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

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

Pudenal 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 urogynocolgists maintain that Botox injections into the vagina for hypertonic pelvic floor muscles is a relatively painless and require only local anesthesia. Based on anecdotal evidence from PN sufferers on group sites patients who receive only local anesthesia experience sharp, intolerable pain. Many PN sufferers avoid trigger point injections because they find needle injections into the vagina too painful.

Make sure to advocate for yourself and discuss pain control and anesthesia with your doctor. If you feel you need to be under during the injections, find a urogynocolgist or urologist whose practice aligns with your needs. It is common to receive anesthesia during vaginal Botox.

The procedure is short, 10 to 20 minutes so you will put under light sedation through an IV i your hard. You will not

be. You will not receive general anesthesia which means you will not be Intubated - a process where a healthcare provider inserts a tube through a person's mouth or nose, then down into their trachea (airway/windpipe).

This procedure will be done under light sedation. This means you will not feel or remember it. Your doctor or staff will their staff will instruct you:

1. Have someone drive you and pick you up

2. No food or water after midnight the night before.

Botox injections should always be done in a surgical center or a hospital. Botox should never be administered to the pelvic floor in an office setting. Sedation should be used because the injections are extremely painful and pain will work against the entire purpose of the injections which is to relax the muscles.

Some doctors include a pudendal nerve block not as a diagnostic tool, but as pain management after the procedure. There can be discomfort in the vagina from the needle injections themselves and the block give four to five hours of pain relief. One only needs over-the-counter medication after that for a day or two if any.

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 seond 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. The team will observe once. 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 5 days before starting up PFPT again.

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.

NOTE: We have seen posts on the pudendal neuralgia Facebook Groups where people warn of fecal incontinence;

1. PNA has not read of cases in publications and

2. Has not confirmed a case.

If you find a study or experience incontinence due to Botox pelvic floor injections, please email us at the address below.

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. If you do not ask, you could be the first and end up with some incontinence or none of the needed paralysis in the correct muscles.

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

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Pudendal Neuralgia Alliance

contact@pudendalneuralgiaalliance.org

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