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

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.

Usually minimal to none. While undergoing treatment, you will receive local anesthesia. (Some clinicians may choose to use other forms of anesthesia.) You may have mild post-surgical soreness for up to 72 hours. An over-the-counter pain reliever will alleviate the discomfort for most patients.

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 - 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 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.

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 - 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 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 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 - 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.

Each individual has different experiences regarding pain. You may feel the following symptoms: slight irritation, red and watery eyes, dryness, a burning onion sensation and your sinuses may feel as if they are plugged. We advise you to go home and nap for several hours. When you wake up, the irritation should have lessened or disappeared. You may then resume activity as specified in your post operative instructions.

x. I really don't want to offend you, but sometimes, you act like you're better than everyone else and stuff. It gets kind of annoying because I used to look up to you. You're really pretty, you used to seem like a good friend, and you know so much about sites. It's kind of sad, but I can't really do anything. :(

You will have some discomfort related to the surgery, but we can reassure you that it will be manageable. Your job will be to communicate with the nurses and doctors about the level of pain you are having, so that it can be effectively managed. Initially you will receive medicine intravenously, but by the time you go home you will be quite comfortable just taking occasional pain tablets by mouth.