PELVIC PAIN AND PUDENDAL NERVE ENTRAPMENT

PELVIC PAIN AND PUDENDAL NERVE ENTRAPMENT

Hi All

On Saturday 29 March I attended Vulva Awareness Day, a pelvic pain seminar organised by GAIN, the Gynaecological Awareness Information Service, www.gain.org.au , in Perth, Western Australia.

The speakers were:-

-Dr Tim Pavy, an anaesthetist specialising in treatment of pelvic pain at King Edward Memorial Hospital in Perth who is using local anaesthetics to relieve pain and trick the brain into not generating previous pain in the future. Sounds wierd, I know.

-Catherine Aurabind, a woman who developed chronic pelvic pain after hysterectomy and spent the following 12 months lying down in an opiate-induced haze because it was the only thing that would relieve the pain. She has now been treated with Botox and further surgery, and is having ongoing treatment for pudendal nerve entrapment which has given her back her life. I sincerely hope that is all the surgery she will need.

-Ass Prof Thierry Vancaillie, a gynaecologist from the Royal Women’s Hospital at Randwick in Sydney who developed the surgery that Catherine eventually had.

Thierry Vancaillie gave a very interesting talk about the pudendal nerve and explained about the three branches of the nerve which supplies the digestive system in the anal area, the reproductive system in the perineal area and the sexual system (the clitoral branch) in the vulval area. This is all explained in detail in Saving the Wholewoman, ed 2, page28 and probably in ed 1 as well.

The interesting bit is that the pudendal nerve can become trapped and squashed before the nerve branches, between the two halves of the sacrospinous ligament when the perineum is lowered, which stretches the nerve and irritates it (just like carpal tunnel syndrome). It is treated with physiotherapy, various other therapies and as a last resort by surgery, which trims the central edges of the ligaments and releases the nerve. I think even I would have this surgery as an alternative to spending the rest of my life as an invalid in an opiate haze, after hearing Catherine’s story. It is often accompanied by spasms of the pelvic floor muscles, which are unable to contract and relax. (Is this vaginismus? L)

This entrapment is mainly a result of the hysterectomy procedure, and Thierry Vancaillie did lament the number of unnecessary hysterectomies that are done, and cause unnecessary damage, pain and suffering to the women concerned, instead of relieving their initial suffering as expected.

Pelvic nerve entrapment also happens in all women who have vaginal deliveries and some women who get it via the surgical damage of caesarean section. In women who deliver vaginally it just about always resolves in time as the body reverts after labour and birth. Hence immediate post partum incontinence, difficulty with bowel motions, lack of sensation in the vulval area for a variable period after birth, for many women.

From here on the theory is mine, resulting from my reading of Christine’s book and listening to Thierry Vancaillie.

However, it does explain why women experience pelvic pain and dysfunction in all three areas and systems of the body that exist in the pelvic area.

As Christine explains on p 29, “blood vessels run alongside the nerves throughout the pelvic diaphragm”. This means that if there is pudendal nerve entrapment there may also be blood vessel entrapment.

Theirry Vancaillie explained that ‘pelvic congestion can also be caused by pudendal nerve entrapment’, (because the veins get squashed as well as the nerves. L) That’s why it feels like you have got varicose veins in the pelvic region. You could well have! I for one remember it well after one of my baby’s births. It felt like I had a football blown up in my pelvis!! Agony!! And all the time I was tucking in my new, small wrinkled belly, and tucking my butt in for all it was worth, trying to get my body ‘back into shape again’, and looking forward to wearing those unattainable jeans again! All I could do was lie on the sofa and hang myself upside down by the legs over the back of the sofa, with my butt halfway up the back of the sofa and my head hanging off the edge. (What a fool I was, in hindsight. L)

Now the interesting bit.

When a woman has POP, Wholewoman posture moves the pelvic organs forward, takes the pressure off the pelvic floor and the perineum, so the perineum can rise and release the stretch in the pudendal nerve as it passes between the two sacrospinous ligaments.

In addition the pelvic floor muscles experience tensioning between the ischial spines, and from the pubic bone to the sacrum and coccyx. In this gently taut configuration they are gently mobilised during everyday movement such as walking, where the two halves of the pelvis nutate and counternutate in opposition to each other, and balance each other. Therefore they are less likely to get into spasm and seize up. I suspect that in the post partum period this gentle everyday exercise is what helps the pelvic floor muscles to recover their tone and remain/become functional again, but WW posture is what is needed in the post partum period to kick the recovery off while the whole pelvic area is still quite malleable.

By not getting WW posture happening soon after birthing I think it is frustrating the body’s own mechanisms for healing itself and become functional again, so it can get back to mother work, and in most parts of the world, physical work as well.

Hearing Thierry Vancaillie was like seeing puzzle pieces drop into place for me, bringing me a much better understanding of how the vulval area works, and giving me once again a sense of profound awe at the miracle which is the way the human body works together as a group of systems, and the Creator who fashioned it.

Any comments on this?

Cheers

Louise