His and Her Health

Niva,
Hi there. I have a question for you. Some backgound:
Vestibulitis

Bi-lateral Pudendal nerve decompression surgery in 2006

I have been going to PT since January, I see a chiropractor every week, I am on the estrogen/testosterone cream, I have been off the birth control pill since January, and I have gotten vaginal injections of homeopathic anti-inflammatory compounds.
I have SI joint dysfunction. Basically, my chiropractor said that I have a lot of muscle spasms going on in my back right at the sacrum...S1 or S2 and it hurts there quite badly when I attempt to sit or if I am sitting and I switch positions and when I go around a curve in a car. It feels like someone is hitting me with a baseball bat at S1 or S2...right at the top of where my butt starts. Could it be the muscle spasm? Or could it be something else that we have missed? I had a CT scan done with and without contrast and it came back normal.
The pain was lower and I was dealing with coccyx pain and severe burning on the left side of my low back (side of SI joint dysfunction), but that is gone now and it hurts higher, more center, and more like bone pain than burning pain. I also have the feeling of a front wedgie.
I also have an external hemorrhoid that is bothering me..can that cause muscle spasm and low back pain?

I appreciate your time.
Kate

Kate2009:
Is the chiro addressing just SI manipultation? Is anyone actually working on releasing the muscle spasm? Are you using any SI belt for support? Is PT for pelvic pain? If yes, are you getting connective tissue manipulation? Sounds like Piriformis muscle needs some work. Is there sacral torsion (ask the chiro or PT).
I am a believer that pain from hemorrhoids can affect the PFM.
have you had any intrarectal release?
Also, there could be scar tissue around the surgery site. Did you have PT prior to surgery?

<small>[ 05-26-2009, 09:51 PM: Message edited by: Moderator ]</small>

Hi Niva,
Thanks for your response!
The chiro is manipulating the SI joint and he has been pushing on the muscle spasm for at least 10 seconds each visit (which in the beginning was more than I could stand), I think trying to get it to release. The muscles are crunchy. Is there anything that I can do to speed the release?

I do not have an SI belt. Would that help me out?

The PT is for pelvic pain (pudendal neuralgia and vestibulitis). I had my pudendal nerve decompression surgery done with the trans-gluteal approach so I had my sacro-spinus ligaments divided according to the operative report. It looks like my nerve was transposed medially, but not laterally, and my muscle bundles were re-attached loosely (gluteus). It looks like my sacrospinous ligaments were tethering the nerve as well but it does not say in the report if those were cut or divided or dissected.

What is connective tissue manipulation? Is that massage?
I have been doing the piriformis stretch. The sacrum has to be adjusted from the right to the left each time I see the chiropractor (2-3 times per week). My PT tried to do an intrarectal release of the coccyx but said that rather than being hypo-mobile I was more hyper-mobile. She said that the pelvic floor exercises will strengthen me and keep things in place. She said that I am higher on my left side and has been giving me exercises to even me out (hips) because the side is compressed.

I did not have PT prior to surgery.

Thanks,
Kate

Here are my exercises:
seated hamstring curl
seated trunk rotation
supine trunk rotation
hip external rotation with theraband
kegels
breathing into abdomen
child's pose
half-kneel hip flexion stretch
quadriped pelvic tilt
priiformis stretch
hamstring stretch
wall slide
heel raises
leg lifts
Some ab exercises without names
walking daily

Kate2009:
Do any of your exercises bother or flare you?
Conn tissue manip is a "massage" like technique, as it is hands on you and releasing, but it is a specific technique.
Your PT should be able to teach you to do some self release, besides stretch, like foam roll, theracane...release on the piriformis or any other muscle spasm...
Also, it sounds like the PT and chiro are both adjusting the SI to some degree, so make sure they are on the same path.

Niva,
I found out that I have an anal fissure and skin tag...not an external hemorrhoid. Apparently my anal sphincter is too tight. Can this cause tailbone pain? The pain in the tailbone is the worst if I have sat for a few minutes and then attempt to get up. Just staying in the sitting position and lifting myself up slightly with my arms causes major tailbone pain that lasts for about 10 seconds. Sometimes I feel like my vagina can't breathe...I know it sounds weird.
The kegel exercises used to make me feel worse but now I think that they are helping. Sitting to do a couple of the exercises can be excruciating. I have a donut cushion but it doesn't really help. My period causes me excruciating tailbone and low back pain.
I will ask the PT and the chiropractor which way they are adjusting the SI to make sure that they are not counteracting one another.

Thanks,
Kate

The muscles around the fissure may be tight and that could be leading to some tailbone pain. Not sure if the external sphincter tightness alone will do that as it is not inserting or moving the tailbone.

<small>[ 06-07-2009, 10:43 AM: Message edited by: Moderator ]</small>

Niva

What is the difference between pudendal neuralgia and levator ani syndrome. Also, if it hurts when your paraurethral muscles are palpated, which muscles should you get botoxed?

thanks

Levator ani syndrome refers to muscle spasming in the levator ani muscles commonly with a feeling of a golf ball in the rectum and symptoms are more rectal ache/discomfort. There is no nerve irritationinflammation in this syndrome compared to PN.

As for Botox-it depends on which muscles are tight or painful.

Niva

If your paraurehral muscles are burny when touched, what muscles would need botoxed to get rid of that

thanks

Niva,
I am working with a new chiropractor and he said that I have myofascial pelvic pain syndrome. He is also a licensed acupuncturist and he uses a different technique. I did not realize that I had these extremely sore spots on the front of my pelvis as well as the tailbone pain. I will write back and let everyone know how I am doing in a few weeks.
All of my pain started 6 hours after a car accident 5 years ago...

Kate

Good Luck Kate! Is this not what the PT is also focusing on, I mean the myofascial restrictions?

In regards to botox, I do not inject Botox in a patient. I will recommend to the doctor performing the procedure for my patients who I treat weekly and know what is going on, the muscle which I believe are tight. I don't think periurethral area is botoxed. Remeber, if you are working with a PT they are probably also working on the inner thighs and abdomen which are probably problem areas too. The PT is also probably releasing the periurethral area if it is tight.

<small>[ 06-09-2009, 12:09 PM: Message edited by: Moderator ]</small>

Niva,
I told my PT about the myofascial pain syndrome and she didn't say...yes that is what I am working on. She was working on some restrictions...but I don't think the main ones which are on the tailbone and the very tip of the pubic bone. I think that they are the main ones because they hurt more than anything ever has in my whole life when they are touched!

Botox is an interesting thing. If what I am doing now doesn't work completely I may look into it. I am actually getting injections of a homeopathic inflammatory into the painful spots by a surgeon here in town.

Thanks!

Kate