Dr. Renney - A good example, a patient goes to Mayo clinic for a week, lays around in a hotel, has tests done, and feels great. The reason, he didn't sit, commute or work. So, yes, it depends on level of activity

Dr. Renney - If the rectal sphincter is injured during childbirth, you probably had a difficult delivery so the pudendal nerve could be stretched or injured. It is not a result of a rectal muscle tear with an episiotomy. Jill O. - Thank you Dr. Renney for appearing tonight.

Dr. Renney - PNE is entrapment of the nerve either at the Ischial Spine, between the two ligaments or in Alcocks canal where it is covered by fascia. (Female Nerve Diagram & Male Nerve Diagram) A majority of the cases are at the spine. The nerve resembles the violin strings. It is stretched and does not lie flat. When you sit, tension is placed on the nerve and you have pain. This can also happen during a bowel movement. Some people have it with sexual relations. Dr.

Dr. Renney - The main symptom is pain with sitting. You feel great in the AM until you sit for coffee, or drive to work. You get better with lying down. The pain is in the distribution of the pudendal nerve....genitalia, perineal or rectal. It can be any combination of these areas depending on the part of the nerve entrapped.

Dr. Renney - The main point is the history. You need to ask specific questions and you can discover the difference. We see many patients with this diagnosis that actually had PNE.

Dr. Renney - Yes, don't do anything if it hurts! The only way to diagnose the difference is at surgery. Dr. Renney - If you have pelvic spasms, whether its from IC or PNE, you need to have this evaluated by a person who knows how to deal with pelvic muscles. Remember, sometimes with PT you get worse before you get better due to the chronic spasms.

Dr. Renney - Yes, because the muscles of the pelvis go into spasms due to the chronic pain. Physical therapy should be directed by someone with interest in the pelvic muscles, not just any physical therapist.

Dr. Renney - CT guided pudendal nerve blocks are done at the level of the spine or canal in the buttocks area. They are not the same as nerve roots are done at the lower spine, a different area and different result.

Dr. Renney - The pain is burning, tingling, sharp, knife like. Sometimes they may have a sensation of a foreign object in the rectum. The pain is hard for people to describe due to the problem being neuropathic. Neuropathic pain is not the same as trauma pain or surgery pain.

Dr. Renney - Three years ago, the only surgeon with experience in PNE was in France, so I went to him. After I improved, I took an interested team of physicians to France to learn from the experts (Prof. Robert and his associates) and so that care would be available in the US. Our group follows their protocols. Hopefully we can publish data together in the future for the US medical community.

Dr. Renney - The diagnosis is based on the history, the results of the injections and the Pudendal Nerve Motor Latency Test (PNMLT). You need at least two of these for us to feel comfortable with the diagnosis of PNE.

Dr. Renney - 2/3 of PNE cases are men. We have not found any real difference in symptoms between men and women. Dr. Renney - The original studies were done in cyclists. The other causes are similar to those you mentioned. You can add chronic constipation to that list.

There is no effective treatment for inclusion-body myositis. This form of myositis causes people to get slowly weaker rather than experience flares. Sometimes doctors give patients a trial course of prednisone followed by methotrexate or azathioprine. If there is no improvement in a month or two, the drugs are discontinued. Patients with IBM need to anticipate the imminent limitations in their strength and mobility and prepare for each change.

Dr. Renney - The treatment is: (1) 3 guided nerve blocks with corticosteroids, (2) use of medications such as neurotin, elavil etc., (3) protection from sitting (4) or the offending factor that causes pain. This can be something as simple as avoiding lifting of bags of groceries or a bike if that causes pain

Dr. Renney - This is my opinion as a patient only. If you still have pain after the injections and the medications don't get you to a zero on the VAS (Visual Analog Scale for pain intensity) and you worry about the pain daily, I say have surgery and hope you get improvement because nothing else has helped. Jill O. - One reason why we invited you to speak is because of a patient named Michael who had been diagnosed with IC. For three years, he tried every IC therapy to no avail.

Dr. Renney - The pain with standing usually deceases somewhat but may not completely resolve if the intensity level is significant.

Dr. Renney - You need to seek out a doctor who is open to suggestions that you have PNE. It could be internist orthopedist, urologist or gynecologist. In my case, it was a radiologist who made my diagnosis.

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PNE is caused by entrapment of the pudendal nerve at any of various places on the nerve. Nerve entrapment occurs when a nerve is constricted for some reason and responds by inflammation, scarring, or thickening. All these cause nerve diameter to increase and the nerve to misbehave. The initial constriction is caused by pressure or trauma of some type or an unknown reason.