New here! Pudendal nevralgia due to cycling... TMS?

Hi! I am an athletic woman, 33 yrs old. I ski (touring/outback/cross-country), I am a long distance runner, avid cyclist, etc. I had a new fitting for my road bike a few weeks ago (new saddle, lower handlebars...). After my first long ride I could feel a weird pelvic pain. People were telling me it was normal with the new fit and I had to get used to it. A few weeks ago I pushed through the pain for 450 km in a week while I should have stopped. Upon finishing my last 130 km ride my pelvic area was totally on fire. I could not sit at all... i had to go to the hospital and they diagnosed me right away with pudendal neuralgia due to a cycling trauma / wrong posture for a long time. They told me I had to take at least two weeks of rest to let the inflammation decrease. They told me acute inflammation was normal after a trauma since the nerve is trying to heal. I did that. I took time off work and laid down for two weeks. I started doing PT yesterday... with not much relief I must say. I am already so depressed... Everything I have read is depressing and Made me feel like I will have to live with this condition for the rest of my life. I will go crazy If I have to quit all sports. I left the Pudendal Hope Facebook forum because it was only making me panic. I am a lawyer and had to take time off work. I love life and enjoy everything to the fullest. I am so sad.

I kinda stumbled on this website and started reading with great interest. It made me do a huge introspection. I have a very anxious/type A/overachiever personality. I also have health anxiety and was able to « create » myself symptoms of diseases I didn’t have I the past.

You also have to know that I already had pelvic pain like 8 years ago. With no specific onset. I went through a battery of tests and was diagnosed with interstitial cystitis. I also thought at that time that my life was over. I was only 24 years old and crushed with this diagnosis. Sex hurt, etc. I’ve been through all the treatments possible in the world and all the meds with side effects etc. I’ve spent like a year and a half focused on treatments I had like one appointment per day (acupuncture, PT, massage, chiropractor, etc) none helped. It’s only when I stopped focusing on the pain and treatments that it subsided slowly by itself lol. Imagine I ended up being an avid long distance cyclist, runner, etc. Which are like the worst sports and while I was told that I should quit all sports.....

But now I am afraid there was really a mechanical compression on the nerve, I.e. the wrong bike fit pressing on nerve too long. The pain really started taking place while riding and worsened with riding more. And I am in this vicious cycle of catastrophyzing, anxiety, etc.

When I look at the TMS criteria - I actually don’t fit them all since I am in an acute phase of pain that just started and don’t decrease.

My question is mostly : can TMS start with a real injury? Or is it just my surrounding actions (panicking, anxiety, etc.) fueling the pain?

I am curious to have your perspectives.
Thanks

 

Pudendal Neuralgia is another wastebasket diagnosis for "we don't know". It's just TMS. All injuries heal. Pain that continues past a few months after the initial injury is brain based pain. It just means that the the brain and our thoughts about the injury keep sending false alarm signals to that area. To fit the TMS criteria, you only need one good one and you have numerous jumping out just in your comment. The solution is to relax and know there is nothing wrong with you. The injury will heal on its own, without you having to do anything. By catastrophizing and focusing on it, and buying into the label (which is simply a nocebo), you are actually creating the situation (albeit unwittingly). My advice is stop thinking about it and resume life. It's nothing.

 

Yep, it's TMS. It's a very sensitive area for biological reasons so when it spasms it hurts more than in other areas, but the best thing that helps is to do something you enjoy and not worrying about it because it goes away on its own and is completely harmless. Based on how you're feeling, it's definitely TMS, and most importantly, you overcame it before so you can again. Don't force healing and go back to living your life.

 

Thanks for your replies. My PT tells me that anything could irritate the nerve more, i.e. sitting, running, stretching, etc. The pain is quite intense. The problem is mainly the pelvic pain- pressure on the bladder. Since it’s only been a few weeks I wonder if is it possible that the nerve is really hurt and still has to heal. Yesterday I tried testing my limit and went for a little jogg (3 km) and obviously I had a major flare up after. But I also thought the whole time I was jogging: omg imagine if I worsen my condition with this jogging try, I should be doing this I should listen to the PT... and my brain was assessing the pain the whole time haha. I don’t really know how to take this. Since it’s only been 3 weeks since the biking incident, maybe it hasn’t healed ?!

 

@Bananas00:

You sound a bit like me (although I am male and almost 2x your age). Long time avid runner, cyclist, etc. Health anxieties. Always tried to return to activity too fast if had an injury or problem.

For sure anxiety and catastrophizing is making whatever going on worse than it needs to be, even if there is or was a legit physical problem. (that is a lot of miles by the way, 450km in a week). All I can say is take the opportunity to do a reset on your mindset ("the gift of injury"). I.e. find ways to calm your nervous system via breathing exercises, meditation, journaling, positive affirmation, etc. All that stuff will be help you for the rest of your life. Anyway, my 2 cents! Good luck and best regards.

 

The PT visits are counter productive because they only reinforce messages of danger and the notion that you can hurt yourself because you have some kind of "damage". My advice is to take a break from your usual exercise routine for a few weeks , stop thinking about this stuff and feeling desperate to "fix"it or heal quickly, and go about your life normally. Impatience isa huge trap and what is driving your anxiety is the fear that you won't be able to do your usual thing in the future. That is simply not true. It's just a fear. All injuries heal and all of this "irritated nerve" massaging and PT jargon is utter nonsense. It's making your brain go into fight or flight and your anxiety skyrocket. Stop going to PT's. Repudiate the physical. Live your life.

 

haha i indeed recognize myself in this description. I regret so much having pushed through the intense pain that week. I feel like I have an excessive personality and cannot do things by halves. Everything I do is always with a huge intensity. I can’t run five miles like normal people, I run 21. I can’t do 50 miles rides, i do 100 miles ones. I am not just a lawyer I had to become a partner. It has always been this way and sometimes I feel maybe I am in so many activities at a time to avoir overthinking life or deeper problems....

 

So you really think I Can’t create more damage to my nerve ? I bought myself a special cushion and everything to not sit on it just in case lol

 

No that's a ridiculous notion propagated by the medical industry. How do you even know your nerve is "damaged"? Just because you have pain? The pain is coming from signals in your brain...it's not that the nerves are "broken". Nerves actually regenerate as well. All these notions of pinched nerves, nerve damage etc. are pure nonsense and have been debunked yet they continue in the collective mythology of the general public.

 

Throw the cushion out the window. Or in the garbage. Better yet, get your money back lol

 

Nope, you don't need a cushion. It's like needing crutches for a leg cramp. Exhaling really slow turns down the jitters including any spasms. Breathe through it. The more you relax, the more easily it will let go.

Instead of being limited to extremes, be willing to adapt your needs and explore more ways of training. Do some things just for the fun of it. Variety is fun. And please don't over train out of an impulse- ease up a bit.

 

If you can train like this, you can overcome this. Just get some breaks to relax. Muscles can't always contract, they need to rest too.

 

There is possibly not a week that goes by that I don't think "How I wish I could go back and give the 30-year old me a talking-to". So many things I would tell him. One of them being calm and joyful and helping others is a way better way to spend your life than beating the sh*t out of everybody at the next 10-k, or whatever.

 

But in some of the threads here people were saying « push through pain and ignore the pain like it was not there ».
it is very difficult for me to calm down my nervous system haha. I’ve always done it with sports.

 

That's incorrect. You can't "ignore" or "push through" because that is going to put you in a state of resistance ("trying"). The key is to "not worry" about symptoms and gradually, gradually challenge your fears. We use fear as the guideline, not symptoms. I think the "gradual" part is hard for some people due to impatience. The brain will quickly go into fight or flight if we scare ourselves too quickly.

 

This comment reasonates with me a lot. Can we discuss ?

 

It is indeed very difficult

 

Sure. (and if you wanted to there is even a way to start a private thread on here I think). But basically my thoughts were largely echoing what Balsa11 said, that there is a lot of power in easing up at times, letting your body heal, finding calm. But I do get it, that if your main method of stress relief is thru a vigorous workout and suddenly you don't have that, it is hard to find a replacement. That actually is exactly my current situation.

 

What I find difficult is how much time will it require to heal ? I believe a nerve takes a while

 

Hi @miffybunny, you are the best.
I have similar problem and struggle with 3 aspects:

1. My muscles are in spasm 24/7 for almost 3 years. No break and trying to relax them does not help.
Is this trying to relase the muscles a state of resistance you talk about? Basically, shall I just let them clench without any attenot to release them?

2. I catch myself thinking sometimes that my muscles clench 24/7 for so long that it is too late for them to go back to relaxed state and work normally anymore. Like they lost capacity how to do it.
Is it a false belief? How did you work on dismantling false beliefs?

3. I figured out I have high anxiety and follow Claire Weekes approach. However, I feel pure fear especially at night. I really try to let it be, allow it. Sadly, it does not go away.
You talk about losing fear, but this pure fear I feel without identifying a thought (I think it is rather just my brain in general fight or flight) could be this repressed emotion? Basically shall I just allow myself to feel this pure fear or challenge through somehow?

Thanks a million!