Botox injection 8 days ago? Report & Now what?

[Judy KR]

After much indecision, I decided to have a botox injection in the puborectalis. My PT was
urging this. I got 100 units at UCI women's clinic, by a doc who is researching this (DR. Noblett).
She has had several successes. I was very anxious about the shot, but went ahead. Then
it turned out I got sick the next day with a sore throat, which 5 days later morphed into a very
bad cough. I have had a very slight fever - 99 most eves. Not in the daytime often. Today
is day 8, I'm worn out with this coughing and staying inside and not having any sense of whether
the botox worked. Mostly it seems like it didn't. I still have lots of pain.

I was told wait 5-10 days. I spoke with my PT yesterday and she said some muscle manipulation is still needed and did not feel as negative about my prospects as I do.
I also am having some odd bowel movements: yesterday and today they were green. Apparently not that unusual. Something to do with fast transit time. I'm wondering if this could be related to the botox in any way.

Mostly, I am in a wait and see mode, so nothing special to report other than a description of my experience. And I guess a query for those who have done this using 100 units: how long did
it take to see some evidence of improvement? If it fails, then what?
Any comments appreciated.

[nyt]

I have not had botox but will keep you in my prayers that this will help your pain and that the flu-like symptoms due to the botox will reside.

[Judy KR]

Thanks for your thoughts. But I didn't mean to imply that there is a connection between the botox
and my flu like symptoms. I think it is just an unfortunate quirk of fate that I happened to get
sick after the injection. My immunity may be low due to my anxiety about the shot -- that's
possible and may be why this thing is hanging on so long. Now 9 days. Incrementally better today.

It's not looking like the botox is going to work for me. But I'll give it a few more days till I see my PT next week. But eventually I'd like to know what other options I have. I'll wait on that
till I know more and also I can catalog what I've done already. This is just such an impossible
ailment. I really value this board where we can compare notes etc.

Thanks again for your response and any future thoughts.

[Violet M]

Judy, sorry Botox does not seem to have helped you. I'm assuming your PT worked in conjunction with your doc to figure out which muscles to Botox. Does PT help at all?

Is your pain primarily in the muscles or is it along the course of the nerve at the ischial spine or alcock's?

[Judy KR]

Hi violet,
Your questions are good ones. My Pt knows my doc, but they do not work together. I live
some distance from where my doc is , about an hour and a half.
The doc made the decision to do the puborectalis muscle mainly on my defocagraphy report
which shows that the puborectalis contracts after a bowel movement. She is also concerned
about not creating a problem with incontinence so I think that is another reason for selection
of this site.
My PT thinks my pain is mainly in the sphincter area, but thought this injection might help.
I can't really tell where the pain is most of the time. When the PT presses certain areas
then I can tell where it's painful. Most of the time it is the sphincter. Sometimes other areas including the levator ani, the perineum and some other muscles I don't remember the names of.

I don't think the pain is along the ischial spine or alcocks. But I'm not totally clear where this area is. I'm curious why you asked this.

Re your PT question. Yes it does seem to help quite a bit. I usually feel better after and over the past year there has been improvement overall. However I've been doing this a long time
now. First 9 months with one PT, a couple months with another PT. Then about 6-9 months
with the PT in the doc's office at UCI where I got the injection. Then I moved to a fourth
PT ten minutes from where I live on the referral of the PT at UCI. I think I am in good hands,
but apparently have an intractible problem. I've been the current PT about two and a half years.

One thing that does help me is to do what I call a "mini" enema during the day. I seem to be hypersensitive to having stool in the rectum, after the mini enema I have 4-6 hours virtually pain free.( A mini enema is a fleet bottle filled with water, not the saline provided. With saline its like an assault on my system, water is quite mild.)

Well, that's more than you asked for. But any feedback you can provide are appreciated.

[Violet M]

I don't think the pain is along the ischial spine or alcocks. But I'm not totally clear where this area is. I'm curious why you asked this.

The reason I asked is because according to the published literature, this is important in determining whether you might have an entrapment that's causing your pain. During a pelvic exam, if they press at the ischial spine or along the course of the nerve and that is your worst area of pain, that can be diagnostic for PNE. Also, if you have a nerve entrapment, PT might be more likely to flare you up than make you feel better afterward.

Did they inject your muscles with marcaine first to see if that would help before going for the Botox?