Has anyone had both of these tests? Were they painful? Were they accurate?
Thanks
PNMLT and EMG
Re: PNMLT and EMG
Yes, a little painful but they don't last very long. As for the accuracy -- the EMG gave some valuable info. The PNMLT measures the motor function but not the sensory function so it's not necessarily going to correlate with your pain levels. Some docs discount it's validity in the diagnosis of PNE. Neither of these tests is considered 100% accurate but may add more pieces to the puzzle in your diagnosis.
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
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elephants27
- Posts: 22
- Joined: Fri Feb 25, 2011 12:04 am
- Location: Maryland
Re: PNMLT and EMG
WOW!!! I have only had a EMG done, and it was long before I had pne, I would not want anyone to go through the horror that was that test!! It was horrible. The doctor said that it wouldn't hurt and it would take 20 minutes. Well really?? NOT true! It took about an hour, maybe even longer...he said it wouldn't hurt, well when i was crying from all of the pain and horror, he kept saying that its not painful. I wanted to shock him repeatly with those needles.
Okay, you lie on your back, have to be very still and not move, then they take needles and put them in about 2inches in your muscles and then shock you repeatedly. It is horrible one of the worst tests ever! He even said ok you can go to work, yeah right I had side effects from the test and my body was still jumping it still felt like something was shocking me, now even if someone shocks me with a little stactic i jump away and yell. Its crazy!
Now my new doctor is trying to push this test again..I told him it is not going to happen!!! I cannot imagine where the needles would go for us. But it was horrible just in the left side of my body from shoulder to ankle. Good luck to you! I don't know what a PNMLT is but EMG was not for me, I just wanted to tell you what they actually do, like I said, I have no idea where the needles would go for us. Good luck!
Okay, you lie on your back, have to be very still and not move, then they take needles and put them in about 2inches in your muscles and then shock you repeatedly. It is horrible one of the worst tests ever! He even said ok you can go to work, yeah right I had side effects from the test and my body was still jumping it still felt like something was shocking me, now even if someone shocks me with a little stactic i jump away and yell. Its crazy!
Now my new doctor is trying to push this test again..I told him it is not going to happen!!! I cannot imagine where the needles would go for us. But it was horrible just in the left side of my body from shoulder to ankle. Good luck to you! I don't know what a PNMLT is but EMG was not for me, I just wanted to tell you what they actually do, like I said, I have no idea where the needles would go for us. Good luck!
Re: PNMLT and EMG
Hello, I've had the Pudendal Nerve Motor Latency Test (PNMLT) before my first rectal surgery in 07' and it showed that my nerves were transmitting slower then normal and my surgeon said that I had nerve damage in this area. He then did a rectal exam and touched towards my spine and was able to recreate my pain and said I had PNE. He had an idea about PNE but not a lot of knowledge to be able to treat me and since it's a learning hospital most surgeons stay for a while and then move on to the next hospital. Since having my two rectal surgeries both my Colon/Rectal surgeons have left the hospital and moved on.
After digging through my medical records I guess I had both the PNMLT & the EMG but honestly I don't recall either of these being painful but then again the nerve damage has half of that area dead where I have no feeling, so that could also be the reason.
Here's what he wrote on my medical records: Pudendal nerve latencies were then assessed and she demonstrated evidence of bilateral pudendal neuropathy. EMG was assessed and there was clear evidence of non-relaxing puborectalis. This is all consistent with her history and the previously demonstrated sphincter defect on ultrasound. Because when my gynecologist repaired my 4th degree laceration during my childbirth she didn't repair it correctly. She should have taken me into the operating room with a general surgeon and had it repaired with guided machinery but she repaired it in the birthing room and never did a 6 week check-up to make sure she did it correctly and I had no idea because this was my 1st baby and I had no idea the laceration was that bad because she never told me anything about it. Just prescribed me pain killers, stool softeners and the basic instructions after you have a baby.
I have tried biofeedback which only made all my symptoms worse because everything in that area is already tight that only made it more tight.
To be honest I don't believe the PNMLT test would hurt at all it's just a probe on their finger inserted either into your vagina or your rectum that checks the nerve and doesn't send any shocks through you. The EMG is the test that will send the shocks like the previous poster said. I had that for my neck surgery and just a year ago checking me for MS symptoms which were really my PNE symptoms. It did hurt me but it wasn't that intolerable that I couldn't get through it. But each person's level of pain is different also.
Good Luck to everyone having their tests done!
After digging through my medical records I guess I had both the PNMLT & the EMG but honestly I don't recall either of these being painful but then again the nerve damage has half of that area dead where I have no feeling, so that could also be the reason.
Here's what he wrote on my medical records: Pudendal nerve latencies were then assessed and she demonstrated evidence of bilateral pudendal neuropathy. EMG was assessed and there was clear evidence of non-relaxing puborectalis. This is all consistent with her history and the previously demonstrated sphincter defect on ultrasound. Because when my gynecologist repaired my 4th degree laceration during my childbirth she didn't repair it correctly. She should have taken me into the operating room with a general surgeon and had it repaired with guided machinery but she repaired it in the birthing room and never did a 6 week check-up to make sure she did it correctly and I had no idea because this was my 1st baby and I had no idea the laceration was that bad because she never told me anything about it. Just prescribed me pain killers, stool softeners and the basic instructions after you have a baby.
I have tried biofeedback which only made all my symptoms worse because everything in that area is already tight that only made it more tight.
To be honest I don't believe the PNMLT test would hurt at all it's just a probe on their finger inserted either into your vagina or your rectum that checks the nerve and doesn't send any shocks through you. The EMG is the test that will send the shocks like the previous poster said. I had that for my neck surgery and just a year ago checking me for MS symptoms which were really my PNE symptoms. It did hurt me but it wasn't that intolerable that I couldn't get through it. But each person's level of pain is different also.
Good Luck to everyone having their tests done!
Re: PNMLT and EMG
Welcome to the forum,
I see you tried biofeedback and said you are tight. Have you seen a PN aware PT? There is a list off the homepage and there may be one in your area that might be able to help. Al though if you do not get relief fairly quickly it could be because PNE usually requires more aggressive treatment such as surgery. There is some good info in the FAQs off the homepage and you may want to consider traveling to one of the PN surgeons if you cannot handle the pain anymore since it could be a very long time before one shows up in Chicago. Unfortunately we are lacking in care for PNE the days at least in widespread medical help. Best to you.
Janet
I see you tried biofeedback and said you are tight. Have you seen a PN aware PT? There is a list off the homepage and there may be one in your area that might be able to help. Al though if you do not get relief fairly quickly it could be because PNE usually requires more aggressive treatment such as surgery. There is some good info in the FAQs off the homepage and you may want to consider traveling to one of the PN surgeons if you cannot handle the pain anymore since it could be a very long time before one shows up in Chicago. Unfortunately we are lacking in care for PNE the days at least in widespread medical help. Best to you.
Janet
2007-08 pelvic muscles spasms treated by EGS. 6/27/10 sat too long on hard chair- spasms, EGS not work Botox help, cortisone shots in coccyx help, still pain, PT found PNE & sent me to Dr Marvel nerve blocks & MRN, TG left surgery 5/9/11. I have chronic bunion pain surgery at age 21. TG gave me back enough sitting to keep my job & join in some social activities. I wish the best to everyone! 2019 luck with orthotics from pedorthist & great PT allowing me to get off oxycodone.
Re: PNMLT and EMG
Hello Janet,
A Urogynecologist recommended that I see a pelvic pain therapist about a year ago and I went to her for 3 days a week for over a month and honestly it was making my pain and shock symptoms down my legs so much worse that I stopped seeing her because I was in better shape before I had her therapy. She was doing the internal manual therapy. She said everything from my abdomen to my knees were extremely tight and she wasn't sure if therapy at that point could even straighten me out but we could give it a try. I have a huge list of things I've gone through and things that are still wrong with me and I'm so lost on what I should do first and if I should even do anything because I'm worried I may make myself even worse off then I am right now.
I had my Son natural birth, he weighed 9 lbs. and was 20 inches long. He was just way to big for my body to have him natural so after I pushed for 3 1/2 hours she finally told me if we didn't get him out we'd have to take me back for a c-section. They attached the vacuum extractor to my Sons head and I pushed with all my might and the vacuum came loose off my Son's head and I was told one more try and I was going for surgery. The next time I was able to finally delivery him with a 4th degree laceration. When my Son was born he had erbs palsy, a fully collapsed left lung, partial collapsed right lung, heart issues, extensive bruising on his chest, arm, and shoulder, and the worst laceration on the back of his head from the vacuum. By the grace of God he was able to overcome his difficult childbirth and he's 100% healthy.
So because she didn't correctly repair my 4th degree laceration or check it at my 6 week appointment I had no idea I had such a severe tear or would have these problems later in life.
1. I have fecal incontinence 2. I've had 2 surgeries to repair a prolapsed colon twice where they removed 18 inches of my large intestine (one from the rectum and the other through my abdomen) 3. mucous incontinence 4. severe chronic low back pain, hurts to sit, stand for over 5 minutes, walk, and later throughout the day it gets so sore it even hurts to lay down. 5. a large rectocele 6. Internal and external sphincter defect, both my sphincter muscles are not together like a 0 like everyone else's mine are now like a u which is why I have no sphincter tone and fecal incontinece. 7. Non-relaxing puborectalis muscles 8. Sacrum is rotated to the left 9. Therapist wrote: decreased pelvic floor muscle strength and indurance, increased overflow with pelvic floor muscle contraction, decreased ability to relax the pelvic floor, decreased pelvic floor muscle cooridination, pain, decreased range of motion and flexibility, and core weakness. Functional limitations include: inability to sit, stand and lie down; difficulty walking. 10. Depression and anxiety (a given with most PN patients). 11. COPD 12. Fibromyalgia (which had to have been brought on from the PNE) because I never had any of those symptoms before this and didn't start getting the Fibro symptoms until about 5 years into the PNE. 13. insomnia 14. MS symptoms but I don't have MS because a neurlologist ran all the tests and it didn't show the same type of brain lesions as found in MS my brain lesions were in the front lobes of my brain and not at the back. 15. Bladder urgency, even after I go I still feel as though I didn't empty my bladder and use the bathroom at least 5 or more times an hour.
So here's where I'm not sure what to do or how to handle my case. Should I have my rectocele repaired first? See a PNE Doctor and try to have this avenue looked into first? Work on my pelvic floor issues? And with everything going on I'm not sure what doctor to see who can help me with everything listed above. Because of my two rectal surgeries a lot of Doctors don't want to touch me in this area because they are worried they may cause additional damage. My last rectal surgery was new territory because my surgeon was worried she might cut off the blood supply to my large intestine because I already had surgery in this area so they had to discuss it in great detail with a few other surgeons to get their opinions. I asked them when they were repairing my last rectal prolapse in 2010 if they could repair my rectocele at the same time and have a urogynecologist in there who could do that part of the surgery and I was told it was too risky to worry about one thing at a time. It's just a mess, I can't find a Doctor who can help me, I have no idea who to turn to or what road to take next. My two colon/rectal surgeons both said I had PNE but they don't treat it and they said this because of my PNMLT tests, EMG, and rectal exam and re-creating the pain upon touching along the pudendal nerve area. I've been seeing a pain management specialist who continues to assume my chronic low back pain, rectal pain, and perineal pain is from my disk somewhere along my S1, 2 or 3 but I've had MRI's and X-ray's and they all come out clean. I told him I have PNE and he won't even consider this option (probably because he don't have any knowledge on it). So he's been giving me injections into my S disks with no resolution at all. It's to the point I've cancelled my last 3 injections because I know that's not the problem and they are very painful and useless. I just wish I knew what I should do to have some of my problems solved. I was thinking about going to Rehabilitation Institute of Chicago in the Woman's health rehabilitation department and seeing if any of their therapists could help me in any way. My only problem with this is I live about an hour and a half away from Chicago one way and that commute is almost impossible for me to do alone and my Husband and all my family works so I don't have transportation other then myself. I'm sorry I wrote a huge book, I just don't know where to turn anymore.
A Urogynecologist recommended that I see a pelvic pain therapist about a year ago and I went to her for 3 days a week for over a month and honestly it was making my pain and shock symptoms down my legs so much worse that I stopped seeing her because I was in better shape before I had her therapy. She was doing the internal manual therapy. She said everything from my abdomen to my knees were extremely tight and she wasn't sure if therapy at that point could even straighten me out but we could give it a try. I have a huge list of things I've gone through and things that are still wrong with me and I'm so lost on what I should do first and if I should even do anything because I'm worried I may make myself even worse off then I am right now.
I had my Son natural birth, he weighed 9 lbs. and was 20 inches long. He was just way to big for my body to have him natural so after I pushed for 3 1/2 hours she finally told me if we didn't get him out we'd have to take me back for a c-section. They attached the vacuum extractor to my Sons head and I pushed with all my might and the vacuum came loose off my Son's head and I was told one more try and I was going for surgery. The next time I was able to finally delivery him with a 4th degree laceration. When my Son was born he had erbs palsy, a fully collapsed left lung, partial collapsed right lung, heart issues, extensive bruising on his chest, arm, and shoulder, and the worst laceration on the back of his head from the vacuum. By the grace of God he was able to overcome his difficult childbirth and he's 100% healthy.
So because she didn't correctly repair my 4th degree laceration or check it at my 6 week appointment I had no idea I had such a severe tear or would have these problems later in life.
1. I have fecal incontinence 2. I've had 2 surgeries to repair a prolapsed colon twice where they removed 18 inches of my large intestine (one from the rectum and the other through my abdomen) 3. mucous incontinence 4. severe chronic low back pain, hurts to sit, stand for over 5 minutes, walk, and later throughout the day it gets so sore it even hurts to lay down. 5. a large rectocele 6. Internal and external sphincter defect, both my sphincter muscles are not together like a 0 like everyone else's mine are now like a u which is why I have no sphincter tone and fecal incontinece. 7. Non-relaxing puborectalis muscles 8. Sacrum is rotated to the left 9. Therapist wrote: decreased pelvic floor muscle strength and indurance, increased overflow with pelvic floor muscle contraction, decreased ability to relax the pelvic floor, decreased pelvic floor muscle cooridination, pain, decreased range of motion and flexibility, and core weakness. Functional limitations include: inability to sit, stand and lie down; difficulty walking. 10. Depression and anxiety (a given with most PN patients). 11. COPD 12. Fibromyalgia (which had to have been brought on from the PNE) because I never had any of those symptoms before this and didn't start getting the Fibro symptoms until about 5 years into the PNE. 13. insomnia 14. MS symptoms but I don't have MS because a neurlologist ran all the tests and it didn't show the same type of brain lesions as found in MS my brain lesions were in the front lobes of my brain and not at the back. 15. Bladder urgency, even after I go I still feel as though I didn't empty my bladder and use the bathroom at least 5 or more times an hour.
So here's where I'm not sure what to do or how to handle my case. Should I have my rectocele repaired first? See a PNE Doctor and try to have this avenue looked into first? Work on my pelvic floor issues? And with everything going on I'm not sure what doctor to see who can help me with everything listed above. Because of my two rectal surgeries a lot of Doctors don't want to touch me in this area because they are worried they may cause additional damage. My last rectal surgery was new territory because my surgeon was worried she might cut off the blood supply to my large intestine because I already had surgery in this area so they had to discuss it in great detail with a few other surgeons to get their opinions. I asked them when they were repairing my last rectal prolapse in 2010 if they could repair my rectocele at the same time and have a urogynecologist in there who could do that part of the surgery and I was told it was too risky to worry about one thing at a time. It's just a mess, I can't find a Doctor who can help me, I have no idea who to turn to or what road to take next. My two colon/rectal surgeons both said I had PNE but they don't treat it and they said this because of my PNMLT tests, EMG, and rectal exam and re-creating the pain upon touching along the pudendal nerve area. I've been seeing a pain management specialist who continues to assume my chronic low back pain, rectal pain, and perineal pain is from my disk somewhere along my S1, 2 or 3 but I've had MRI's and X-ray's and they all come out clean. I told him I have PNE and he won't even consider this option (probably because he don't have any knowledge on it). So he's been giving me injections into my S disks with no resolution at all. It's to the point I've cancelled my last 3 injections because I know that's not the problem and they are very painful and useless. I just wish I knew what I should do to have some of my problems solved. I was thinking about going to Rehabilitation Institute of Chicago in the Woman's health rehabilitation department and seeing if any of their therapists could help me in any way. My only problem with this is I live about an hour and a half away from Chicago one way and that commute is almost impossible for me to do alone and my Husband and all my family works so I don't have transportation other then myself. I'm sorry I wrote a huge book, I just don't know where to turn anymore.
Re: PNMLT and EMG
Wow and oh my! You have certainly been through so much but I admire you for working continually to resolve the problems. I wish I were more seasoned to guide you so hoping some of the others would come in to help. You seem to be looking at the retocele, pelvic floor and PNE. We usually say to do PNE last as a general rule however the pelvic floor may not settle until after working on PNE. Sorry I do not have more knowledge but you have my sympathy and I wish the very best for you. You may want to copy your post to a new topic in the welcome center to get more response.
Janet
Janet
2007-08 pelvic muscles spasms treated by EGS. 6/27/10 sat too long on hard chair- spasms, EGS not work Botox help, cortisone shots in coccyx help, still pain, PT found PNE & sent me to Dr Marvel nerve blocks & MRN, TG left surgery 5/9/11. I have chronic bunion pain surgery at age 21. TG gave me back enough sitting to keep my job & join in some social activities. I wish the best to everyone! 2019 luck with orthotics from pedorthist & great PT allowing me to get off oxycodone.
Re: PNMLT and EMG
Thank you so much Janet, I really appreciate you listening to me and trying to help me, it means more to me then you'll ever know.
I found a website www.pelvicpain.org today on the internet and they are based out of Chicago and I started a email to them telling them my story and asking them if they know of any Doctors or PT's closer to me in the Northern Indiana area. I'll finish it later after I try to get some sleep, I'm just having one of my really bad days where I haven't been able to sleep because the pain is so unbearable and my Vicodin 7.5 aren't even touching it whatsoever, I even soaked in the warm tub with epsom salts, lol.
I will also copy and paste the post like you suggested later on when I wake up.
I hope you have a pain free day and once again thank you so much!
Christie
I found a website www.pelvicpain.org today on the internet and they are based out of Chicago and I started a email to them telling them my story and asking them if they know of any Doctors or PT's closer to me in the Northern Indiana area. I'll finish it later after I try to get some sleep, I'm just having one of my really bad days where I haven't been able to sleep because the pain is so unbearable and my Vicodin 7.5 aren't even touching it whatsoever, I even soaked in the warm tub with epsom salts, lol.
I will also copy and paste the post like you suggested later on when I wake up.
I hope you have a pain free day and once again thank you so much!
Christie
Re: PNMLT and EMG
Christie,
We try to help one another, glad you have a lead for some PT help. The warm baths with epsom salts were great for me pre-surgery but one of those things I need to figure out post. Not as difficult a challenge as yours, just something on my list. Hope the pain lowers and you get a bit of rest.Sweet dreams.
janet
We try to help one another, glad you have a lead for some PT help. The warm baths with epsom salts were great for me pre-surgery but one of those things I need to figure out post. Not as difficult a challenge as yours, just something on my list. Hope the pain lowers and you get a bit of rest.Sweet dreams.
janet
2007-08 pelvic muscles spasms treated by EGS. 6/27/10 sat too long on hard chair- spasms, EGS not work Botox help, cortisone shots in coccyx help, still pain, PT found PNE & sent me to Dr Marvel nerve blocks & MRN, TG left surgery 5/9/11. I have chronic bunion pain surgery at age 21. TG gave me back enough sitting to keep my job & join in some social activities. I wish the best to everyone! 2019 luck with orthotics from pedorthist & great PT allowing me to get off oxycodone.
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helenlegs 11
- Posts: 1779
- Joined: Fri Sep 17, 2010 9:39 am
- Location: North East England
Re: PNMLT and EMG
Hi Christie,
Heavens, you have been through the mill girl!
If it is at all possible I would try and see someone who IS pn aware, just to see what they think (after all they are the ones who do know, I have no faith in the rest tbh).
I have to say that if there is any pain when the pudendal nerve is pressed. anywhere along it's length (obviously at accessible places) then it's a no brainer. You have PN!
I have (well we all do) a median nerve. I can press really hard on it, it is rather uncomfortable when pressed, really hard. . . but that discomfort disappears fairly quickly. BUT, press on my pudendal nerve (please don't!) at the right spot, and the exact, right spot will immediately become very apparent.
Hope the PT brings good results.
Take care
Helen
Heavens, you have been through the mill girl!
If it is at all possible I would try and see someone who IS pn aware, just to see what they think (after all they are the ones who do know, I have no faith in the rest tbh).
I have to say that if there is any pain when the pudendal nerve is pressed. anywhere along it's length (obviously at accessible places) then it's a no brainer. You have PN!
I have (well we all do) a median nerve. I can press really hard on it, it is rather uncomfortable when pressed, really hard. . . but that discomfort disappears fairly quickly. BUT, press on my pudendal nerve (please don't!) at the right spot, and the exact, right spot will immediately become very apparent.
Hope the PT brings good results.
Take care
Helen
Fall 2008. Misdiagnosed with lumber spine problem. MRN June 2010 indicated pudendal entrapment at Alcocks canal. Diagnosed with complex variant piriformis syndrome with sciatic, pudendal and gluteal entrapment's by Dr Filler 2010.Guided piriformis botox injection 2011 Bristol. 2013, Nerve conduction test positive; new spinal MRI scan negative, so diagnosed for the 4th time with pelvic nerve entrapment, now recognised as Sciatic, pudendal, PFCN and cluneal nerves at piriformis level.