32. HerniaTalk LIVE Q&A: Pudendal Neuralgia

[@annie.bo.briggs]

My pelvic floor dysfunction started after having to sleep sitting up for six weeks after rotator cuff surgery. I will never have surgery again without knowing the risks involved in the aftercare. Live and learn.

[@user-le8sl9nq3j]

SALAM BENDEDE AYNI SORUN VAR AMELYAT IYI DEYILMI

[@fdimichele]

Dr. Towfigh - Do you know if any other doctors are learning Dr. Hibner's techniques should he retire? From my understanding, Dr. Stanley Antolak had a good diagnostic workup routine for pudendal neuralgia with concurrent neuropathies found and he recently retired. If you have not read this pdf, it is very good and may help with differential diagnosis. Just search for Observations on the Transgluteal Decompression of the Pudendal Nerve Stanley J. Antolak, Jr., MD

[@daniellepilon7433]

Yes, please bring him back. Thank you both

[@annie.bo.briggs]

Yep, I'm skinny, no hips...Thank you so much for making this video

[@tommylandrix6070]

No discussion of acoustic shockwave therapy? This is the one treatment that actually worked for me and everyone in the medical field is still only talking about nerve blocks and surgery. Regardless, thank you to both of you for your work in helping people.

[@herniadoc]

Great to know! Thanks

[@tommylandrix6070]

@@herniadoc My pleasure - Since it worked for me I am just sharing it everywhere to get the word out. It was a miserable several years leading up to it.

[@toby073]

@@tommylandrix6070 Intersting. Are you able to tell more specific which problem that therapy helped?

[@stevef7814]

May I ask where your pain was and who performed the shockwave?

[@truelies3690]

Nerve blocks and specially surgery is where the big big bucks come from, that's why. Therapies are non invasive for the most part and bring low bucks. Health care in America has always been about the big money, and not really curing the actual disease or problems. Big pharma is the billions of dollars king pin that takes the cake and trophy. They push drugs legally that cure nothing, just masks the disease and it's symptoms and meanwhile gives you side effects that give you more health problems and you end up with a baker's dozen of different drugs to take for life. Buyer beware.

[@Airandfiretarot]

Was kicked while on the swings in 6th grade. Have had a host of strange symptoms for my whole life. Recent diagnosed with sciatica and discovered this and thought wow, those are all my symptoms.

[@herniadoc]

See a specialist!

[@Airandfiretarot]

Right now I am mostly numb with a sharp tearing pain mostly with movement or sitting, especially the toilet but my only hesitation is located below my left butt cheek. Could that still be related? Left side of vagina always have been dull achey itchy and numb but is flaring up especially now with the sciatica. Only the pain from my whole left leg settled down and I started to ponder why that happened it started to make sense. I'm seeking a referral to a neurologist soon. Was referred to a PT bit I'm a trooper and can manage the pain for now I want a diagnosis and then I can relax and work on management.

[@Airandfiretarot]

Ironic the whole toilet sing thing, because that's where I spend oh so much time 🥲.

[@fdimichele]

@@Airandfiretarot See peripheral nerve pain specialist like Dr. Tollestrup could do evaluation for $500 and give you more information on what might be underlying cause. Dr. Tollestrup is famous for the piriformis lumbosacral plexus decompression if you have true piriformis syndrome. A neurologist is not typically trained in peripheral nervous system in terms of pain control besides medications so I don't really think that is going to help you. Northwestern also has a very good neurosurgery department with many varied specialists and would actually take your insurance as well.

[@fdimichele]

One branch of the posterior femoral cutaneous nerve gets hit when males ejaculate and those pelvic floor muscles go into action. So you can have pseudo sciatica like pain along with the pudendal nerve pain on your genitals and perineum and unfortunately anus as well. So, no sex life and now you have to sit on special cushions the rest of your life. With time, more providers are starting to cover this "gap" between different specialties. It sucks that females actually have more options for providers, but at least Dr. Hibner has his own practice and can see both sexes. Just keep in mind that even the lesser nerves that might just be cutaneous can wreak havoc as the pain cycle gets going. Wish everyone luck in their journey to health and happiness.

[@dorothybeveridge3133]

Hi . Iv had a burning & painful vulva for nearly 3 years. I’m 74 years old woman. Can you help me please? I feel I’m sitting on a painful lump . Please please reply me. I’m suffering & I don’t have a very good life with this condition. I’m in Scotland . Thank you. X

[@herniadoc]

Thank you for your message. Please direct your consultation request to Beverly Hills Hernia Center via email: [e-mail]

[@Delmarksman]

My PN started after having the Rezum procedure done, without anesthetic. The pain is extreme and sharp and generally comes in waves. I have been trying to determine my triggers and they vary: sitting, standing, laying down, bike riding. I have added a donut to my office chair and that has helped a little. I am skinny with an athletic build, so not much "natural padding" on my backside. I do not believe that there is an entrapment, but my akin to a complex regional pain syndrome (CRPS /RSD). The pain presents during urination and bowel movement. Referral pain areas are anal, perineum, base of tip of the penis. Often the pain is on one side only, but not always.

[@chass5438]

Me too.

[@Delmarksman]

@@chass5438 I'm very sorry to hear that! I wouldn't wish this on anyone!

[@evetted21]

Hi back in February of this year I had pain in pelvic and rectal pain after a bowel movement and burning after urine . Ct scan of the pelvic and bladder results was look good.and I had a cyoscope of the bladder. I have a disics lumber problem in lower back . I seen many specialist gynecologist, unclogist, frequent urine urge to go , I still in pain ,burning. Please help

[@herniadoc]

Please contact my office directly to see how I can help you. [e-mail]

[@johns1577]

I'm really struck that he said scrotal pain, not testicle pain. Why is that important? I've had what feels like left testicle pain since 2008. Orchiectomy didn't help. PN block before surgery missed the nerve because later block took pain away for 2 glorious hours. I had the perineal branch cut, gf nerve too. Nothing has helped. Can a proximal compression only hurt in one area?

[@herniadoc]

You should consider calling the office

[@johns1577]

Thanks for the advice. I actually have an inguinal hernia. But it appears to have been caused by a hole from my laparoscopic prostatectomy I had due to cancer found while trying to find the source of my pain.

[@johns1577]

I actually did just see his office emailed me, telling me they don't accept insurance. I get that they're not a charity, but it's disappointing as he's very knowledgeable.

[@herniadoc]

Watch my HerniaTalk LIVE episode with Dr David Josephson, urologist . We discuss how hernia can occur with prostate surgery.

[@JL-zj4qt]

What about pulsed radio frequency - stunning the nerves rather than damaging them? Is this recommended?

[@herniadoc]

for some situations, yet.

[@user-rc7ro2xw7s]

It's an anatomic nerve.You can't stunn the nerve.

[@user-rc7ro2xw7s]

@@herniadoc ,It's an anatomic nerve os thats not possible.

[@denaking2884]

Could it be in connection with fibromyalgia with nerve entrapment?

[@herniadoc]

Usually notn

[@annie.bo.briggs]

I have small inguinal hernias. Nothing was recommended for them. Could that be the issue? I'm getting a diagnostic pudendal nerve block. I don't have a uterus but I was diagnosed with hypertonic pelvic floor. Thank you.

[@herniadoc]

Hypertonic pelvic floor may be due to small inguinal hernias. See a specialist

[@annie.bo.briggs]

@@herniadoc Really? Thank you so much.

[@annie.bo.briggs]

​@Dr. Shirin Towfigh This is making a lot of sense now. This would explain why I had so much pelvic pain after PT and after dancing or pilates. Also walking hurts more than sitting.

[@canergunay3047]

@@herniadocthis really can be reason? İ have small inguinal hernia on the left side. İ feel numbness around my pelvic floor and i have constipation problem

[@chass5438]

I have 2 of them in each side. The surgeon wouldn't do anything. A 5 minute consultation to find out he wouldn't help. I think my pelvic pain issues are related to them. My physical therapist said she could feel the nerve spasming. It doesn't seem to really work having therapy.

[@fdimichele]

DOI 10.2310/7900.15034 - Scientific American Pain Management - Chronic Pelvic Pain: The Peripheral Neuropathic Basis (Stanley J Antolak Jr, MD)

[@udaylove7158]

please tell me, does this cause scrotal sagging and penis swelling?

[@herniadoc]

No