Pelvic Pain Care Background

Chronic Pelvic Pain Treatment in Patna

CLINICAL OVERVIEW

Understanding Chronic Pelvic Pain & Pudendal Neuralgia

Chronic Pelvic Pain Syndrome (CPPS) is defined as non-malignant pain perceived in the pelvis, perineum, vulva, scrotum, rectum, or lower abdomen persisting for >6 months.

A major and frequently under-diagnosed cause of chronic pelvic pain is Pudendal Neuralgia. The Pudendal Nerve (S2, S3, S4) travels through a narrow anatomical tunnel between the sacrotuberous and sacrospinous ligaments (Alcock's Canal). When pinched or irritated by prolonged cycling, childbirth trauma, pelvic surgery, or chronic spasm of the levator ani muscle, it produces agonizing burning, tingling, or "foreign body sensation" in the perineum that worsens dramatically on sitting and is relieved on standing or sitting on a toilet seat.

Other common causes include refractory Endometriosis, Interstitial Cystitis (Painful Bladder Syndrome), and Chronic Prostatitis / CPPS in men.

Interventional Pelvic Pain Medicine provides pinpoint solutions: ultrasound-guided Pudendal Nerve Blocks/PRF at the ischial spine, Superior Hypogastric Plexus Blocks, and Ganglion of Impar RFA eliminate debilitating pelvic and perineal pain without surgical organ resection.

Chronic Pelvic Pain, Pudendal Nerve Anatomy and Alcock Canal Pathway
Pudendal Neuropathy
Alcock's Canal Entrapment, Superior Hypogastric Plexus & Pelvic Floor
DIAGNOSTIC SPECTRUM

Conditions Causing Chronic Pelvic Pain

Pinpointing the exact neurovascular or musculoskeletal pain generator to tailor the correct intervention.

Pudendal Neuralgia (Alcock's Canal)

Burning, knife-like pain or feeling like "sitting on a golf ball" in the perineum, rectum, or genitalia that worsens upon sitting and vanishes when standing or lying flat.

Refractory Endometriosis & Adenomyosis

Deep visceral uterine and ovarian pain that persists despite laparoscopic surgery or hormonal therapy. Treated via Superior Hypogastric Plexus Block.

Painful Bladder & Levator Ani Spasms

Interstitial Cystitis (IC) with severe suprapubic pain upon bladder filling, and hypertonic pelvic floor muscle spasms causing painful bowel movements.

NANTES CRITERIA

Our 4-Step Diagnostic Protocol for Pelvic Pain

Applying international Nantes Criteria to accurately diagnose Pudendal Nerve Entrapment and visceral pain pathways.

1

Nantes Clinical Exam

Testing 5 essential criteria: pain in pudendal territory, aggravated by sitting, does not wake patient at night, no objective sensory loss, and positive block.

2

Pelvic Floor Palpation

Transvaginal or transrectal palpation of the ischial spine and levator ani/obturator internus muscles for localized trigger points.

3

3T Pelvic MRI Neurography

High-resolution MR Neurography visualizing pudendal nerve entrapment at the ischial spine and ruling out pelvic congestion or deep endometriosis.

4

Diagnostic Test Block

Gold Standard: Ultrasound-guided Pudendal nerve block. Immediate >80% relief while sitting confirms diagnosis.

SPECIALIZED PROCEDURES

Interventional Treatments for Pelvic Pain

Pinhole daycare procedures performed under live ultrasound and fluoroscopic C-Arm guidance by Dr. Shrutika Bhagat in Patna.

Ultrasound Guided Pudendal Nerve Block & PRF
Gold Standard

Pudendal Nerve Block & Pulsed RFA

High-resolution ultrasound guidance tracks the pudendal nerve between the sacrospinous and sacrotuberous ligaments at the ischial spine, delivering anti-inflammatory fluid and pulsed RF to reset chronic sitting pain.

  • Instant relief from burning sitting agony
  • 10-minute daycare procedure with zero downtime
Superior Hypogastric Plexus Block for Endometriosis
Visceral Relief

Superior Hypogastric Plexus Block

C-Arm fluoroscopy-guided precision block at the L5/S1 vertebral junction, blocking sympathetic and visceral sensory pain from the uterus, ovaries, bladder, and colon in endometriosis and pelvic pain.

  • Stops deep chronic uterine & ovarian aching
  • Avoids repeated invasive pelvic laparoscopies
Ganglion of Impar Block for Perineal Pain
Perineal Center

Ganglion of Impar Block & RFA

C-Arm guided block of the solitary terminal sympathetic ganglion in front of the sacrococcygeal joint, eliminating burning and aching in the rectum, perineum, vulva, and tailbone.

  • Discharges sympathetic pelvic burning
  • Long-lasting relief without surgery
Pelvic Floor Muscle Trigger Point Hydrodissection
Pelvic Floor Release

Pelvic Floor Trigger Hydrodissection

Targeted release of chronic hypertonic spasms in the levator ani, coccygeus, and obturator internus muscles to relieve pelvic tightness and painful intercourse (Dyspareunia).

  • Eliminates deep pelvic muscle spasms
  • Restores painless bowel movements
Autologous PRP Pelvic Prolotherapy
Biologic Healing

Autologous Pelvic PRP Biotherapy

High-concentration platelet growth factors injected under ultrasound into damaged sacrotuberous ligaments, pubic symphysis, and perineal fascia to heal post-childbirth tears.

  • 100% natural, patient's own healing cells
  • Restores pelvic ring ligamentous stability
Sacral Nerve Modulation & Pelvic Rehabilitation
Neuromodulation

Sacral Neuromodulation & Rehab

Sacral nerve root (S3) pulsed stimulation, specialized pelvic floor relaxation physiotherapy, and ergonomic pressure-relieving seat offloading cushions.

  • Comprehensive long-term control
  • Restores bladder and bowel harmony
TREATMENT COMPARISON

Repeated Pelvic Surgeries vs. Targeted Interventions

Why non-surgical nerve blocks stop the cycle of unnecessary exploratory operations and organ resections.

Clinical Feature Repeated Laparoscopies / Hysterectomy Interventional Pudendal & Hypogastric Blocks / RFA
Cause of Failure Does not address neuropathic nerve entrapment in Alcock's canal Directly frees and desensitizes the entrapped pudendal nerve
Pelvic Adhesion Risk Surgeries create extensive new post-operative scar tissue adhesions Zero scar tissue; gentle fluid hydrodissection separates planes
Organ Preservation High risk of unnecessary organ removal without pain resolution 100% natural pelvic organ and reproductive anatomy preservation
Sitting Tolerance Sitting remains severely painful after surgery Immediate ability to sit comfortably in cars and office chairs
Hospital Stay 3 to 7 days hospital admission with long surgical recovery Daycare: Discharged in 1 to 2 hours under local anesthesia
Dr. Shrutika Bhagat - Interventional Pain & Spine Endoscopy Specialist in Patna
Fellowship-Trained Spine Specialist

Dr. Shrutika Bhagat

MBBS, MD, FIRA, FIAPM | Interventional Pain & Spine Endoscopy

Dr. Shrutika Bhagat brings super-specialized training in full-endoscopic spine surgery and image-guided interventional pain management, having successfully treated thousands of patients with severe back pain, disc prolapse, sciatica, nerve compression, and joint arthritis in Patna.

FAQS

Chronic Pelvic Pain FAQs

Clinical answers regarding Pudendal Neuralgia, sitting discomfort, Superior Hypogastric blocks, and recovery.

The Pudendal Nerve travels through Alcock's Canal between two dense pelvic ligaments. When you sit on a hard chair, your body weight squashes the nerve against the ischial bone, triggering intense burning, sharp shocks, and a foreign body sensation in the perineum. Pain is relieved on standing or sitting on a toilet seat (which offloads the ischial center).
Under real-time ultrasound guidance, Dr. Shrutika Bhagat identifies the internal pudendal artery and nerve at the ischial spine level. A gentle micro-injection delivers soothing local anesthetic and anti-inflammatory solution to bathe the nerve, releasing surrounding fascial adhesions and stopping burning pain immediately.
Yes. Even after surgical excision of endometriotic implants, visceral nerve pathways (Superior Hypogastric Plexus) often remain in a state of chronic hyperexcitability. A C-Arm guided Superior Hypogastric Plexus block calms these visceral signals, providing lasting relief without further surgery.
No. The ultrasound-guided precision technique targets sensory pain fibers. Normal sphincter motor control and bladder function are completely preserved. Patients walk and urinate normally immediately after the procedure.
A specialized "U-shaped" or center-channel cutout cushion (which suspends the perineum and tailbone in free air) is best. Avoid round donut cushions, as they pinch the lateral ischial borders and increase pressure on Alcock's canal.
Please bring all previous Pelvic Ultrasound & 3T MRI reports, previous gynaecological or urological surgical notes (laparoscopies/cystoscopies), and past prescription records for a confidential consultation with Dr. Shrutika Bhagat.
CTA Background Pattern
CTA Background
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Don't Let Chronic Pain Control Your Life.

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