levator ani problem, pudendal nerve test, question?

[Maurice]

Hi folks,

After having a burning tip of the penis for over 10 years without significant results from meds I found a pelvic floor specialist who could recreate the pain by internally going in and working on the levator ani muscles. I have seen her each week for the last 4 months with minimal results. She has suggested to my doctor who is willing to do a diagnostic procedure(he has done it on one man and over a thousand women) that I determine whether or not the pain is ingrained in my head(continue to use valium and neurontin), or if there is an actual nerve problem along the pudendal nerve somewhere. Under a nerves thread Webslave showed an excellent diagram of where this pudental nerve runs. My doctor has proposed that he use an anestetic to numb the area and then put a needle in about 1.5 inches in and inject marcaine to numb the area. He says that it will only take effect for about 4 hours and that if I get up and walk around , rub the head of my penis against my clothes as I walk, I should feel very little irritation like the way I have for years. If I feel the same way with irritation and pain, then we need to cross this potential problem out.

I am asking any of you folks who are familiar with what is being proposed here makes sense, if you have had it done before, and what I should expect, should I decide to go ahead with this short term Diagnostic procedure.

Thanks

Maurice

[Ken]

I am also looking in that direction now since 5 Uro's and 2 GP's haven't done
squat for me. Seems strange that I make it 38 years into my life just fine and then one day all hell breaks loose. Coming up on one year now for me.

[dayne1234]

The best place in the country to determine if the pudendal nerve is the problem is Dr. Renney in Houston, Texas. He has performed the PNMLT many times. He actually had entrapment of the nerve and went to France to have surgery perfomed. I've been to the Mayo, Dr. Renney and Dr. Weiss in San Francisco for my pain. I've had multiple pudendal nerve injections that did not help. I went to Houston and had the PNMLT (Pudendal Nerve Motor Latency Test) and my results were very low...this meant that the nerve itself was fine. But the muscle tension wasn't.

I would highly recommend getting this test done by someone who has done it many times. Dr. Renney is one of the best.

Hope that helps.

[webslave]

Regarding the surgical procedure on the pudendal nerve, where all this is leading: most people who have had it are negative about it (see Pudendal Pain forum). Ligaments are cut, the spine can be destabilized, and there is a 6 inch scar on each buttock. People who have had it are often on morphine pain medication afterwards, indefinitely. Stay as far away from it as possible.

The "pain at the end of penis" syndrome is cured by the Stanford/Wise-Anderson Protocol by applying 60-90 seconds pressure to the trigger point on the anterior levator ani where it attaches to the prostate.

[MS]

...determine whether or not the pain is ingrained in my head(continue to use valium and neurontin), or if there is an actual nerve problem along the pudendal nerve somewhere.
Maurice

I'm not sure what you mean by "ingrained" in your head. Unless you are refering to anxiety perpetuating your symptoms. If Valium is helping you, the Valium is most likely acting on/relaxing your voluntary muscles. If your PT palpated your levator ani muscles and it referred pain, perhaps you should look at AHIP viewtopic.php?t=392 or some articles on myofascial pain: http://ucpps.men/1/docs/IC_pelvicpain.pdf (acrobat)

also see this post: viewtopic.php?t=1176

Did your PT specifically mention the Pudendal nerve? I would think that the numbing agent might be a trigger-point injection into pelvic floor muscles (e.g. levator).

The Neurontin is for neuropathic pain, so I don't see how taking both Neurontin and Valium would determine if the pain is in your head.

[Maurice]

Regarding the surgical procedure on the pudendal nerve, where all this is leading: most people who have had it are negative about it (see Pudendal Pain forum). Ligaments are cut, the spine can be destabilized, and there is a 6 inch scar on each buttock. People who have had it are often on morphine pain medication afterwards, indefinitely. Stay as far away from it as possible.

The "pain at the end of penis" syndrome is cured by the Stanford/Wise-Anderson Protocol by applying 60-90 seconds pressure to the trigger point on the anterior levator ani where it attaches to the prostate.

Thanks everyone for the information. It is actually my pelvic floor specialist who does the 2 minute press to the levator ani muscle who has asked my doctor to do a diagnostic test by putting marcaine into the pudendal nerve area and seeing if if the burning and pain in the tip goes away for 3-5 hours. I guess with women, longer term nerve blocks are done where the levator ani muscle can then be worked on more successfully. I am just trying to determine what this diagnostic test feels like, if any one else has had it done,etc.

It is good to know about surgery and comments mentioned but at this point surgery has never even been contemplated or mentioned.

Thanks

Maurice

[NoMoPain]

The "pain at the end of penis" syndrome is cured by the Stanford/Wise-Anderson Protocol by applying 60-90 seconds pressure to the trigger point on the anterior levator ani where it attaches to the prostate.

I completely agree with this Webslave. This was my experience also after seeing my Physical Therapist. I had that pain there for several months and after my first PT session over 90% of it was gone. I still have some other symptoms but they are getting better too (not in a linear fashion but in a general trend type). I used to think that there was something wrong at the penile tip, but that seems to be how these trigger points operate, in that they can refer pain to other areas. All I can say is Thank God for Trigger Point release therapy and progressive relaxation.

I wish everyone the best out there.

[Ken]

Does the PT actually feel a bump on the tissue or a twitching spasm or both?
And what is meant by appliying pressure? Is it just pressing down on a spot and holding it there or do they slide the finger along the muscle tissue while pressing down?

[Maurice]

The "pain at the end of penis" syndrome is cured by the Stanford/Wise-Anderson Protocol by applying 60-90 seconds pressure to the trigger point on the anterior levator ani where it attaches to the prostate.

I completely agree with this Webslave. This was my experience also after seeing my Physical Therapist. I had that pain there for several months and after my first PT session over 90% of it was gone. I still have some other symptoms but they are getting better too (not in a linear fashion but in a general trend type). I used to think that there was something wrong at the penile tip, but that seems to be how these trigger points operate, in that they can refer pain to other areas. All I can say is Thank God for Trigger Point release therapy and progressive relaxation.

I wish everyone the best out there.

Unfortunately I have seen my PT every week since November of 2003 and she hits the spot, the levator ani muscle as she calls it, and basically holds pressure to it for around 2 minutes max, only to the pressure that I can stand. It is extremely painfull as it does refer pain to the tip of the penis. Since I have seen her so many times (about 15) without significant results she is the one that is asking my doctor to see if the freezing of the prudendal nerve area with marcaine would make any difference in pain levels for 3-5 hours.

While I am posting, would an increase in 60-90 seconds sessions assist in the elongation of the levator ani muscle without significant flaring. I ask the question as my PT is open to teaching my wife the process which could be done every day, or every 3rd day instead of only once a week if this makes sense to do so.

Thanks

Maurice

[NoMoPain]

Excellent Questions.

In my case, the PT could actually feel the trigger point in which she said it felt almost like a small pearl or like a very hard green pea (this is supposed to be quite typical for trigger points).

While I get the PT, sometimes I can feel the muscles starting to release and let go, it is kind of a strange but good sensation (symptoms feel better).

My understanding is that there are two techniques for applying the pressure on the pelvic muscles. One is a constant pressure applied (not a lot of force is required here), this is the method that I usually get from my PT. The other method is a sort of sweeping like motion.

Most of the time, I can now feel when I am voluntarily relaxing or tensing my pelvic floor muscles. This has been very helpful for me, because if I were to continue to chronically tense then the PT would not help nearly as much. I was never able to "tune into" this kind of muscle tension before. Again, this kind of awareness has been extremely helpful because no matter how tight the muscles are at any given point in time, I now have some physical tools to help relax them (before I had nothing but a feeling of helplessness).

I still have a long way to go with all this but I have experienced enough improvement on a consistent basis to know that the muscle tension disorder theory applies to me (and I would surmise to most men with pelvic pain\prostatitis).

Good Luck to all

[webslave]

Unfortunately I have seen my PT every week since November of 2003 and she hits the spot, the levator ani muscle as she calls it, and basically holds pressure to it for around 2 minutes max, only to the pressure that I can stand. It is extremely painfull as it does refer pain to the tip of the penis. Since I have seen her so many times (about 15) without significant results she is the one that is asking my doctor to see if the freezing of the prudendal nerve area with marcaine would make any difference in pain levels for 3-5 hours.

Dr D. Wise comments on this case:

...there is no way anyone can say whether the problem he has is a nerve problem or not. As I said, if someone is not experienced in the internal trigger point work, deactivating very sensitive trigger points can be missed...