Does perineal descent correlate with pudendal neuropathy?

1993 ◽  
Vol 36 (5) ◽  
pp. 475-483 ◽  
Author(s):  
Marcio J. N. Jorge ◽  
Steven D. Wexner ◽  
Eli D. Ehrenpreis ◽  
Juan J. Nogueras ◽  
David G. Jagelman
Keyword(s):  
Pudendal Neuropathy ◽  
Perineal Descent

scholarly journals Evidence of pudendal neuropathy in patients with perineal descent and chronic straining at stool.

Gut ◽  
1984 ◽  
Vol 25 (11) ◽  
pp. 1279-1282 ◽  
Author(s):  
E S Kiff ◽  
P R Barnes ◽  
M Swash
Keyword(s):  
Pudendal Neuropathy ◽  
Perineal Descent

Correlation Between Echodefecography and 3-Dimensional Vaginal Ultrasonography in the Detection of Perineal Descent in Women With Constipation Symptoms

2016 ◽  
Vol 59 (12) ◽  
pp. 1191-1199 ◽  
Author(s):  
Sthela M. Murad-Regadas ◽  
Francisco Sergio Pinheiro Regadas ◽  
Lusmar V. Rodrigues ◽  
Adjra da Silva Vilarinho ◽  
Guilherme Buchen ◽  
...  
Keyword(s):  
Perineal Descent ◽  
3 Dimensional ◽  
Vaginal Ultrasonography

scholarly journals Measuring the Quality of Pudendal Nerve Perineural Injections

2016 ◽  
Vol 4;19 (4;5) ◽  
pp. 299-306 ◽  
Author(s):  
Stanley Antolak, Jr
Keyword(s):  
Pain Relief ◽  
Pelvic Pain ◽  
Local Anesthetic ◽  
Private Practice ◽  
Pain Control ◽  
Pudendal Nerve ◽  
P Value ◽  
Pudendal Neuropathy ◽  
Nerve Branch

Background: Pudendal neuropathy is a tunnel syndrome characterized by pelvic pain and may include bowel, bladder, or sexual dysfunction or a combination of these. One treatment method, pudendal nerve perineural injections (PNPIs), uses infiltration of bupivacaine and corticosteroid around the nerve to provide symptom relief. Bupivacaine also anesthetizes the skin in the receptive field of the nerve that is injected. Bupivacaine offers rapid pain relief for several hours while corticosteroid provides delayed pain control often lasting 3 to 5 weeks. Not all pudendal nerve blocks may provide complete pain relief but long-term pain control from the steroid appears to be associated with immediate response to bupivacaine. We offer a method of evaluating the quality of a pudendal block on the day it is performed using pinprick sensation evaluation. Objective: To demonstrate that pinprick sensory changes provide a simple and rapid method of measuring response to local anesthetic and pain reduction provided by a PNPI on the day it is performed. This response defines the quality of each PNPI. Study Design: This is a case series based on retrospective review of a private practice database that is maintained by HealthEast hospitals in Minnesota. Database information includes standard physical examination, recording techniques, and treatment processes that had been in place for several years. Setting: Private practice in United States. Methods: Patients with a diagnosis of pudendal neuropathy are treated with PNPIs. Two hours after each block, 2 endpoints are measured: response to a sensory pinprick examination of the pudendal territory and difference in patient-reported pain level before and after nerve block. Fifty-three men from a private practice treating only pelvic pain received the treatment in 2005. Reported pain level was not recorded for 2 patients. Results: Bupivacaine in perineural injections produces varying degrees of analgesia or hypalgesia to pinprick. Normal pinprick response suggests pudendal nerves were not penetrated by bupivacaine. Patient responses varied from complete, i.e. all 6 branches anesthetized to none. Most men had 2 – 5 nerve branches anesthetized. One man had a single nerve branch that responded to bupivacaine. Three men failed to respond to local anesthetic. Changes in pre-PNPI to post-PNPI pain scores were significantly decreased (n = 51, P-value < 0.0001), indicating that bupivacaine in the PNPI reduced pain. Forty-one patients (80.4%) indicated less pain after the procedure and only 2 patients (4.0%) indicated more pain. The number of nerve branches successfully anesthetized was also significantly correlated with change in score. On average, an additional successful nerve branch anesthetized corresponded to a drop of about 0.66 in the change score (n = 51, P - value = 0.0005). Conclusion: PNPIs relieve pain. Anesthesia affected all 6 pudendal nerve branches in only 13.2% of patients. Complete pain relief occurred in 39.2%. This argues against use of perineural pudendal blockade as a diagnostic test. Pain relief after PNPI is associated with number of nerve branches that are anesthetized. At 2 hours after a PNPI its quality (the number of the 6 nerve branches with reduced response to pinprick from the perineural local anesthetic) is associated with subjective reduction of pain. Key words: Pudendal neuralgia, chronic perineal pain, pudendal nerve block, sensory examination, neurologic examination, pain management, chronic pelvic pain syndrome

scholarly journals Pulsed Radiofrequency Ablation of Pudendal Nerve for Treatment of a Case of Refractory Pelvic Pain

2017 ◽  
Vol 3 (20;3) ◽  
pp. E451-E454 ◽  
Author(s):  
Stephanie Jones
Keyword(s):  
Radiofrequency Ablation ◽  
Pain Relief ◽  
Pelvic Pain ◽  
Pudendal Nerve ◽  
Pudendal Neuropathy ◽  
Ischial Spine ◽  
Pulsed Radiofrequency ◽  
Pudendal Neuralgia ◽  
Mr Neurography ◽  
The Right

Pudendal neuralgia (PN) is a result of pudendal nerve entrapment or injury, also called “Alcock syndrome.” Pain that develops is often chronic, and at times debilitating. If conservative measures fail, invasive treatment modalities can be considered. The goal of this case report is to add to a small body of literature that a pulsed radiofrequency (PRF) ablation can be effectively used to treat PN and to show that high resolution MR neurography imaging can be used to detect pudendal neuropathy. Case Presentation: We present a case of a 51-year-old woman with 5 years of worsening right groin and vulva pain. Various medication trials only lead to limited improvement in pain. The first diagnostic right pudendal nerve block was done using 3 mL of 0.25% bupivacaine with 6mg of betamethasone using a transgluteal technique and a target of the right ischial spine; this procedure resulted in ~8 hours of > 50% pain relief. The patient was then referred for MR neurography of the lumbosacral plexus. This study revealed increased signal of the right pudendal nerve at the ischial spine and in the pudendal canal, findings consistent with the clinical picture of PN. Six weeks after the initial block, the patient underwent a second right transgluteal pudendal nerve block, utilizing 3 mL of 0.25% bupivacaine with 40 mg of triamcinolone acetonide; this procedure resulted in ~8 hours of 100% pain relief. Satisfied with these results the patient decided to undergo pudendal nerve PRF ablation for possible long-term relief. For this therapeutic procedure, a right transgluteal approach was again utilized. PRF ablation was performed for 240 seconds at 42° Celsius. Following this ablation the patient reported at least 6 weeks of significant (> 50%) pain relief. Discussion and Conclusion: In this paper we presented a case of successful treatment of PN with PRF ablation and detection of pudendal neuropathy on MR neurography. We believe that transgluteal PRF ablation for PN might be an effective, minimally invasive option for those patients that have failed conservative management. MR neurography employed in this case is not only helpful in confirming the diagnosis of PN but could also be useful in ruling out other causes of pelvic pain, such as genitofemoral neuropathy, endometriosis, adenomyosis, or pelvic mass lesion. To conclude, transgluteal PRF ablation can serve as a viable treatment option for mitigating symptoms of pudendal neuropathy and MR neurography is useful in confirming a clinically suspected diagnosis of PN. Key words: Pelvic pain, pudendal neuralgia, MR neurography, pulsed radiofrequency ablation, transgluteal technique, Alcock canal syndrome

A Study of the Correlation of Pudendal Neuropathy and Pelvic Floor Dysfunction in Constipated Patients

2011 ◽  
Vol 140 (5) ◽  
pp. S-604
Author(s):  
Rebekah Kim ◽  
Andrea Ferrara ◽  
Joseph Gallagher ◽  
Paul Williamson ◽  
Samuel Dejesus ◽  
...  
Keyword(s):  
Pelvic Floor ◽  
Pelvic Floor Dysfunction ◽  
Pudendal Neuropathy

scholarly journals Defecography by digital radiography: experience in clinical practice

2016 ◽  
Vol 49 (6) ◽  
pp. 376-381 ◽  
Author(s):  
Amanda Nogueira de Sá Gonçalves ◽  
Marco Aurélio Sousa Sala ◽  
Rodrigo Ciotola Bruno ◽  
José Alberto Cunha Xavier ◽  
João Mauricio Canavezi Indiani ◽  
...  
Keyword(s):  
Uterine Prolapse ◽  
Descriptive Study ◽  
Continuous Variables ◽  
Perineal Descent ◽  
Radiological Findings ◽  
Age And Gender ◽  
Complex Disorders ◽  
Rectal Evacuation ◽  
And Gender ◽  
Clinical Conditions

Abstract Objective: The objective of this study was to profile patients who undergo defecography, by age and gender, as well as to describe the main imaging and diagnostic findings in this population. Materials and Methods: This was a retrospective, descriptive study of 39 patients, conducted between January 2012 and February 2014. The patients were evaluated in terms of age, gender, and diagnosis. They were stratified by age, and continuous variables are expressed as mean ± standard deviation. All possible quantitative defecography variables were evaluated, including rectal evacuation, perineal descent, and measures of the anal canal. Results: The majority (95%) of the patients were female. Patient ages ranged from 18 to 82 years (mean age, 52 ± 13 years): 10 patients were under 40 years of age; 18 were between 40 and 60 years of age; and 11 were over 60 years of age. All 39 of the patients evaluated had abnormal radiological findings. The most prevalent diagnoses were rectocele (in 77%) and enterocele (in 38%). Less prevalent diagnoses were vaginal prolapse, uterine prolapse, and Meckel's diverticulum (in 2%, for all). Conclusion: Although defecography is performed more often in women, both genders can benefit from the test. Defecography can be performed in order to detect complex disorders such as uterine and rectal prolapse, as well as to detect basic clinical conditions such as rectocele or enterocele.

Sex differences in anorectal angle and perineal descent

1987 ◽  
Vol 12 (1) ◽  
pp. 353-355 ◽  
Author(s):  
Elwira Skomorowska ◽  
Viktor Hegedüs
Keyword(s):  
Sex Differences ◽  
Perineal Descent ◽  
Anorectal Angle

Denervation, reinnervation, and perineal descent

1987 ◽  
Vol 2 (1) ◽  
pp. 48-48
Author(s):  
Michael Swash ◽  
D. C. C. Bartolo
Keyword(s):  
Perineal Descent
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