Kara29
03-03-2008, 11:47 AM
:welcome: All PNE/PN patients and their family members and friends. The Good News about PNE/PN is that there are Doctors out there who recognize it and have taken large steps to treating it and getting the word out. It's all about finding a Doctor who understands and has knowledge about how to help you get moving in the treatment process.
Pudnedal Nerve Entrapment or Pudnedal Neuralgia can be a related condition to IC or it can exist all on it's own. It's categorized at the moment as being a Chronic Pelvic Pain Condition.
What is PNE/PN?
"Pudendal Neuralgia is a painful neuropathic condition that is caused by inflammation of the pudendal nerve. Triggers for the sensitivity include trauma secondary to childbirth, surgery, cycling, squatting exercises, bio-mechanical abnormalities (e.g., sacro-iliac joint dysfunction, pelvic floor dysfunction), chronic constipation, repetitive vaginal infections and direct falls on the tailbone. Pudendal neuralgia is known in some circles as ‘cyclist’s syndrome’, ‘pudendal canal syndrome’ or ‘Alcock’s syndrome.’
Primary symptoms of Pudendal Neuralgia include:
· Pelvic pain with sitting that may be less intense in the morning and increase throughout the day. Symptoms may decrease when standing or lying down. The pain can be perineal, rectal or in the clitoral / penile area; it can be unilateral or bilateral.
· Sexual dysfunction. In women, dysfunction manifests as pain or decreased sensation in the genitals, perineum or rectum. Pain may occur with or without touch. It may be difficult or impossible for the woman to achieve orgasm. In men, dysfunction presents as pain during erection, difficulty sustaining an erection or painful ejaculation.
· Difficulty with urination / defecation. Patients may experience urinary hesitancy, urgency and/or frequency. Post-void discomfort is not uncommon. Patients may feel that they have to ‘strain’ to have a bowel movement and the movement may be painful and/or result in pelvic pain after. Constipation is also common among patients with pudendal neuralgia. In severe cases, complete or partial urinary and/or fecal incontinence may result."
How is PNE or PN Treated?
"Medical - Analgesic medications, even those containing narcotics may have limited efficacy for neuropathic pain. Pain modulators such as tricyclic antidepressants and neuroleptics (i.e. Neurontin, Zonegran, etc.) have varied efficacy. Nerve infiltration with a combination of local anesthetic (Lidocaine or Marcaine) combined with steroid (Triamcinolone or Solu-Medrol) or combined with Heparin can be used. Multiple injections (usually 3-5) may be required. Timing intervals vary but 3-6 week interval between infiltration seems reasonable. Success rates also vary widely where between 15-60% are cured or improved with this approach alone.
Lifestyle Modifications – Avoiding activities which worsen the condition is crucial (cycling, sitting, etc.). Sitting pads, especially those designed with cutouts to transmit pressure away from the perineum, can be very helpful.
Physical Therapy - Musculoskeletal dysfunctions can cause pudendal neuralgia as well as other painful pelvic syndromes. Physical therapy is an effective method of minimizing or eliminating the concurrent pain generators that occur when the pudendal nerve is irritated (i.e., pelvic floor hypertonicity and myofascial trigger points, extrapelvic hypertonicity and trigger points, adverse neural tension, sacro-iliac joint dysfunctions, connective tissue restrictions, and faulty neuromuscular recruitment patterns). It is important to acknowledge this interaction between musculoskeletal and neural dysfunction as it is unusual that one exists without the other.
Physical therapists require special training to treat pudendal neuralgia. The therapist should have a strong manual therapy bias and an extensive working knowledge of pudendal neuralgia. The program should emphasize restoring normal length to the pelvic floor (through internal myofascial release) and pelvic floor relaxation techniques. Typically, the shortened pelvic floor/pudendal neuralgia will become symptomatically exacerbated with Kegel exercises and these should be avoided until otherwise instructed by a professional. The program should also include connective tissue mobilization, neural mobilization and a home exercise program.
Surgical - Three main surgical techniques are currently available (worldwide) for nerve decompression. The theory is similar to other nerve decompression procedures performed for nerve entrapments in other regions of the body (i.e. carpal tunnel release). The procedures differ in their approach to the area of entrapment and have never been compared head to head.
Post-Operative Physical Therapy - The above mentioned musculoskeletal dysfunctions can be responsible for pain that persists after a decompression procedure. It is recommended that external physical therapy begin one month post-operatively and that pelvic floor rehabilitation gets initiated at three months.
Sacro-iliac joint dysfunction commonly co-exists with pelvic pain. When the sacrotuberous ligament is severed during decompression, SIJD is a common post-operative complication. Patients typically will have persistent (or ‘new’) pain and pelvic dysfunction. This situation is correctable through proper stabilization techniques: through physical therapy in less involved circumstances and through proliferative therapy and physical therapy in more severe circumstances."
It's important to have a Doctor that is comfortable in dealing with these conditions. That is half the battle. Knowledge is the next tool to have when talking with your Doctors about PNE/PN.
For a Lisiting of North American Physicians you can go to this site: http://www.spuninfo.org/index_files/Page771.htm
This information is quoted from the The Society for Pudendal: http://www.spuninfo.org/index.htm
For more information feel free to PM me as I also suffer from Pudendal Nerve Entrapment.
Kara
I was thinking about symptoms.........many women are diagnosed with something called Vestibulitis along with PNE because the symptoms are similar are often overlap. Here is some info on it:
Patient Information: Vulvar - Vaginal Disease
Vestibulitis
What is vulvar vestibulitis?
Vestibulitis is a condition which causes redness and pain of the vestibule. Vestibulitis is an inflammation of this skin and the mucous secreting glands found in the skin. The mucous secreting glands are called the lesser vestibular glands. Vestibulitis may include all the area around the opening of the vagina but ismost commonly seen in the lower part.
Vulvar vestibulitis occurs in women of all ages. It can occur in women who are sexually active and also in women who have never been sexually active.
Many women with this problem have suffered physically and emotionally for months or years, have seen a number of physicians, and have tried many unsuccessful treatments in search of relief.
What are the signs and symptoms of Vulvar Vestibulitis?
* Severe pain with pressure (for example: biking, exercise, tight fitting clothes ).
* Vaginal entry such as tampon use or intercourse.
* Burning, stinging, irritation, or raw sensation within the vestibular area.
* Vestibular redness
* The urge to urinate frequently or suddenly
How is vulvar vestibulitis diagnosed (identified)?
Your doctor or health care provider will examine the vulva and vestibule to identify the common skin changes seen with vulvar vestibulitis. Pain is usually felt if the vestibule area is touched with a cotton tipped applicator. A sample of your vaginal discharge is collected and tested to rule out infection.
PM me if you want to talk further............
Kara
Pudnedal Nerve Entrapment or Pudnedal Neuralgia can be a related condition to IC or it can exist all on it's own. It's categorized at the moment as being a Chronic Pelvic Pain Condition.
What is PNE/PN?
"Pudendal Neuralgia is a painful neuropathic condition that is caused by inflammation of the pudendal nerve. Triggers for the sensitivity include trauma secondary to childbirth, surgery, cycling, squatting exercises, bio-mechanical abnormalities (e.g., sacro-iliac joint dysfunction, pelvic floor dysfunction), chronic constipation, repetitive vaginal infections and direct falls on the tailbone. Pudendal neuralgia is known in some circles as ‘cyclist’s syndrome’, ‘pudendal canal syndrome’ or ‘Alcock’s syndrome.’
Primary symptoms of Pudendal Neuralgia include:
· Pelvic pain with sitting that may be less intense in the morning and increase throughout the day. Symptoms may decrease when standing or lying down. The pain can be perineal, rectal or in the clitoral / penile area; it can be unilateral or bilateral.
· Sexual dysfunction. In women, dysfunction manifests as pain or decreased sensation in the genitals, perineum or rectum. Pain may occur with or without touch. It may be difficult or impossible for the woman to achieve orgasm. In men, dysfunction presents as pain during erection, difficulty sustaining an erection or painful ejaculation.
· Difficulty with urination / defecation. Patients may experience urinary hesitancy, urgency and/or frequency. Post-void discomfort is not uncommon. Patients may feel that they have to ‘strain’ to have a bowel movement and the movement may be painful and/or result in pelvic pain after. Constipation is also common among patients with pudendal neuralgia. In severe cases, complete or partial urinary and/or fecal incontinence may result."
How is PNE or PN Treated?
"Medical - Analgesic medications, even those containing narcotics may have limited efficacy for neuropathic pain. Pain modulators such as tricyclic antidepressants and neuroleptics (i.e. Neurontin, Zonegran, etc.) have varied efficacy. Nerve infiltration with a combination of local anesthetic (Lidocaine or Marcaine) combined with steroid (Triamcinolone or Solu-Medrol) or combined with Heparin can be used. Multiple injections (usually 3-5) may be required. Timing intervals vary but 3-6 week interval between infiltration seems reasonable. Success rates also vary widely where between 15-60% are cured or improved with this approach alone.
Lifestyle Modifications – Avoiding activities which worsen the condition is crucial (cycling, sitting, etc.). Sitting pads, especially those designed with cutouts to transmit pressure away from the perineum, can be very helpful.
Physical Therapy - Musculoskeletal dysfunctions can cause pudendal neuralgia as well as other painful pelvic syndromes. Physical therapy is an effective method of minimizing or eliminating the concurrent pain generators that occur when the pudendal nerve is irritated (i.e., pelvic floor hypertonicity and myofascial trigger points, extrapelvic hypertonicity and trigger points, adverse neural tension, sacro-iliac joint dysfunctions, connective tissue restrictions, and faulty neuromuscular recruitment patterns). It is important to acknowledge this interaction between musculoskeletal and neural dysfunction as it is unusual that one exists without the other.
Physical therapists require special training to treat pudendal neuralgia. The therapist should have a strong manual therapy bias and an extensive working knowledge of pudendal neuralgia. The program should emphasize restoring normal length to the pelvic floor (through internal myofascial release) and pelvic floor relaxation techniques. Typically, the shortened pelvic floor/pudendal neuralgia will become symptomatically exacerbated with Kegel exercises and these should be avoided until otherwise instructed by a professional. The program should also include connective tissue mobilization, neural mobilization and a home exercise program.
Surgical - Three main surgical techniques are currently available (worldwide) for nerve decompression. The theory is similar to other nerve decompression procedures performed for nerve entrapments in other regions of the body (i.e. carpal tunnel release). The procedures differ in their approach to the area of entrapment and have never been compared head to head.
Post-Operative Physical Therapy - The above mentioned musculoskeletal dysfunctions can be responsible for pain that persists after a decompression procedure. It is recommended that external physical therapy begin one month post-operatively and that pelvic floor rehabilitation gets initiated at three months.
Sacro-iliac joint dysfunction commonly co-exists with pelvic pain. When the sacrotuberous ligament is severed during decompression, SIJD is a common post-operative complication. Patients typically will have persistent (or ‘new’) pain and pelvic dysfunction. This situation is correctable through proper stabilization techniques: through physical therapy in less involved circumstances and through proliferative therapy and physical therapy in more severe circumstances."
It's important to have a Doctor that is comfortable in dealing with these conditions. That is half the battle. Knowledge is the next tool to have when talking with your Doctors about PNE/PN.
For a Lisiting of North American Physicians you can go to this site: http://www.spuninfo.org/index_files/Page771.htm
This information is quoted from the The Society for Pudendal: http://www.spuninfo.org/index.htm
For more information feel free to PM me as I also suffer from Pudendal Nerve Entrapment.
Kara
I was thinking about symptoms.........many women are diagnosed with something called Vestibulitis along with PNE because the symptoms are similar are often overlap. Here is some info on it:
Patient Information: Vulvar - Vaginal Disease
Vestibulitis
What is vulvar vestibulitis?
Vestibulitis is a condition which causes redness and pain of the vestibule. Vestibulitis is an inflammation of this skin and the mucous secreting glands found in the skin. The mucous secreting glands are called the lesser vestibular glands. Vestibulitis may include all the area around the opening of the vagina but ismost commonly seen in the lower part.
Vulvar vestibulitis occurs in women of all ages. It can occur in women who are sexually active and also in women who have never been sexually active.
Many women with this problem have suffered physically and emotionally for months or years, have seen a number of physicians, and have tried many unsuccessful treatments in search of relief.
What are the signs and symptoms of Vulvar Vestibulitis?
* Severe pain with pressure (for example: biking, exercise, tight fitting clothes ).
* Vaginal entry such as tampon use or intercourse.
* Burning, stinging, irritation, or raw sensation within the vestibular area.
* Vestibular redness
* The urge to urinate frequently or suddenly
How is vulvar vestibulitis diagnosed (identified)?
Your doctor or health care provider will examine the vulva and vestibule to identify the common skin changes seen with vulvar vestibulitis. Pain is usually felt if the vestibule area is touched with a cotton tipped applicator. A sample of your vaginal discharge is collected and tested to rule out infection.
PM me if you want to talk further............
Kara