Discussions By Condition: I cannot get a diagnosis.

Pudendal Nerve Entrapment?! Pls Help!

Posted In: I cannot get a diagnosis. 3 Replies
  • Posted By: N_122AB
  • May 10, 2011
  • 01:00 AM

Hello everybody :)

Given the following information, would you agree that Pudendal Nerve Entrapment/Neuralgia seems like a very likely explanation for my symptoms?

-Mid-20s white, otherwise healthy, Canadian male
--Constant rectal discomfort, which is far worse when sitting for extended periods (e.g. on forklift at work); pain after bowel movements; pain diminishes when lying down or standing; pain is 95-100% relieved when Xylocaine (5% Lidocaine anesthetic) is applied to rectum
--Itching/Stinging/Burning/"hot" sensations and Allodynia (pain resulting from normal fabrics, e.g. pillow) around pelvic area, i.e., lower back, inner thighs, inner legs (knees to hips), penis, and scrotum; pain which is made worse when body temperature increases (e.g. doing physical activity)
--Constant lower back pain (for years and years now); lower back throbs with discomfort instantly after lying down
--Occassional feeling of needing to further empty bladder directly after using the washroom (additional urine does come out)
--I had been weight-lifting for a year before the pain in my genital areas started

The following medical tests have revealed NO abnormal results:
-MRIs of brain, neck, and mid to upper spin (no MRI of lower spine has been done); no evidence of any kind of de-myleniating diseases
-'Trigger Points' for Fibromyalgia do not produce painful responses
-Extensive STD testing
-EMG tests
-Heart tests

Creams (e.g. steroid-based ointments) and various kinds of anti-depressants/anti-convulsants (e.g. Lyrica, Amitriptyline, Cymbalta) have produced no relief.

For the last 3 months I've been taking 90mg Cymbalta daily (60mg @ 8am; 30mg @ 8pm). The medication does not help with any of the discomfort but it has helped me deal with my depression and give me a bit of 'zest' for life again.

I am currently trying to get into a well-known pain clinic in my city's downtown area where there is a specialist who applies pudendal nerve blocks. I believe a nerve block is my best option from here.

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3 Replies:

  • Any thoughts? :)
    N_122AB 2 Replies Flag this Response
  • I agree that it could be pudental nerve entrapmant syndrome. But I was also thinking if this could be something vascular, like venous incompetence? There is a condition called May-Thurner syndrome. It is when the right iliac artery compresses the left iliac vein against the spine. This causes the blood to congest in the left leg because it can not normally pass the compression on its way back to the heart. It does not necessarily results in the pain at the compression site (if it does it gives a lower back pain); most often it causes pain or swelling or both in the left leg and/or buttock. (Sometimes the anatomical structures are different and this can happen on the right side). If you have a compression like this, after a while your circulatory system is trying to develop alternative veins. They are called collateral veins. Most often there are transpelvis collaterals (horizontal ones from left to right in pelvis), but some patients can develop them near the spine or even inside it. Then it can give pressure on nerves and give numbness and tingling sensation in legs. Another typical symptom is ambulating pain, the pain moves around depending on where the pressure is high at the moment. Also, the pain subsides when you lay down. This condition is vastly underdiagnosed. It is impossible to discover with ultrasound and even difficult to discover with venography (phlebography). The only certain way to discover it is by means of intravascular ultrasound (IVUS) where the probe is inside the vein. The best research has been done by Neglén and Raju in Jackson, Miss. The treatment is to put a stent inside the vein at the site of the compression. The typical patient is a young – middle-aged woman, previously healthy where the doctors have not found other explanation for the symptoms. If left untreated, there is a big risk of thrombosis either at the compression site in the left common iliac vein or in the left leg. Could this possibly help? The best of luck!
    Felsen 510 Replies Flag this Response
  • In what city are you? Anywhere near san francisco? Check out www.pelvicpain rehab.com
    Anonymous 42789 Replies Flag this Response
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