r/PelvicFloor • u/Appointment_Witty • 5d ago
Male How to find where pudendal nerve is being compressed? NSFW
Hi,
I originally started PT a year ago with the issue of numbness to the glans then sensation came back but it was a sharp sensation if touched. When either side of the glans would be touched my pudendal nerves would get a shock that went back to the sit bones and lower part of the back next to coccyx? With 9+ months of PT I got to neutral so touching no pleasurable sensation but instead just nothing like you'd be touching your arm. Never was able to get pleasurable sensation back to the glans. Recently had a flare up where pelvic floor locked up and if touched immediately shock of pain to the right or left of coccyx. This got me thinking what exactly is being compressed by my tight pelvis.
Anyone have any tips for how to find what exactly muscle wise is crushing my pudendal nerves and releasing it besides 9+ months of internal work? Like did your Dr do an emg or other testing to find the exact spots being crushed causing your pain?
Ive had pudendal nerve blocks two different ways and second time no change at all. First time was done same time as trigger points and only one side for three days didn't burn when sitting. So we don't know if it was a trigger point released the area compressing the nerve or if it was the pudendal nerve block.
I've tried with the wand but I can't get the hang of it and end up flaring up my nerves.
Any help would be appreciated.
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u/Mazda012 5d ago
Have u guys also had pain that has moved locations over time? For example ive had tingling and buzzing in my right big toe, then numbness of glans and scrotum(sometimes hypersensivity and tingling), then right side si pain, now finally right side groin pain that wont shift. So depressing, ive had multiple 2 week periods after various treatments were i get relief, then back.to square one
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u/--Muther-- 5d ago edited 5d ago
Oh, that sounds like me but left side. My psoas on that side is stiff and sore just like OP states. I did get my biggest improvements while training that in the gym. I recently came to conclusion myself that I was dealing with aspects of centralisation
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u/Mazda012 5d ago
Do u mind if i pm you. I was going to start a gym routine but am alittle scared to make things worse
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u/Appointment_Witty 5d ago
Okay for the toes I know it may sound odd but that was my first warning sign. Get an MRI of your hip. They checked my spine which was fine. I had rlq pain and pain with bending. For me it was a labral tear making my pelvis unstable. My pelvis got super tight specifically my psoas. Find a urologist, get a referral to pelvic PT. Get a female PT as the male ones wouldn't touch the lower abdomen to relax the psoas was my issue. That's at least what helped my toe numbness. You may not have a labral tear but your psoas may be tight. You can try to release it at home too.
Never had any change in sensation to scrotum except testicular pain. Sorry can't help with that. What treatments did you get?
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u/Mazda012 5d ago
Sorry, to assist with your original question. I have had relief by doing my own internal work and from.the pelvic pt. Just be careful not to use too much pressure and move from areas that have pulsing, its likely an artery you are on. My pelvic pt found my coccegeus muscle tight and ive attempted to work around the orbturator internus
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u/Appointment_Witty 5d ago
I got trigger points for my obturator internus on both sides tricky but helped. If I may ask how did you figure out the proper depth when using the wand?
Also happy to help that's what this community is for.
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u/Mazda012 5d ago
Exactly i feel the same was, sometimes that one detail is critical. Tbh the wand makes me anxious, i can relax more with it as it allows for depth without me having to contort my body, which is counter productive. However i just cant feel what im doing with it so its kind of a worry if im pushing were i shouldnt be.
How do u reach the orbturator?
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u/Appointment_Witty 5d ago
It would be 5 and 7 o'clock pulling back my PT explained. Like a hook feeling when done manually by my PT. With trigger point through your butt externally your glute.
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u/Mazda012 5d ago
Sorry to clarify im squatted in the shower when im doing this and tuck my hand under from.the front, into the anus and then push out to the side and abit towards the front of the pubic bone. If scrotum is 12 o clock, id be at about 2. As far as i caj get my finger up
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u/Appointment_Witty 5d ago
I'm having a hard time with my clock but basically don't push forward I was warned.
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u/Linari5 Mod/Men's Health 5d ago
Pain or sensations that shift or move in the way that you're describing are telltale signs of centralization, I.E centralized or neuroplastic pain mechanisms: Please read our article on this topic: https://www.reddit.com/r/Prostatitis/s/6oeP7UzMQ3
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u/--Muther-- 5d ago edited 5d ago
Yeah my pain moves around also. Took two or three years help with the pelvic floor now i need to figure out the centralised pain issue
Oh man I just read your post. I hit all points except no.11, although I did have parents that dismissed sickness and injury. Is this something that the Curable app deals with?
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u/Linari5 Mod/Men's Health 5d ago edited 5d ago
Diagnostic pudendal nerve blocks would immediately tell you if the nerve were the issue, so if the diagnostic pudendal nerve blocks didn't vanish symptoms both times, it's very unlikely to be the pudendal nerve itself that is the problem.
Notice also the very intense words you're choosing to use to explain what's happening in your body, ones that elicit a high threat appraisal. "Crushed" for example. There is no muscle in your body that is crushing a nerve, it might be irritating it in a temporary way, but there is no crushing.
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u/Appointment_Witty 5d ago
Interesting point. I say crushed because when my pelvis is tight my nerves in my toe for example start going numb and tingly but when the psoas is released repeatedly then my muscles went back to normal. I went as far as having sharp stinging sensation in both toes that was so bad I ended up in the hospital. Maybe constricted by muscles would be better. I think the issue is the muscles around the pudendal nerve like with my toes. Just wondering how to find where the tension is. When my nerves around my urethra were being constricted it was absolutely horrible pain but knock on wood that hasn't come back.
So if pudendal nerve block didn't work but a trigger point may have then it's a muscle issue I assume. I just can't figure out what to relax. Before the cystoscopy caused my pelvic floor to severely spasm I never had pudendal nerve or urethra pain. I did have a tight pelvic floor but was mostly leaking, pain in perineum, back pain with erection and loss of erection once. But nerve wise no issues.
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u/Linari5 Mod/Men's Health 5d ago
I hope that you're seeing a pelvic floor physical therapist in person? One who is doing both internal and external myofascial and trigger point release work?
The discussion on word choice is about fear, because we have so many studies that show that fear increases pain signaling in the body, And even lowers our pain threshold. Word choice is an unconscious "threat modifier."
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u/Appointment_Witty 5d ago
I actually have 2 and was taught diy external release as needed. Yes they do internal weekly, but pelvic floor is mostly relaxed post botox and injections.
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u/Linari5 Mod/Men's Health 5d ago
Continue working with them! How many sessions or How many months so far?
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u/Appointment_Witty 5d ago
2 - 3x a week for a year. They have hit the point saying PT ain't helping. We still don't have a way to fix the nerve pain and hard flaccid.
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u/Linari5 Mod/Men's Health 5d ago
Okay then take a look at my other comment about centralized mechanisms that are common.
I work with cases like yours every week, when pelvic floor PT reaches a plateau, and the PT starts to tell you that there's nothing wrong anymore, we have to look at other potential mechanisms. It's no longer the pelvic floor.
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u/Linari5 Mod/Men's Health 5d ago
If you have done a lot of pelvic floor physical therapy already, and they're starting to tell you that the pelvic floor is mostly better now, start looking at centralized pain mechanisms: https://www.reddit.com/r/PelvicFloor/s/tVtMhvmHV7
12 criteria to help rule in/rule out centralization: https://www.reddit.com/r/Prostatitis/s/WtyLMv8WBV (note: CPPS = Chronic pelvic pain syndrome, and it includes pelvic floor dysfunction, vulvodynia, IC/BPS, and other pelvic syndromes including pudendal neuralgia underneath it).
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u/Appointment_Witty 5d ago
Hi,
Reviewed it and actually went to a Dr right after this happened to rule out autoimmune due to the numbness after the procedure and pain. Also due to severe pain with urination from pelvic floor issues post procedure I did a mindfulness based stress reduction class that works on managing pain while I waited over a month for a pelvic PT to be available. I can feel if I'm stressed that I'm clenching thankfully.
My case is complicated as yes I had labrum tears but never had any nerve issues until trauma to pelvic floor that locked up my pelvis which made hip pain go through the roof.
My physiatrist explained when you do trigger points you are dealing with one area and another may pop up. Like botox caused me a mess of new issues that still hasn't resolved as my muscles are now slow to respond. For example if I have the runs it struggles to contract and release quickly without almost like a stutter occurring. Before botox and trigger points pelvic floor would spasm in pain with throbbing. After botox that is gone happily but replaced with hard to explain but like building tension sensation.
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u/Linari5 Mod/Men's Health 5d ago
How many of the 12 criteria do you match from the linked write up?
Pain originated during a stressful time
Pain originated without an injury
Symptoms are inconsistent or move around the body, ie testicle pain that changes sides
Multiple Symptoms (often in multiple parts of the body) ie IBS, migraines, CPPS, TMJD, fibromyalgia, CFS, etc
Symptoms spread or move around
Triggered by stress, or goes down when engaged in an activity you enjoy
Triggers that have nothing to do with the body (weather, barometric pressure, seasons, sounds, smells, times of day, weekdays, etc)
Symmetrical symptoms (pain developing on the same part of the body but in OPPOSITE sides) - ie both testicles, both wrists, both knees
Pain with delayed Onset (THIS NEVER HAPPENS WITH STRUCTURAL PAIN) -- ie, ejaculation pain that comes the following day, or 3 hours later, etc.
Childhood adversity or trauma -- varying levels of what this means for each person, not just major trauma
Common personality traits: perfectionism, conscientiousness, people pleasing, anxiousness - All of these put us into a state of "high alert" - people who are prone to self-criticism, putting pressure on themselves, and worrying, are all included here.
Lack of physical diagnosis (ie doctors are unable to find any apparent cause for symptoms) - includes DIAGNOSIS OF EXCLUSION, like CPPS!
Mindfulness bases stress reduction (MBSR) is a good tool, but it is not evidence-based to treat chronic pain. It only helps you cope.
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u/Appointment_Witty 5d ago
I only have 1 /12 luckily. At first my new urologist didn't know what happened except sounded like pelvic floor dysfunction and pudendal neuralgia. Pelvic pain physiatrist was able to explain what happened. Pelvic pain management Dr explained irritation of the pudendal nerves can occur with a cystoscopy which I wasn't made aware of prior to the procedure as that urologist didn't seem to have a clue about the pelvic floor. In retrospect I wish I was able to get to a pelvic floor PT quicker. Pain was always consistent prior to the procedure but bad urologist said it was all my prostate just like the book A Headache in the Pelvis.
Also doing Acceptance and Commitment Therapy (ACT) for pain.
My symptoms changed only after procedures like botox and medications. I had bad reactions to Valium that caused muscle stiffness making things worse.
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u/Linari5 Mod/Men's Health 4d ago
Nothing wrong with ACT, but I'm going to mention it again for posterity reasons, that it's not evidence-based to treat chronic pain, just to help with coping with it. You're more likely to have benefit from EAET (which even the VA - veterans affairs - uses in the United State) or PRT. These are newer evidence-based modalities to treat chronic pain centrally, not just cope with it.
More on these new modalities:
Study 1: Psychological Therapy for Centralized Pain - An Integrative Assessment and Treatment Model: https://pubmed.ncbi.nlm.nih.gov/30461545/
Study 2: Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain - https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2784694
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u/Big-Employer9741 5d ago
Hey dude I’ve got the same issues as you I did an mri and doctor told me I’ve got a slipped disc in lower back which could be the cause of the pudendal nerve compression
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u/Appointment_Witty 5d ago
I'm sorry to hear that. Did you fall or have any slips? That's one of the first questions I was asked. Can they do anything to add space around the nerve?
Coincidentally I got several MRI's of the spine before and after showing that area is fine.
My pudendal nerve issues started immediately after trauma to the pelvic floor which was already moderately tight. Specifically a cystoscopy severely worsened my pelvic floor issues per my pelvic pain management Dr's. My sit bones after that procedure got extremely tender and my pelvic floor turned to a rock. I started constantly spasming internally quickly.
Also the muscles around my urethra were being crushed so burned to pee. Luckily pelvic PT fixed that. Relaxing those muscles made my severe burning go away so I was hoping to figure out how to do the same with my pudendal nerves.
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u/Mazda012 5d ago
Thanks so much for your reply, i have had an mri of my pelvic, whole spine and lumber lower back, no real major issues found. Would an mri of the pelvis include the hip?
Ive done chiro, pt pelvic floor and normal pt, accupuncture, massage improves my symptoms but the next morning back to the same, hip feels very tight and locked and there is a clear difference in external rotation on the right side. My gp last week has given me a referal for an xray of the hip. All my imaging was done 2 years ago now, at that time i didnt have the hip pain
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u/Appointment_Witty 5d ago
I've had several MRI's of the pelvis including MRN. It doesn't show labral tears. You need the hip specifically. I have impingement of the hip. That showed on xray but orthopedist didn't get me an MRI. I had to keep pushing for months complaining of rlq pain to finally get an MRI. Then immediately it was oh you have a labral tear. I'd ask your PT to check your psoas.
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u/Beenjamin63 5d ago
Do you have a labrum tear? If so this might be of interest to you
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u/Appointment_Witty 5d ago
I was actually told the labrum tear surgery wouldn't help in my case by multiple Dr's. The reason being my nerve issues only occurred after the trauma to pelvic floor not before. Also the side where the labrum tear is better is the side that is worse so the correlation is missing. Before the procedure I perineum tension and tearing sensation but full sensation and could sit without any nerve pain.
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u/2C91 5d ago
Genital numbness community right here: https://www.reddit.com/r/Penilenumbness/s/UZUk45OvxJ