His and Her Health

Hey Niva

Which muscle/muscles are spasming in particular when you have a constant burning - feeling like a hot poker up ur butt that lasts and lasts until u lie down and fall asleep?

Also, some days its here and others it is not, do you know why that might be? Almost like a pattern, one day good - one day bad- is this typical?

thanks!

Do you mean causing rectal burning?
I would check the Iliococcygeus, Coccygeus and Obturator Internus muscles.

I am not sure I can answer why the randomness in symptoms. But I often hear symptoms going up and down. Everyother day is unusual?

well thats usually how it is, mornings are always the best, then if its going to kick in like it did today, its always in the afternoon- and it will not subside until I fall asleep in the night- then the next day, ( if I had a bad day before- will be almost perfect) I was hoping to get some insight into the inconsistency I experience with it:(

I also wanted to ask you, is there anything that I can do on my own ( pt ) to calm the spasm there when it flares up. This is insane. Everything I read on levator ani syndrome says
"etiology unknown" I love that! grrrrr
It seems like its not a new disorder, so I wonder why the doctors don't have a clue what causes it?
Also, do you have success in treating this? Everything I read about it, seems like its a sentence:(

I teach my patients a variety of stretches, Deep Breathing (very important) and to do their own release of pelvic muscles via a tool, posture education, etc...
There are some medicated suppositories that patients have had success with for the spasm; you need to speak with your doctor about those.
I definitely have heard patients like yourself report feeling better when laying down. You may need a cushion while seated. I just down know if I have seen someone who said symptoms are good one day and next bad...maybe a few here and there but not one and one-sorry.

Niva,

What kind of tool are you referring to in message above? What is your success rate in treating levator ani/vestibulitis? The one doctor I saw made it sound like something one never recovers from?
Another issue I am experiencing is the opinions I am getting as to the cause of the spasms. One said that pelvic muscle spasms occur because of vestibulitis, another said NO other way around- that the spasms are causing the vestibular pain- very FRUSTRATING! Can you offer any insight into this one? One gyne said nerve meds another said none. The women you treat with this diagnosis, do they take nerve pain meds?
thank you

Niva/Dr Goldstein

Why is the pain of levator ani better when walking or lying down. Do trp injections or botox help the spasms??

Some women are on meds. Some choose not to use meds. some are prescribed muscle relaxants. many are on estrogen/testosterone creams. I do think the the injections work. Lying down is probably better for you b/c there is no pressure on the vestibule, which I think you are saying you have. Also, sitting causes more pressure on the perineum or if slouching on the posterior muscles and sacral region. You are probably tensing the muscle more in sitting as opposed to being relaxed in lying down. You can look at the muscle activity of the muscles via biofeedback in these positions. Tools to do internal work are dilators and such.

Niva

Sorry for all the questions. Act of a desperate woman~- But what type of injections do you hear are the best- Trps( my doctor is talking about a series of these- I just would prefer to go straight to the botox) or botox? He said he does not do the trps intravaginally or thru the rectum but rather thru the skin-and word on which works best? Also do women with these disorders every get COMPLETELY better?

thanks!

just a footnote to last email, he says he used the trps diagnostically to see if one would respond to botox. I just want out of this mysery as quickly as possible:(

Levator,

I can truly sympathize with you as I have gotten the same run around. I don't think that the doctors truly know which causes which. The vestibulitis causing the levator spasms or vica versa. I read an article, I believe it was from a Dr Zolnourn, ( spelling) anyway he firmly believes that the levator ani spasms are secondary to the vestibulitis. Which is contrary to what my doctor told me as well.
Why don't they get a clue already??????

S

This is the excerpt I am referring to:

"A modest literature search and extensive clinical experience suggest that pelvic floor muscular spasm can accompany vestibulitis, so treating the pelvic floor with biofeedback or physical therapy or both is helpful.1 The presence of muscular spasm is sometimes interpreted to mean that muscle dysfunction is the primary disorder and the vestibular response secondary, but my clinical experience favors the opposite view: Vestibulitis happens first, and then the muscles become involved. For many patients, both aspects require treatment."

So, why do some doctors send you out the door with a script in hand for pt while not addressing the potential nerve issue, which probably in some opinion is the catalyst to these spasms?????
thoughts??????

Levatorani
Yes there are women that get completely better!
The doctors I know doing injections do them to the muscles intravaginally. There may also be some areas externally. Trigger point injections do not last as long as Botox, but some people say the botox is more painful. We are also talking about different chemicals botox vs anesthetic (w/ or w/out steroid). Not all of my patients who have had Botox had Trp Injections prior to or at all.
I don't know if there is reseaarch out there saying which causes which. I usually see the patients when both are already occuring.

<small>[ 03-14-2009, 11:52 AM: Message edited by: Moderator ]</small>

Niva

Are the patients that get COMPLETELY better
usually the ones that are using the nerve pain meds while doing pt???

Also not sure if you answered the previous question- which patients get better quicker-those that have gotten the botox or the trp injections?

Honestly, I have not done studies or really kept track of which of my patients did better with those treatments. Since I am a PT I do not administer nor prescribe these things-it is out of the scope of my practice. I think some women do well with one, both or neither. An observation I have made is those with Vestibulodynia have done really well with Botox and PT. Those with unprovoked vulvodynia have good results with muscle release, but usually are treated with more medication.