What's the Deal with ... Pelvic Botox?

By Bel Connolly

Botox isn't just for wrinkles, in fact it's uses in the medical community are anything but superficial - it can provide relief for those suffering chronic pelvic pain associated with endometriosis and/or adenomyosis. Susan Evans and Deb Bush, in their book Endometriosis and Pelvic Pain, describe pelvic botox as an adjunct treatment to physiotherapy - it doesn't replace it, but can make it easier and facilitate progress. In endometriosis, the pelvic floor muscles are often too tight and need some help relaxing, botox can help relax these muscles in the same way it relaxes the muscles of the face for cosmetic purposes. If you suffer from pelvic muscle spasm, the botox can assist with preventing this spasm, which is often associated with severe, cramping pelvic pain.

Botox is injected under anaesthesia and takes a couple of weeks to work and usually is effective for 4-6 months. It can be helpful, but the pain may come back when it wears off, which is why Evans and Bush suggest that pelvic physiotherapy is a must alongside it to try and downtrain and relax the pelvic floor while the botox is in effect. 

Like any treatment for endometriosis, pelvic botox may or may not be right for you. If you have persistent pain that is causing you difficulties in your day to day life and has the characteristics of tight pelvic floor muscles (pain on one side, pain down the front of the thigh, pain with certain types of exercise) ask your gynaecologist about a referral to a pain specialist and/or pelvic physiotherapist to discuss your options. For more information you can read Endometriosis and Pelvic Pain or check out some of the other resources available on the QENDO site or Pelvic Pain Foundation Australia. 

Bel, from our Education Team, shares her honest account of pelvic botox for her persistent pelvic pain. 

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Bel's Experience With Pelvic Botox 

As I sit in a yellow gown the nurses do their three-point checklists and ask what procedure I am having?  In response I reply a pudendal nerve block, pelvic floor Botox and cervical screening. The aim of the pudendal nerve block is to numb the pelvic region, as for the pelvic floor Botox it is to aid in relaxing the pelvic floor muscles that could be contributing to muscle spasms producing pain.   

As I woke from the anaesthetic there was optimism, hope, pelvic tenderness and leg numbness similar to an epidural.  Upon discharge it was advised that there will be some bleeding and increased pain for the following 48-hours. As I reflect on my journey I noted the following:

Day 1:  Pelvic tenderness and fatigue.

Day 2:  Pelvic tenderness, fatigue, nausea (Prescription pain relief taken).

Day 3:  Increased pain.

Day 4: Normal daily pain, nausea.

Day 5:  Normal daily pain, nausea and emotional (queried having put my body through so much without a positive outcome).

Day 6:  Felt like I had endured an abdominal workout with perineum heaviness, tenderness to sit, flushed and light headed (prescription pain relief taken).

Day 8:  Horrendous pain, nausea and hot flushes.  

Day 10:  Woke on my 35th birthday uncomfortable.

Day 11:  Uncomfortable.

Day 12:  Uncomfortable and purchased CBD to help with pain.

Day 14:  Commenced intensive pelvic floor physiotherapy for the first time since the procedure.  

Day 15:  Disheartened due to minimal effect on pain.

Day 17:  Needed nil prescription pain relief for the following fifteen and a half days.

As recommended I continued intensive at home and hospital pelvic physiotherapy which included pelvic floor assessments as well as at home exercises with a pelviwand (an S-shaped acrylic instrument).  I thought muscle spasms could be a contributor to my daily chronic pelvic pain as I felt tender spots when utilising the pelviwand. Although I had increased pain the following day, it felt better when pressure was applied to tender spots within the pelvis.   

However, despite all my efforts the need for prescription pain relief increased and on 22/11/2018 I had an emergency department visit as I could not control my pain.  The medical team could not find a cause and put my increased pain down to an acute on chronic endometriosis flare-up.

In 2018, my body has endured six months of monthly Zoladex injections, attending a chronic pelvic pain clinic for six-months that included weekly to fortnightly appointments to see an array of specialists that included a gynaecologist, pain specialist, psychologist and physiotherapist.  In December, due to funding I was discharged from the clinic with only some relief. Unfortunately, the pelvic pain continues to be daily and affecting almost every aspect of my life.

As a result, I have come to the conclusion that this disease is part of my life and it is up to me to take control of managing the symptoms.  I have commenced a natural approach to managing my daily pain in the hopes of living a happy and fulfilling life. I aim to attain this through incorporating a clean eating diet, light exercise, vitamins, traditional indigenous medicine, pelvic physiotherapy, yoga and meditation, aromatherapy and minimising stress.

I am 1 in 10 and you are not alone.

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