Der chronische Beckenbodenschmerz aus der Sicht der Neurologie

Antje Wiesner, Wolfgang H. Jost
In: Der chronische Beckenbodenschmerz · 2003 · pp. 83–89 · doi:10.1007/978-3-642-57396-5_6 · W2104581142
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Neurological assessment can help pinpoint specific nerve involvement in chronic pelvic pain patients, avoiding unnecessary surgical interventions by differentiating between neurogenic and other pain sources.

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This chapter discusses chronic pelvic floor pain from a neurological perspective, focusing on patients’ common belief that a “pinched nerve” causes their pain. The authors state that only a very small fraction of such patients show a confirmed or highly probable neurogenic lesion, and they argue that accurate pain-to-anatomical-structure mapping (nerve, nerve root, lumbosacral plexus, or spinal/central structures) is necessary to avoid unnecessary procedures. A key limitation explicitly implied is that neurogenic causes cannot be reliably demonstrated in most cases, so conclusions must be cautious and based on careful localization. Relevance to endometriosis: it does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Patienten mit chronischen Beckenboden-schmerzen haben häufig die Vorstellung, da „müsse doch ein Nerv eingeklemmt sein`, der den Schmerz verursache. Tatsächlich lässt sich nur bei einem sehr geringen Teil dieser Patienten eine neurogene Läsion sichern oder zumindest mit großer Wahrscheinlichkeit vermuten. Um den Patienten unnötige Eingriffe, z. B. Dekompressions-oder Bandscheibenoperationen, zu ersparen, ist die exakte Zuordnung der Schmerzen zu einem Nerven, einer Nervenwurzel, dem Plexus lumbosacralis oder einer spinalen oder zentralen Struktur erforderlich.
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Zusammenfassung Patienten mit chronischen Beckenboden-schmerzen haben häufig die Vorstellung, da „müsse doch ein Nerv eingeklemmt sein`, der den Schmerz verursache. Tatsächlich lässt sich nur bei einem sehr geringen Teil dieser Patienten eine neurogene Läsion sichern oder zumindest mit großer Wahrscheinlichkeit vermuten. Um den Patienten unnötige Eingriffe, z. B. Dekompressions-oder Bandscheibenoperationen, zu ersparen, ist die exakte Zuordnung der Schmerzen zu einem Nerven, einer Nervenwurzel, dem Plexus lumbosacralis oder einer spinalen oder zentralen Struktur erforderlich. Preview Unable to display preview. Download preview PDF. Similar content being viewed by others Literatur Alevizon SJ, Finan MA (1996) Sacrospinous colpopexy: management of postoperative pudendal nerve entrapment. Obstet Gynecol 88(4 Pt 2): 713–715 Amarenco G, Kerdraon J, Bouju P, Le Bedut C, Cocquen AL, Bosc S, Goldet R (1997) Treatment of perineal neuralgia caused by involvement of the pudendal nerve. Rev Neurol (Paris) 5:331–334 Attal N (2001) Pharmacologic treatment of neuropathic pain. Acta Neurol Belg 101(1):53–64 Chiu WS (1976) The syndrome of retroperitoneal hemorrhage and lumbar plexus neuropathy during anticoagulant therapy. South Med J 69 (5): 595–599 Finsen V (2001) Corticoid injection for coccygodynia. Tidsskr Nor Laegeforen 120:121 Jost WH (1997) Kompressionssyndrom des N. pudendus. In: Jost (Hrsg) Neurologie des Beckenbodens. Chapman & Hall, Weinheim, S 315–317 Jost WH, Schimrigk K (1994) A new method to determine pudendal nerve motor latency and central motor conduction time to the external anal sphincter. Electroenceph Clin Neurophysiol 93:237–239 Kiff ES, Swash M (1984) Normal proximal and delayed disal conduction in the pudendal nerves of patients with idiopathic (neurogenic) faecal incontinence. J Neurol Neurosurg Psychiatry 47: 820–823 Kovacs P, Gruber H, Piegger J, Bodner G (2001) New, simple ultrasound-guided infiltration of the pudendal nerve: ultrasonographic technique. Dis Colon Rectum 44(9):1381–1385 Krahenbuhl L, Striffeler H, Baer HU Buehler MW (1997) Retroperitoneal endoscopic neurectomy for nerve entrapment after hernia repair Br J Surgery 84(2):216–219 Matzel KE, Stadelmaier U, Hohenfellner M, Hohenberger W (2001) Chronic sacral spinal nerve stimulation for fecal incontinence: long-term results with foramen and cuff electrodes. Dis Colon Rectum 44(1):59–66 Mauillon J, Thoumas D, Leroi AM, Freger P, Michot F, Denis P (1999) Results of pudendal nerve neurolysis-transposition in twelve patients suffering from pudendal neuralgia. Dis Colon Rectum 42(2):186–192 Morren GL, Walter S, Lindehammar H, Hall-book O, Sjodahl R (2001) Latency of compound muscle potentials of the anal sphincter after magnetic sacral stimulation. Muscle Nerve 24(9):1232–1235 Mumenthaler M (1993) Läsionen des Plexus lumbosacralis. In: Mumenthaler M, Schliack H(Hrsg) Läsionen peripherer Nerven. Thieme Verlag, Stuttgart New York, S 315–321 Mumenthaler M (1993) Läsionen einzelner Nerven des Beinplexus und der unteren Extremität. In: Mumenthaler M, Schliack H (Hrsg) Läsionen peripherer Nerven. Thieme Verlag, Stuttgart New York, S 326–328 Sato T, Nagai H (2002) Sacral magnetic stimulation for pain relief from pudendal neuralgia and sciatica. Dis Colon Rctum 45:280–282 Shafik A (1919) Pudendus-Kanal-Syndrom. Beschreibung eines neuen Syndroms und seine Behandlung. Bericht über sieben Fälle. Coloproctology 13:102–109 Siegel S, Paszkiewicz E, Kirkpatrick C, Hinkel B, Oleson K (2001) Sacral nerve stimulation in patients with chronic intractable pelvic pain. J Urol 166(5):1742–1745 Silbert PL, Dunne JW, Edis RH, Stewart-Wynne EG (1991) Bicycling induced pudendal nerve pressure neuropathy. Clin Exp Neurol 28:191–196 Thoumas D, Leroi AM, Mauillon J, Muller JM, Benozio M, Denis P, Freger (1999) Pudendal neuralgia: CT-guided pudendal nerve block technique. Abdom Imaging 24(3):309–312 Wiesner A, Jost WH (2001) Vaginal versus anal stimulierte Pudenduslatenz - ein Vergleich. Akt Neurol 28:388–390 Editor information Editors and Affiliations Rights and permissions Copyright information © 2003 Springer-Verlag Berlin Heidelberg About this chapter Cite this chapter Wiesner, A., Jost, W. (2003). Der chronische Beckenbodenschmerz aus der Sicht der Neurologie. In: Merkle, W. (eds) Der chronische Beckenbodenschmerz. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-642-57396-5_6 Download citation DOI: https://doi.org/10.1007/978-3-642-57396-5_6 Publisher Name: Steinkopff, Heidelberg Print ISBN: 978-3-642-63256-3 Online ISBN: 978-3-642-57396-5 eBook Packages: Springer Book Archive

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