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Pelvic Floor Botox & Pudendal Nerve Block

Overview

Pelvic floor muscle overactivity and pudendal nerve-related pain can be debilitating and often under-recognised. These conditions may cause chronic pelvic pain, pain with sex, urinary urgency, difficulty with bladder or bowel emptying, and a persistent sense of pelvic tightness or burning.

Botulinum toxin (Botox) and pudendal nerve blocks are highly specialised treatments that may offer relief when other therapies have not been effective.

These procedures can be used alone or in combination, depending on your symptoms, findings on examination or ultrasound, and response to previous treatments.

Who Might Benefit?

You may benefit from pelvic floor Botox or a pudendal nerve block if you have:

  • Pelvic floor overactivity or myalgia on examination
  • Vaginismus, dyspareunia, or pain with penetration or orgasm
  • Pudendal neuralgia – burning, sharp, or electric-type pain in the vulva, perineum, or anus, often worse with sitting
  • Chronic pelvic pain not explained by endometriosis or other conditions
  • Bladder or bowel dysfunction due to muscle hypertonia
  • Incomplete relief from medications or physiotherapy

These treatments are typically offered as part of a broader pelvic pain or endometriosis management plan, and are not first-line therapies.

Pelvic Floor Botox – What to Expect

Botulinum toxin is injected directly into the pelvic floor muscles under ultrasound guidance to reduce involuntary contraction and pain.

  • Performed under light general anaesthetic
  • Usually a day-stay procedure
  • Botox starts working within 10-14 days, peak effect by 4–6 weeks
  • Effects last 3–6 months, and may be repeated if helpful

You will be asked to resume or continue pelvic floor physiotherapy after Botox for best outcomes.

Pudendal Nerve Block – What to Expect

Pudendal nerve blocks involve injecting local anaesthetic and sometimes corticosteroid near the pudendal nerve to reduce inflammation and interrupt pain signalling.

  • May be done under sedation or local anaesthetic
  • Often done as an outpatient or short-stay procedure
  • Relief may be temporary (hours to months) but can help diagnose pudendal neuralgia and guide further treatment

In some cases, thermal treatment or surgical decompression may be considered, but this is rarely needed.

What Will I Feel Afterwards?

After pelvic floor Botox:

  • Muscle soreness or heaviness for 24–48 hours
  • Temporary difficulty with bladder emptying or bowel movements
  • Relief of spasm or pain usually follows within a few days
  • Rarely, urinary retention may occur (catheter support rarely needed)

After pudendal nerve block:

  • Numbness or tingling in the buttock, vagina, or perineum for a few hours
  • Pain relief may be temporary or prolonged
  • You may be asked to track your symptoms for 1–2 weeks

You can usually return to work the following day unless you experience dizziness, discomfort, or sedation-related effects.

Risks

These procedures are generally safe but may carry the following risks:

Botox

  • Urinary retention (less than 5%)
  • Constipation
  • Infection (rare)
  • Temporary weakness in surrounding muscles
  • No effect or incomplete relief (30–50%)

Pudendal Nerve Block

  • Bruising, bleeding, or infection at the injection site
  • Temporary nerve irritation or tingling
  • Incomplete or short-lived relief
  • Rare allergic reactions to local anaesthetic or steroids

Both treatments are best considered part of a multidisciplinary pain management plan that includes physiotherapy, pain education, and psychological support where appropriate.

Dr Sam Holford

Find relief from chronic pelvic pain.

I specialise in pelvic floor Botox & pudendal nerve blocks—innovative treatments offered in Auckland to relax muscles & block pain.

Book an appointment

FAQs

Is it painful to get pelvic floor Botox or a pudendal nerve block?
These procedures are typically performed under light anaesthesia or sedation, so you will be comfortable and will not feel the injections. Afterwards, you might experience some temporary muscle soreness at the injection sites, similar to having a vaccine.
How long do the effects of pelvic floor Botox last?
The muscle-relaxing effects of Botox usually begin within a week or two and can last for 3 to 6 months. Many people find that with the help of pelvic physiotherapy during this time, the relief can last even longer as they retrain their muscles.
What is the main difference between a pudendal nerve block and Botox injections?
A pudendal nerve block uses local anaesthetic and steroid to numb the main nerve associated with pelvic pain, which is useful for both diagnosis and temporary pain relief. Pelvic floor Botox targets the muscles themselves, forcing them to relax to break a cycle of spasm and pain. They treat different aspects of pelvic pain and are sometimes used together.
Are these treatments covered by health insurance?
Coverage can vary. While pudendal nerve blocks and Botox for certain conditions are often covered, it depends on your specific policy and the indication for treatment. We can provide the necessary information to help you seek prior approval from your insurer.
Will I need to do pelvic floor physiotherapy as well?
Yes, absolutely. These injections are most effective when used as part of a multidisciplinary approach. The "window of opportunity" provided by the Botox or nerve block is the ideal time to work with a pelvic floor physiotherapist to release tension, improve muscle function, and achieve long-term results.

Resources and Support

Why Choose This Practice?

As a gynaecologist with advanced training in pelvic pain, ultrasound, and surgical management, I offer:

  • A trauma-informed, patient-centred approach
  • Experience with pelvic floor ultrasound and targeted injection
  • Collaborative care with pelvic floor physiotherapists and pain specialists
  • Honest advice about expected outcomes and recovery

You’re not alone, and pelvic pain is treatable. Let’s work together to reduce your symptoms and restore your quality of life.

Please note: This information is general in nature and not a substitute for medical advice tailored to your specific situation.