By Dr. Janaki Natarajan, MD
At Pelvic Rehabilitation Medicine, we offer treatment through the PRM Protocol™, a proprietary, patented, simple, office-based procedure to treat the symptoms of chronic pelvic pain by a direct treatment of inflamed pelvic nerves and spastic pelvic muscles.
One of the largest groups of patients we treat through our protocol are women suffering from Endometriosis. Endometriosis is a systemic inflammatory disease process in which tissue similar to the uterine lining grows outside of the uterus. The inflammation caused by endometriosis irritates the nerves in that region thereby leading to possible bowel, bladder, sexual dysfunction, and an overall heightened sensitivity to pain.
How can the PRM Protocol™ help endometriosis patients?
To treat the pelvis and the inflammation we see with endometriosis patients; we need the treat the whole pelvic floor. We essentially are taking a trip around the pelvis and treating the nerves that innervate the muscles in the pelvic floor, abdominal core, inner thigh, and genitalia. These nerves include but are not limited to the pudendal nerve and its branches, branches of the posterior femoral cutaneous nerve, ilioinguinal nerve, and genitofemoral nerves.
Some common questions that are asked…
What is a nerve block for pelvic pain?
A nerve block is when a combination of anesthetic or numbing medication (Lidocaine or Bupivacaine) and steroid (dexamethasone or kenalog) is injected near specific nerves to temporarily block the signals traveling along that nerve for the purpose of pain relief.
A nerve block is not permanent and will usually provide numbness to the region for several hours.
How safe is treatment?
The PRM Protocol™ is a safe and effective way to treat inflammation and spasm in the pelvic floor. Because treatment is provided using ultrasound guidance and externally – we are never inserting needles into the vagina – patients can rest assured. Because our approach to pelvic pain is conservative, our in-office treatment is the safest offering for healing pelvic pain and is provided by pelvic pain specialists who are highly trained by our Chief Medical Officer, Dr. Allyson Shrikhande, the creator of the treatment.
Learn More About Safety & Effectiveness
DOES THE PROCEDURE HURT?
At PRM, our unique outpatient, nonoperative, minimally invasive ultrasound guided approach to the pelvis is the first of its kind in the country. Our pelvic nerve and muscle treatments, also called ultrasound-guided pelvic peripheral nerve blocks and trigger point injections, can be an important part of a patient’s pelvic floor treatment.
The nerve block injections and pelvic floor trigger point injections that we do at PRM are external (rather than done from an internal vaginal approach) and done under sterile technique with ultrasound guidance in the office setting.
The treatments are generally well tolerated and only take a few minutes. A brief initial localized burning sensation from the anesthetic may be felt along with pressure sensation that resolves within a few minutes. Post-procedure ice is applied for 10-15minutes and then patients are out the door back to their normal daily routines. If any minor soreness is experienced afterwards an anti-inflammatory medication (i.e. Motrin or Aleve) with food along with a warm bath is recommended.
After 3-months, our patients are experiencing a decrease in pain by 50%, a 35% increase in functional ability in intercourse, bowel movements and bladder function, and seeing improvement in absenteeism and presenteeism at work and in their lives. That’s our goal: get patients back to their lives.
