BOTOX

Botox (Botulinum toxin) injections relaxes muscle by blocking

the release of a chemical called acetylcholine.. It is used to treat

hypertonic pelvic floor muscles, overactive bladder, neck spasms,

spasticity in individuals with cerebral palsy, sweating, lazy eye,

migraines, and other conditions.

Many people with pudendal neuralgia have pelvic floor tension

myalgia, also known as hypertonic (tight) pelvic floor muscles. The muscles

irritate the pudendal nerve as it gets stuck in the lock, rather than gliding with ease.

Botox injections every three to four months enhances pelvic floor physical therapy (PFPT) by paralyzing the muscles and help relax the pelvic floor and alleviate pain.

Pudendal neuralgia can occur on both sides (bilateral) or one-sided (unilateral). We are confirming if Botox should only be injected on one side at a time if a patient has bilateral PN.

As with any procedure, make sure to only see an experienced urogynecologist or urologist with experience injecting the pelvic floor with Botox.

The Procedure

Some doctors maintain that Botox injections into the vagina for hypertonic pelvic floor muscles is relatively painless and requires only local anesthesia (in the needle itself). Based on anecdotal evidence from PN sufferers on group sites and through Zoom meetings, most experience sharp, intolerable pain which is unnecessary.

Sedation

Most doctors use IV propofol sedation which has a rapid onset and offset. It is used for less invasive procedures like pelvic Botox. You will be unconscious and feel and remember nothing. You will need a driver to take you home.

This is completely different from general anesthesia which is used for major surgeries. General anesthesia requires breathing assistance. The patient is intubated. This is when the anesthesiologist inserts an endotracheal tube (ET)

into the airway (trachea) to hold it open.

You can also ask your doctor to give you a bilaterial pudendal nerve block while you're still under. This is not for diagnostic purposes but to help with post-op pain. There is usually not a lot of pain after the injections and it will only last a day or two, but the block will prevent any pain for four to eight hours to allow you to get home without discomfort.

Time, Cost, Locations

The procedure itself is short: 10 to 20 minutes. It will take time to check in, go through pre-op questions, talk to the anesthetist and your doctor. There is also the chance that your physician can run behind because of procedures proceeding yours. A good estimate of the total amount of time from when you arrive until you can leave the hospital or surgery center is three hours.

Botox injections should always be done in a surgical center or a hospital. If you are paying cash, surgical centers charge much less than hospitals and are just as safe.

Botox should never be administered to the pelvic floor in an office setting. (Trigger point injections can).

The Experience

You will first enter a small room where there will be many others with a sliding door or curtain for privacy. Your nurse will come to begin preparations. This will include taking your vitals, confirming medications, that you have not eaten since midnight. The nurse will provide you with a hospital gown and ask you to remove all of your clothing. They will step out of the room to give you privacy. The nurse will return and continue to ask you routine pre-op questions.

The aestheticist will visit within 15 minutes depending on how many patients are there that day. They will explain the process. The doctor will visit just before you go into the surgical room or theater to repeat the procedure and sign a

few documents.

You will be wheeled into a surgical room, bright, cold, probably with several staff there to help. You may or may not see the doctor in the theater. The anesthesiologist will put you under almost immediately. The team will unclothe you and put your legs into stirrups after you are unconscious. WOMEN and MEN, with adjustable Allen stirrups. The patient is face-up, arms to the sides, but the legs are separate, raised, and supported by stirrups so the doctor can easily see your pelvic floor. .

The standard amount is 100 Botox Units diluted in 20cc saline, 25 united injected into each spastic, tight muscle. are generally injected. If this is your first time receiving Botox, a doctor should start at this minimal amount. More can be used depending on the patient for second and third treatments. The FDA limit is 400 units.

Hypertonicity/spasticity of pelvic floor found are most often found along the following muscles:

1. Obturator Internus

2. Pubococcygeus

3. Ileococcygeus

4. Coccygeus

You will wake up either in the surgical room after the team as laid your legs back down and covered you, but you probably will wake up back in the room where you began the day which is now your recovery room.

Everyone wakes up differently. Once you're more aware, they will offer your juice and crackers.

After 30 to 60 minutes, you should be able to go home with your driver.

Botox starts to work in 5 to 10 days. The full effect of your injections will be seen between 10 and 14 days.

It might be best to wait five (5) days before starting up pelvic floor physical therapy (PFPT) again. You don't want our vagina to still be tender and sensitive.

Botox lasts three to four months. Many doctors like to repeat the procedure three to four times for optimal results.

IMPORTANT: Restart pelvic floor physical therapy as soon as possible after 5 days to maximum relaxation of tight, painful muscles around the pudendal nerve. Botox without PFPT is a waste of time. "Botox combined with soft tissue myofascial release physical therapy can be effective in treating women with chronic pelvic pain secondary to myofascial pelvic pain (MFPP)." 1 WE INCLUDE MEN in this conclusion.

Women see urogynecologists for Botox injections. They also see men.

Men can see a urologist for Botox pelvic floor injections. PNA needs to do more research into men's care.

NOTE: Make sure to see a doctor with many years' experience doing this procedure. ASK how many years and/or procedures. If you do not ask, you could be the first and that would create unnecessary risk.

1 *https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5330376/

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Pudendal Neuralgia Alliance

contact@pudendalneuralgiaalliance.org

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