Pelvic floor Botox injections

[kevin]

I'm trying to get a list of doctors who perform Botox injections in the pelvic floor for CPPS. Botox is commonly used for pelvic pain in women, but I don't know the names of many urologists who are using it in men's pelvic floors. Dr. Berger at the University of Washington does this, and so does Jerome Weiss, reportedly. Has anyone here in North America seen a doctor who does this?

For those of you who don't know, Botox temporarily (3-6 months) disables the nerves that cause muscle spasticity. So, some doctors are injecting it into spastic pelvic floors in order to reduce spastic behavior there.

Botox is also used for several other things in urology: it's sometimes injected into the bladder to disable the sensory nerves, and can also be used in the urinary sphincter for retention/severe difficulty voiding. Also, J. Curtis Nickel is currently doing a clinical trial of intraprostatic Botox injections, with the goal of disabling sensory nerves that cause pain there. This is a new (untested) application of Botox, and it'll be interesting to see what it does. http://clinicaltrials.gov/ct2/show/NCT00529386

[rysocal]

I am actually getting this done by Dr Jordan in L.A. next week ( pelvic floor muscles) . I have been seeing a physical therapist for the past 6 months and she wrote a report to him about which muscles are consistantly tight. Think it helps big time to have a PT report with this. I will keep everyone posted on how it goes.
Ryan

[kevin]

What's Dr. Jordan's first name?

I'm interested to hear about the results. Do you know what exact muscle will be injected?

[kevin]

By the way, rysocal, if you haven't seen it already, you should read bti20's description of his Botox experience: viewtopic.php?t=3558

Basically, there is a small amount of evidence that Botox in the pelvic floor can help CPPS, but we're still waiting on larger studies.

Paper on injection of Botox around the urethral sphincter

I'm considering getting Botox in the urethral sphincter and possibly pelvic floor because:

Sphincter: I have dyssynergic voiding
Pelvic floor: I have a tendency to tense the pelvic floor that has not improved even after serious long-term efforts to stop.

[chrisjiujitsu]

I am very interested in this. I am thinking of trying this before going to california. I have a specific internal area that I am sure is causing all my pain, discovered through self internal TP work. If it is discovered there is nothing there but some tense muscles, I can see some real potential in Botox injections in the area. This is much different then picking some random spot on the pelvic floor to inject. I am not sure if that is what is being done in the studies. I think injecting into a known problematic area should provide much better results.

[kevin]

If all you've done is self PT, I would definitely try seeing a qualified PT first. That should be the first line of treatment, as it is very safe. If that doesn't work to get rid of your trigger points, then you might look into more invasive options (dry needling, trigger point injections, Botox). A few people on this forum have had these treatments; read around.

There's more evidence that these help for female chronic pelvic pain than for CPPS; the reason people try them for chronic prostatitis / chronic pelvic pain syndrome is mostly extrapolation from those results. Although I am considering these treatments myself, I can't recommend them in general for everyone, because there isn't enough evidence to show that they help CPPS. On the other hand, they are relatively safe.

I am very interested in this. I am thinking of trying this before going to california. I have a specific internal area that I am sure is causing all my pain, discovered through self internal TP work. If it is discovered there is nothing there but some tense muscles, I can see some real potential in Botox injections in the area. This is much different then picking some random spot on the pelvic floor to inject. I am not sure if that is what is being done in the studies. I think injecting into a known problematic area should provide much better results.

[ramana]

Cleveland clinic in Florida definitely does this. I happened to talk to a neurologist who does this.
Front desk at Stanford pain management center told me that they also do Botox injections.
Also there is a list of docs who do Botox at <<link to pudendal site removed, please see RULES>>
Please keep us updated. Wish you the good luck.

[ramana]

Forgot to mention that the muscle where to inject and the amount of Botox that is to be injected are very important inputs.

[rysocal]

I just got a Botox injection today of the obturator internus and the levator ani by Dr Sheldon Jordan in Los Angeles. He told me it takes a week or two to notice any results. I will keep everyone posted in a few weeks.
Ryan

[ramana]

Hi rysocal
Thanks for keeping us posted. Can you provide information on this
a) How much Botox was injected and what factors are taken into consideration on deciding this. Different docs have given me different answers
b) You have mentioned Elavil / baclofen suppository in your signature. Did it help? If taken that way won;t it avoid the side effects of constipation?
c) Did it hurt? (I am tired of pain and now even an injection irritates me)

[scoobysnacks]

Ryan,

Please keep us informed of this.

Where in the levators if you dont mind me asking, front or back towards anal sphincter.

Thanks

Ss

[rysocal]

I will get the operative report back in a couple weeks with the details on the CC's of Botox. I am not exactly sure what part of the Levator he injected , I can ask him though.I think it was more towards the back.It wasn't very painful. If you ever had a prostate massage , thats 10x worse. Think he used a ultrasound x ray to guide the needle in the appropriate part of the muscles. Through the butt cheeks. I took two .5 Xanax before going in. They do offer anaesthesia if you're sensitive. I feel really good today but I dont know if its because of the massive amount of Xanax I took yesterday. I think I need to wait at least two weeks and some time with my PT to give a valid opinion.

As for the Elavil/baclofen suppository. Yeah it helped a lot , plus you could loosen up the levator at the same time. I hated it in the beginning because it was so inconvenient. I dont know if it causes less constipation in the suppository form. I have never taken Elavil in the oral form. It was only 20 mg of each compounded into a suppository. I will keep you guys posted.
Ryan

[scotsman]

How often do you expect to have to repeat the injections/treatment? Could it be a once only procedure?

[MB]

I had Botox done by Dr.Jordan a while ago. It was a total disaster. The pain increased significantly for 6 weeks.
The levator, obturator and, adductor were injected.

[chrisjiujitsu]

I wanted to reply to the message to me above. It is not what it seems. I have been doing internal TP work alone and the therapist I saw didn't think it was necessary. I did however and feel more comfortable doing it myself. Because she told me she would only use her finger, I could guess she would have missed the worst spots that I didn't with my 7" wand. Anyways, if you interested in my background I sort of listed some of it here in a recent post that adds a twist to my situation.

viewtopic.php?t=5139