Health Organization for Pudendal Education

desperate wrote:Hello doctor,

I know this is a little off the topic of nerve blocks but I am just wondering if you can differentiate between pudendal vs the superior hypogastric nerve?

From your years of experience has anyone come into your clinic with absolutely no urge to urinate at all? The reason I ask is because I do not know if no urge to urinate is a symptom of PNE or another nerve like the hypogastric nerve. I know these are the only two nerves that innervate the bladder so I'm curious to hear your thoughts.

Thank you so much
-Dom

Dear Dom,

This is a good question.

I'll refer you to the EXCELLENT anatomy education at:
http://www.pudendalhope.info/node/13

The pudendal nerve is a sensory and partial motor nerve. The pudendal nerve transmits (or causes) pain along a very discreet anatomical area.

The hypogastric nerve is a transition zone between the superior and inferior hypogastric plexus. It is not a target for interventional pain procedures in general. We always prefer to target the superior or inferior hypogastric plexus.
http://en.wikipedia.org/wiki/Hypogastric_nerve

The superior hypogastric plexus is a spider-web like cluster of nerves that lives just ventral to the L5-S1 disc and sacrum.
http://en.wikipedia.org/wiki/Superior_h ... ric_plexus
It is not a "nerve" per se, but a cluster of them. It also is a sympathetic plexus. The sympathetic nerve system is a distinct part of your anatomy and it is responsible for some pain sensations, blood flow, hair growth, hormone release,etc. We can do injections to the superior hypogastric plexus to alleviate generalized pelvic pain, typically originating from the organs. We can also kill the hypogastric plexus with alcohol or phenol injections for people with invasive tumors in the area.

I cannot say I've had any patients without the urge to unrinate unless they have suffered from a spinal cord injury or stroke. This symptom is usually not a result of or associated with typical pelvic pain issues.

Best Regards, Dr. Attaman

Dr. Attaman if I may ask do you have experience in treating patients with genital numbness issues (but no sitting pain)? Do you know of any non-surgical treatments that may be effective for these types of issues?

IHatePNE wrote:Dr. Attaman if I may ask do you have experience in treating patients with genital numbness issues (but no sitting pain)? Do you know of any non-surgical treatments that may be effective for these types of issues?

If there is pure numbness and no pain, this indicates the pudendal nerve or S3-5 nerve roots may be damaged or seriously compressed. There is also a rare condition called caudal equina syndrome in which the nerve roots within the spinal cord are compressed and this results in genital numbness. All of these potential issues would need to be evaluated in cases of numbness.

@ Dr. Attaman

Thank you very much for the reply

IHatePNE wrote:@ Dr. Attaman

Thank you very much for the reply

My pleasure.

One more question Dr. Attaman if I may. When you do Dorsal Nerve Blocks do you inject steroids or other anti-scarring/inflammatory meds or do you only inject anesthetics?

What do you suggest for chronic coccyxgeus muscle spasms? Botox and muscle relaxer pill form don't phase me.

IHatePNE wrote:One more question Dr. Attaman if I may. When you do Dorsal Nerve Blocks do you inject steroids or other anti-scarring/inflammatory meds or do you only inject anesthetics?

Dear IHatePNE,

Sorry for the delayed reply. Yes generally I will inject steroids, a short acting local anesthetic, and a long acting local anesthetic all at once. On occasion I will also inject Sarapin to prolong the block. Steroids are optional but help improve outcomes in general. Best Regards, Dr. Attaman

No problem Dr. Attaman thank you very much for your time.

Dr Attaman

Can you suggest any type of injections for the tailbone and coccxygeus muscle being locked up?

Also are any injections affective for the sciatic nerve if it is partially entrapped?