DOCSLIB.ORG

UNJ Dec 2000

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
UNJ Dec 2000 C o n s e rvative Management of Female Patients With Pelvic Pain Hollis Herm a n he primary symptoms of Female patients with hy p e r t o nus of the pelvic musculature can ex p e- h y p e rtonus of the pelvic rience pain; burning in the cl i t o r i s , u r e t h r a , vag i n a , or anu s ; c o n s t i- m u s c u l a t u r e in female p a t i o n ; u r i n a ry frequency and urge n cy ; and dy s p a r e u n i a . P hy s i c a l patients include pain; t h e r a py techniques are effective in treating female patients with Tb u rning in the clitoris, ure t h r a , pelvic pain, and can successfully reduce the major symptoms asso- vagina or anus; constipation; uri- ciated with it. Using a treatment plan individualized for each patient’s n a ry frequency and urgency; and s y m p t o m s , these techniques can provide considerable relief to d y s p a reu nia (DeFranca, 1996). patients with debilitating pelvic pain. T h e re are many names for hyper- tonus diagnoses involving these symptoms including: levatore s ani syndrome (Nicosia, 1985; Salvanti, 1987; Sohn, 1982), ten- alignment and instability are pre- Olive, 1998), vaginal pH alter- sion myalgia (Sinaki, 1977), sent (Lee, 1999). Patients have ation, dermatological disease, p roctalgia fugax (Swain, 1987), functional impairment with sit- c a n c e rou s vulvar disease, epi- coccygodynia (Dittrich, 1951; ting, walking, urination, and s i o t o m y, laceration, birthing trau- Thiele, 1937; 1963; Wa t e r s , defecation (DeFranca, 1996), and ma with forceps or vacuum 1992), dyspareunia (Glatt, 1990), with household and community extraction, vaginal infection, uri- vaginismus (Hall, 1952), animus, activities of daily living. A high n a ry tract infection, inflamma- vulvodynia (MacLean, 1995; resting baseline, excessive signal tion, skin irritation from chemi- M a r i n o ff & Tu rn e r, 1992; Reid, v a r i a b i l i t y, and a low net rise on cals, nerve irritation from entrap- 1993; Secor, 1992), vulvar s u rface EMG (sEMG) is common- ment, neuro h o r monal alteration vestibulitis (deJong, 1995; Spadt, ly re c o rde d. Muscle hypert o n u s p a rticularly estrogen deficiency 1995), interstitial cystitis, puden- can be palpated on external and ( G l a z e r, Romanzi, & Polaneczky, dal neuralgia (Tu r n e r, 1991), i n t e rnal pelvic floor muscle 1999), psychiatric disord e r s , pelvic pain (Baker, 1993), and examination. Muscle weakness is instability of the pelvis (Lee, u rethral syndrome (Steege, m e a s u red in the levatores ani, 1999), prolapse, vasocongestion, M e t z g e r, & Levy 1998). obturator internus, gluteus and sexual trauma. Physical ther- The objective findings in medius, iliopsoas, adductor, and apy treatment coverage of dys- patients with hypertonus include lateral hip rotator muscles. Some p a reunia may be denied under its pain on palpation to the geni- d e g ree of dyspareunia is usually p r i m a ry ICD-9 code if viewed as talia, pain on palpation of the re p o rted. a psychiatric or sexual dysfunc- perineal region from 3 to 9 tion rather than an anatomic or o’clock, or pain in the ure t h r a , D y s p a re u n i a physiologic dysfunction. perineal body, perianal area, pos- D y s p a reunia is better defined M a r i n o ff and Tu rner (1992) terior thigh, gluteal, and abdomi- as painful penetration rather defined three levels of dyspare u- nal areas (Costello, 1998). than painful intercourse, as nia (see Table 1). Burning, sting- S a c roiliac, coccyx, symphysis many patients re p o r t painful ing, irritation, rawness, tearing, pubis, lumbosacral joint mal- gynecologic examinations using and searing pain are the most speculums or a gloved examining common complaints with pene- digit. Causes for dyspareunia can tration during and afterw a rd. If include: abscess, fissure, adhe- these symptoms are felt at the Hollis Herman, M S , P T, O c s, is a sions from prior surg e ry, adhe- i n t roi tus, superficial stru c t u re s P hysical T h e rapist in Pri vate Pra c t i c e sions causing conditions such as such as the genitalia, perineal in Cambri d g e, MA. endometriosis (Blackwell & b o d y, posterior fourchette, epi- UROLOGIC NURSING / December 2000 / Volume 20 Number 6 393 Table 1. Pelvic Floor Muscle T h r ee Levels of Dyspare u n i a E x e rc i s e s Using sEMG with pelvic pain Level 1: Painful intercourse not severe enough to prevent the activity. patients, Glazer, Rodke, and Level 2: Painful intercourse which limits frequency of the activity. Swencionis (1995) demonstrated unstable and abnormally high Level 3: Abstinence from intercourse because of severe pain. resting baselines (tension). Unstable and weak amplitudes w e r e re c o rded during phasic, tonic, and endurance voluntary Table 2. contractions. The use of sEMG Treatment for Dyspareunia of Musculoskeletal Origin was proposed as an objective method for forming a diff e re n t i a l 1 . C o rrect any joint(s) malalignment to promote pain-free joint(s) mobility. diagnosis between functional 2 . Teach the patient self-correction joint(s) techniques (musculoskeletal) vulvovaginal (see Tables 3, 4, & 5). pain syndromes and other 3 . Stabilize the joint(s) with muscle stabilization exerc i s e s . s o u rces of vulvovaginal pain such as infections. Stabilizing 4 . Eliminate trigger points in all of the muscles. muscle variability overall and 5 . Eliminate or reduce scar adhesions and tissue restrictions (see Table 6). p r edominantly at rest was a 6 . Teach pelvic floor muscle awareness using a biofeedback device (see major factor in effective tre a t- Table 7). ment, rather than focusing on 7 . C o rrect muscle imbalances by down training (relaxation) and up train- i n c reases in the contractile ing (stre n g t h e n i n g ) . amplitude. Glazer and Mac- Conkey (1996) proposed simulta- 8 . Re-educate the pelvic floor muscles to be relaxed upon penetration. neous use of diff e rent muscle 9 . Combine down training with dilators (see Table 8). combinations to enhance the 1 0 . Educate about positions for intimacy. pelvic floor muscles contraction, 1 1 . Educate about lubricants. in order to “break” the re s t i n g tension level and reduce pain. Thus, the “Glazer protocol” (see Table 3) consists of two 20- Table 3. minute exercise sessions per day. G l a z e r ’s Pro t o c o l Each session is 60 repetitions of 10-second contractions altern a t- Patient is supine, semi-reclining, sitting, or standing. ing with 10-second re l a x a t i o n phases. Patients are asked to con- Contract the pelvic floor muscles up and in as hard as possible. tract the pelvic floor muscles maximally with all other sur- You may contract any other muscles along with the pelvic floor muscles. rounding muscles. They are re q u i r ed to use home sEMG Hold the contraction for 10 seconds. training devices with intravagi- Relax for 10 seconds. nal sensors. Over time the clinician may Repeat 60 times twice a day. o b s e rve increased contractile amplitudes, decreased variability of the contraction and re l a x a t i o n amplitude, and faster rise and re c o v e ry times with subjective siotomy site, and superf i c i a l establish that the cause is muscu- re p o rts of less pain. muscle layer may be implicated. loskeletal rather than fungal, bac- A c c o rding to Glazer, after If deeper pain occurs, adhesion terial, viral, or otherwise infec- t r eatment the sEMG demon- of the vaginal canal, adhesive tious is essential for eff e c t i v e strates a reduction in the hyper- disease, cervix and uterine dys- physical therapy treatment. Once tonicity and instability associat- function, levatores ani muscle the diagnosis is established that ed with chronic uncoord i n a t e d trigger points, or sacroiliac and pelvic pain is of musculoskeletal d i s c h a rge of fast twitch fibers symphysis pubis joint dysfunc- origin, treatment may include the seen in the resting sEMG of vul- tion may be involved. steps listed in Table 2. Following vovaginal pain patients. Va r i a t i o n s When evaluating patients o ffice treatment to correct the on “Glazer’s protocol” that have with dyspareunia, it is import a n t joint malalignment, the patient had equally significant t re a t m e n t to first rule out any medical con- can continue with self-corre c- results are two 15-minute rather ditions. Diff e rential diagnosis to tions at home. than two 20-minute sessions. 394 UROLOGIC NURSING / December 2000 / Volume 20 Number 6 Table 4. P r otocol for Using sEMG and Dilators 1 .
Load more

Recommended publications
  • Chronic Pelvic Pain & Pelvic Floor Myalgia Updated
    Welcome to the chronic pelvic pain and pelvic floor myalgia lecture. My name is Dr. Maria Giroux. I am an Obstetrics and Gynecology resident interested in urogynecology. This lecture was created with Dr. Rashmi Bhargava and Dr. Huse Kamencic, who are gynecologists, and Suzanne Funk, a pelvic floor physiotherapist in Regina, Saskatchewan, Canada. We designed a multidisciplinary training program for teaching the assessment of the pelvic floor musculature to identify a possible muscular cause or contribution to chronic pelvic pain and provide early referral for appropriate treatment. We then performed a randomized trial to compare the effectiveness of hands-on vs video-based training methods. The results of this research study will be presented at the AUGS/IUGA Joint Scientific Meeting in Nashville in September 2019. We found both hands-on and video-based training methods are effective. There was no difference in the degree of improvement in assessment scores between the 2 methods. Participants found the training program to be useful for clinical practice. For both versions, we have designed a ”Guide to the Assessment of the Pelvic Floor Musculature,” which are cards with the anatomy of the pelvic floor and step-by step instructions of how to perform the assessment. In this lecture, we present the video-based training program. We have also created a workshop for the hands-on version. For more information about our research and workshop, please visit the website below. This lecture is designed for residents, fellows, general gynecologists,
    [Show full text]
  • Perinea] Musculature in the Black Bengal Goat
    J. Bangladesh Agril. Univ. 3(1): 77-82, 2005 ISSN 1810-3030 Perinea] musculature in the Black Bengal goat Z. Hague, M.A. Quasem, M.R. Karim and M.Z.1. Khan Department of Anatomy and Histology, Bangladesh Agricultural University, Mymensingh Abstract With the aim of preparing topographic descriptions and illustrations of the perineaj muscles of the black Bengal does, 12 adult animals were used. The animals were anaesthetized and bled to death by giving incision on the right common carotid artery. Whole vascular system was flashed with 0.85% physiological saline solution and then 10% formalin was injected through the same route for well preservation. After preservation, the muscles of the perineum were surgically isolated, transected and studied. It revealed that muscles of the pelvic diaphragm were M. levator ani and M. coccygeus. The M. levator ani was originated entirely from the sacrosciatic ligament and M. coccygeus from the medial side of the ischiatic spine and from the inside of the sacrotuberal ligament. M. levator ani was poorly developed and was blended with coccygeus for some distance at their insertion. Muscles of the urogenital diaphragm were M. urethralis, M. ischiourethralis and M. bulboglandularis. M. bulboglandularis was a small circular muscle which enclosed the major vestibular gland. Anal musculature of the perineum were M. sphincter ani externus, M. rectococcygeus and M. rectractor clitoridis. M. sphincter ani externus completely encircled the anus. Its fibers crossed ventral to the anus and continued into the opposite labium and the labium on the same side. M. rectococcygeus inserted on th the ventral surface of the 5th and 6 caudal vertebrae.
    [Show full text]
  • Anatomy and Histology of Apical Support: a Literature Review Concerning Cardinal and Uterosacral Ligaments
    Int Urogynecol J DOI 10.1007/s00192-012-1819-7 REVIEW ARTICLE Anatomy and histology of apical support: a literature review concerning cardinal and uterosacral ligaments Rajeev Ramanah & Mitchell B. Berger & Bernard M. Parratte & John O. L. DeLancey Received: 10 February 2012 /Accepted: 24 April 2012 # The International Urogynecological Association 2012 Abstract The objective of this work was to collect and Autonomous nerve fibers are a major constituent of the deep summarize relevant literature on the anatomy, histology, USL. CL is defined as a perivascular sheath with a proximal and imaging of apical support of the upper vagina and the insertion around the origin of the internal iliac artery and a uterus provided by the cardinal (CL) and uterosacral (USL) distal insertion on the cervix and/or vagina. It is divided into ligaments. A literature search in English, French, and Ger- a cranial (vascular) and a caudal (neural) portions. Histolog- man languages was carried out with the keywords apical ically, it contains mainly vessels, with no distinct band of support, cardinal ligament, transverse cervical ligament, connective tissue. Both the deep USL and the caudal CL are Mackenrodt ligament, parametrium, paracervix, retinaculum closely related to the inferior hypogastric plexus. USL and uteri, web, uterosacral ligament, and sacrouterine ligament CL are visceral ligaments, with mesentery-like structures in the PubMed database. Other relevant journal and text- containing vessels, nerves, connective tissue, and adipose book articles were sought by retrieving references cited in tissue. previous PubMed articles. Fifty references were examined in peer-reviewed journals and textbooks. The USL extends Keywords Apical supports .
    [Show full text]
  • Anococcygeal Raphe Revisited: a Histological Study Using Mid-Term Human Fetuses and Elderly Cadavers
    http://dx.doi.org/10.3349/ymj.2012.53.4.849 Original Article pISSN: 0513-5796, eISSN: 1976-2437 Yonsei Med J 53(4):849-855, 2012 Anococcygeal Raphe Revisited: A Histological Study Using Mid-Term Human Fetuses and Elderly Cadavers Yusuke Kinugasa,1 Takashi Arakawa,2 Hiroshi Abe,3 Shinichi Abe,4 Baik Hwan Cho,5 Gen Murakami,6 and Kenichi Sugihara7 1Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan; 2Arakawa Clinic of Proctology, Tokyo, Japan; 3Department of Anatomy, Akita University School of Medicine, Akita, Japan; 4Oral Health Science Center hrc8, Tokyo Dental College, Chiba, Japan. 5Department of Surgery, Chonbuk National University School of Medicine, Jeonju, Korea. 6Division of Internal Medicine, Iwamizawa Kojin-kai Hospital, Iwamizawa, Japan; 7Department of Surgical Oncology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan. Received: September 21, 2011 Purpose: We recently demonstrated the morphology of the anococcygeal liga- Accepted: October 24, 2011 ment. As the anococcygeal ligament and raphe are often confused, the concept of Corresponding author: Dr. Yusuke Kinugasa, Division of Colon and Rectal Surgery, the anococcygeal raphe needs to be re-examined from the perspective of fetal de- Shizuoka Cancer Center Hospital, velopment, as well as in terms of adult morphology. Materials and Methods: We 1007 Shimonagakubo, Nagaizumi-cho, examined the horizontal sections of 15 fetuses as well as adult histology. From ca- Sunto-gun, Shizuoka 411-8777, Japan. davers, we obtained an almost cubic tissue mass containing the dorsal wall of the Tel: 81-55-989-5222, Fax: 81-55-989-5783 anorectum, the coccyx and the covering skin.
    [Show full text]
  • The Anatomy of the Pelvis: Structures Important to the Pelvic Surgeon Workshop 45
    The Anatomy of the Pelvis: Structures Important to the Pelvic Surgeon Workshop 45 Tuesday 24 August 2010, 14:00 – 18:00 Time Time Topic Speaker 14.00 14.15 Welcome and Introduction Sylvia Botros 14.15 14.45 Overview ‐ pelvic anatomy John Delancey 14.45 15.20 Common injuries Lynsey Hayward 15.20 15.50 Break 15.50 18.00 Anatomy lab – 25 min rotations through 5 stations. Station 1 &2 – SS ligament fixation Dennis Miller/Roger Goldberg Station 3 – Uterosacral ligament fixation Lynsey Hayward Station 4 – ASC and Space of Retzius Sylvia Botros Station 5‐ TVT Injury To be determined Aims of course/workshop The aims of the workshop are to familiarise participants with pelvic anatomy in relation to urogynecological procedures in order to minimise injuries. This is a hands on cadaver course to allow for visualisation of anatomic and spatial relationships. Educational Objectives 1. Identify key anatomic landmarks important in each urogynecologic surgery listed. 2. Identify anatomical relationships that can lead to injury during urogynecologic surgery and how to potentially avoid injury. Anatomy Workshop ICS/IUGA 2010 – The anatomy of the pelvis: Structures important to the pelvic surgeon. We will Start with one hour of Lectures presented by Dr. John Delancy and Dr. Lynsey Hayward. The second portion of the workshop will be in the anatomy lab rotating between 5 stations as presented below. Station 1 & 2 (SS ligament fixation) Hemi pelvis – Dennis Miller/ Roger Goldberg A 3rd hemipelvis will be available for DR. Delancey to illustrate key anatomical structures in this region. 1. pudendal vessels and nerve 2.
    [Show full text]
  • Innervation of the Levator Ani and Coccygeus Muscles of the Female Rat
    THE ANATOMICAL RECORD PART A 275A:1031–1041 (2003) Innervation of the Levator Ani and Coccygeus Muscles of the Female Rat RONALD E. BREMER,1 MATTHEW D. BARBER,2 KIMBERLY W. COATES,3 1,4 1,4,5 PAUL C. DOLBER, AND KARL B. THOR * 1Research Services, Veterans Affairs Medical Center, Durham, North Carolina 2Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio 3Department of Obstetrics and Gynecology, Scott and White Clinic, Temple, Texas 4Department of Surgery, Duke University Medical Center, Durham, North Carolina 5Dynogen Pharmaceuticals, Inc., Durham, North Carolina ABSTRACT In humans, the pelvic floor skeletal muscles support the viscera. Damage to innervation of these muscles during parturition may contribute to pelvic organ prolapse and urinary incontinence. Unfortunately, animal models that are suitable for studying parturition-in- duced pelvic floor neuropathy and its treatment are rare. The present study describes the intrapelvic skeletal muscles (i.e., the iliocaudalis, pubocaudalis, and coccygeus) and their innervation in the rat to assess its usefulness as a model for studies of pelvic floor nerve damage and repair. Dissection of rat intrapelvic skeletal muscles demonstrated a general similarity with human pelvic floor muscles. Innervation of the iliocaudalis and pubocaudalis muscles (which together constitute the levator ani muscles) was provided by a nerve (the “levator ani nerve”) that entered the pelvic cavity alongside the pelvic nerve, and then branched and penetrated the ventromedial (i.e., intrapelvic) surface of these muscles. Inner- vation of the rat coccygeus muscle (the “coccygeal nerve”) was derived from two adjacent branches of the L6-S1 trunk that penetrated the muscle on its rostral edge.
    [Show full text]
  • Pelvic Wall Joints of the Pelvis Pelvic Floor
    ANATOMY OF THE PELVIS Prof. Saeed Abuel Makarem OBJECTIVES • By the end of the lecture, you should be able to: • Describe the anatomy of the pelvis regarding (bones, joints & muscles). • Describe the boundaries and subdivisions of the pelvis. • Differentiate the different types of the female pelvis. • Describe the pelvic walls & floor. • Describe the components & function of the pelvic diaphragm. • List the blood & nerves & lymphatic of the pelvis. The bony pelvis is composed of four bones: • Two hip bones, which form the anterior and lateral walls. • Sacrum and coccyx, which form the posterior wall. • These 4 bones are lined by 4 muscles and connected by 4 joints. • The bony pelvis with its joints and muscles form a strong basin-shaped structure (with multiple foramina), that contains & protects the lower parts of the alimentary & urinary tracts and internal organs of reproduction. 3 FOUR JOINTS 1- Anteriorly: Symphysis pubis (2nd cartilaginous joint). 2- Posteriorlateraly: Two Sacroiliac joints. (Synovial joins) 3- Posteriorly: Sacrococcygeal joint (cartilaginous), between sacrum and coccyx. 4 The pelvis is divided into two parts by the pelvic brim. Above the brim is the False or greater pelvis, which is part of the abdominal cavity. Pelvic Below the brim is the True or brim lesser pelvis. The False pelvis is bounded by: Posteriorly: Lumbar vertebrae. Laterally: Iliac fossae and the iliacus. Anteriorly: Lower part of the anterior abdominal wall. It supports the abdominal contents. 5 The True pelvis has: • An Inlet. • An Outlet. and a Cavity. The cavity is a short, curved canal, with a shallow anterior wall and a deeper posterior wall.
    [Show full text]
  • The Ilio-Coccygeus Muscle
    ogy: iol Cu ys r h re P n t & R y e s Anatomy & Physiology: Current m e o a t r a c n h Guerquin, Anat Physiol 2017, 7:S6 A Research ISSN: 2161-0940 DOI: 10.4172/2161-0940.S6-002 Review Article Open Access The Ilio-Coccygeus Muscle (ICM) Does it have an Enabling Role in Urination? Bernard Guerquin* General Hospital, Avenue of Lavoisier, CS20184, Orange 84100, France *Corresponding author: Guerquin B, General Hospital, Avenue de Lavoisier, CS20184, Orange 84100, France, Tel: +3304 901124 53; E-mail: [email protected] Received Date: January 20, 2017; Accepted Date: February 01, 2017; Published Date: February 10, 2017 Copyright: © 2017 Guerquin B. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract An analysis of the literature has allowed for a redefinition of the anatomy of the ilio-coccygeus muscle (ICM) its insertions and its trajectory, the direction of its fibers and its relation to the base of the bladder. Static MRI studies have revealed its V-shaped appearance, while dynamic MRI has been used to visualize its concave contraction into a dome-shape that provides support to the levator plate, raising the base of the bladder. Histological studies have shown that the percentage of type I muscle fibers is 66% to 69%, which is comparable to the type I fiber content of the pubovisceral muscle (PVM), thus reflecting both its postural role as well as functions based on frequent voluntary contractions.
    [Show full text]
  • Architectural Design of the Pelvic Floor Is Consistent with Muscle Functional Subspecialization
    Int Urogynecol J (2014) 25:205–212 DOI 10.1007/s00192-013-2189-5 ORIGINAL ARTICLE Architectural design of the pelvic floor is consistent with muscle functional subspecialization Lori J. Tuttle & Olivia T. Nguyen & Mark S. Cook & Marianna Alperin & Sameer B. Shah & Samuel R. Ward & Richard L. Lieber Received: 24 April 2013 /Accepted: 6 July 2013 /Published online: 1 August 2013 # The International Urogynecological Association 2013 Abstract human cadavers (mean age 85 years, range 55–102). Funda- Introduction and hypothesis Skeletal muscle architecture is mental architectural parameters of skeletal muscles [physio- the strongest predictor of a muscle’s functional capacity. The logical cross-sectional area (PCSA), normalized fiber length, purpose of this study was to define the architectural proper- and sarcomere length (Ls)] were determined using validated ties of the deep muscles of the female pelvic floor (PFMs) to methods. PCSA predicts muscle-force production, and nor- elucidate their structure–function relationships. malized fiber length is related to muscle excursion. These Methods PFMs coccygeus (C), iliococcygeus (IC), and parameters were compared using repeated measures analysis pubovisceral (PV) were harvested en bloc from ten fixed of variance (ANOVA) with post hoc t tests, as appropriate. Significance was set to α=0.05. Results PFMs were thinner than expected based on data report- L. J. Tuttle ed from imaging studies and in vivo palpation. Significant dif- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA ferences in fiber length were observed across PFMs: C=5.29±0.32 cm, IC=7.55±0.46 cm, PV=10.45±0.67 cm O.
    [Show full text]
  • Chronic Female Pelvic Pain—Part 1: Clinical Pathoanatomy and Examination of the Pelvic Region
    TUTORIAL Chronic Female Pelvic Pain—Part 1: Clinical Pathoanatomy and Examination of the Pelvic Region Gail Apte, PT, ScD*; Patricia Nelson, PT, ScD†; Jean-Michel Brisme´e, PT, ScD*; Gregory Dedrick, PT, ScD*; Rafael Justiz III, MD‡; Phillip S. Sizer Jr., PT, PhD* *Center for Rehabilitation Research, Texas Tech University Health Science Center, Lubbock, Texas; †Department of Physical Therapy, Eastern Washington University, Spokane, Washington; ‡Saint Anthony Pain Management, Oklahoma City, Oklahoma, U.S.A. n Abstract: Chronic pelvic pain is defined as the presence symptoms (lumbosacral, coccygeal, sacroiliac, pelvic floor, of pain in the pelvic girdle region for over a 6-month per- groin or abdominal region) can be followed to establish a iod and can arise from the gynecologic, urologic, gastro- basis for managing the specific pain generator(s) and man- intestinal, and musculoskeletal systems. As 15% of women age tissue dysfunction. n experience pelvic pain at some time in their lives with yearly direct medical costs estimated at $2.8 billion, effective eval- Key Words: myofacial pain, pelvic pain, signs and symp- uation and management strategies of this condition are toms, female examination necessary. This merits a thorough discussion of a systematic approach to the evaluation of chronic pelvic pain condi- tions, including a careful history-taking and clinical exami- INTRODUCTION nation. The challenge of accurately diagnosing chronic pelvic pain resides in the degree of peripheral and central Pain in the pelvic region can arise from musculoskele- sensitization of the nervous system associated with the tal, gynecologic, urologic, gastrointestinal, and/or neu- chronicity of the symptoms, as well as the potential influ- rological conditions.
    [Show full text]
  • A Vaginal Approach to Pelvic Floor Prolapse
    30 O B .GYN. NEWS • December 1, 2007 M ASTER C LASS A Vaginal Approach to Pelvic Floor Prolapse n a recent Master Class the pubic bones and the sacrum. Posterior to the spine is searcher and much-sought-after lecturer. As this year’s sci- (OB.GYN. NEWS, Aug. 1, the sacrospinous ligament with the overlying coccygeus entific program chairman of the American Association I2007, p. 24), abdominal muscle. The sacrospinous ligament marks the posterior of Gynecologic Laparoscopists’ Global Congress of Min- sacral colpopexy via a laparo- limit of the pelvic diaphragm. imally Invasive Gynecology, I invited Dr. Sand to present scopic approach was featured Because he is a nationally recognized expert in the vagi- a surgical tutorial on the vaginal approach to prolapse. for the treatment of vaginal nal approach to pelvic floor prolapse, I have asked Dr. Pe- Just as the participants found his discussion interesting and vault prolapse. However, for ter Sand to discuss vaginal vault suspension, the evolu- informative, I am sure our readers will feel the same. ■ the gynecologic surgeon who tion of the procedure, and the prevailing literature that BY CHARLES E. is more adroit with vaginal compares this technique with abdominal sacral colpopexy. DR. MILLER is clinical associate professor, University of MILLER, M.D. surgery, sacrospinous vaginal Dr. Sand is currently a professor of ob.gyn. at North- Chicago and University of Illinois at Chicago and President vault suspension also offers a western University, Chicago, and the director of urogy- of the AAGL. He is a reproductive endocrinologist in private safe and effective remedy for this disorder.
    [Show full text]
  • PELVIC and THIGH MUSCLES of ORNITHORHYNCHUS by HELGA S
    PELVIC AND THIGH MUSCLES OF ORNITHORHYNCHUS By HELGA S. PEARSON University College, London OF recent years attempts to establish homologies between the muscles found in one class of Vertebrates and those in another have been placed on a much sounder basis by the study of the fossil bones of common ancestral forms. These bones often show muscle insertions as well marked as those on the bones of animals living to-day. Moreover, being often intermediate in shape, they indicate how the skeletal differences between living groups have arisen, differences intimately connected with the different position and action of the muscles moving that skeleton. Watson in England, Gregory and Camp in America, were pioneers in this line of work. More recently Romer', using similar methods and also considering the nerve supply, has made a very careful comparative study of the locomotor apparatus in Amphibia, Reptiles and Mammals with especial reference to the mammalian line of descent. Of these three classes he himself dissected three living types, Cryptobranchus, Iguana and Didelphys, but at that time no Monotreme, relying on Westling's descrip- tion of conditions in this group. Recently I have had the opportunity ofdissecting the hind limb musculature of two specimens of Ornithorhynchus (kindly lent me for this purpose by Prof. D. M. S. Watson). I find that, in the light of Romer's results from other groups of vertebrates, many of Westling's homologies can no longer be ac- cepted; moreover they are unaccompanied by any figures. Although since the days of Cuvier and Meckel there have been other, partially illustrated, descrip- tions by Mivart, Alix, Coues, Manners-Smith and Frets, the homologies of these investigators are for the most part equally unacceptable, so that a new and fully illustrated description of these muscles seems to be needed.
    [Show full text]