the vestibule, not the muscles- do you do this?