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 - 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 - In France, they say they are able to help 68% of their patients with a nerve block (i.e. the pain decreases 80% on the VAS). So, you have to focus on improvement not cure! We have one patient with complete recovery from injections alone (0 on VAS).

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 - Yes, we try to avoid more than 4 injections due to the further irritation to the nerve, the addition of scar tissue or reaction to the steroids. Bone problems can result from steroid use but that is usually long term steroid by mouth such as for asthma patients or different medical problems.

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 - 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 - 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.

A nerve root injection is done primarily to determine if a specific nerve root is the source of back, buttock and leg pain. The procedure is similar to an epidural injection, where the lower spinal canal is injected. Selective nerve root injections of cortisone and anesthetic can help diagnose as well as treat nerve root inflammation that causes sciatica, a numbness or pain in the leg. This very precise injection can help alleviate leg pain coming from nerve roots in the lower back.

From stress. It may occur in infancy from a difficult birth or from childhood falls. Later in life, emotional tension or stress can gradually damage your spine or violent injuries from automobile accidents or sports can suddenly knock you "out of whack."

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.

Subluxation is the alteration of the bones, muscles, and nerves of the spine which causes compression, tension, irritation and damage to the Central Nerve System. This disturbs the Central Nerve system and causes the organs and muscles of the body to malfunction and heal poorly. Subluxations are caused by a lifetime of stress and trauma. Any stress that your body cannot deal with at a point in time may produce spinal subluxation.

I took a fall at home in January. Hurt my neck up high. Slowly, I got weakness in arms with uncoordination, then in the legs, with fasciculations, weakness and heaviness. There are 2 kinds of nervous system; central nervous system (CNS) and peripheral nervous system (PNS). The CNS consists of brain and spinal cord. EMG has no role in diseases or lesions of CNS.

Nerve blocks are recommended for those who suffer from neck pain, low back pain, sciatica resulting from herniated discs, lumbar canal stenosis, complex regional pain syndrome (reflex sympathetic dystrophy), pain arising from peripheral vascular disease, shingles pain, myofascial pain syndrome and cancer pain.

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.