In the pain clinic, we often encounter patients who often stammer when asked to describe their condition, but only after careful questioning do we learn that they are suffering from perineal pain syndrome. Perineal pain syndrome is a group of syndromes in which there is no organic lesion and the cause is unknown. It is also a chronic and persistent pain syndrome with unclear cause and no clear diagnosis, which seriously affects the quality of life and makes treatment difficult.
Patients are often reluctant to confide in their family or friends about the disease they are suffering from, finding it difficult to talk about it and unwilling to go to the hospital, thus delaying the treatment and making the pain more complicated. Perineal pain is often caused by cancer or chronic pain disorders in the pelvic area. The sensation of perineum is innervated by rich sympathetic nerves and somatic nerves, which is a pain disorder that is clinically more difficult to treat and has common causes.
I. Chronic pelvic pain syndrome
(a) psychological chronic pelvic pain: dull pain, persistent episodes, often pain upon awakening, episodes in the presence of psychosocial factors, pain sites and nerve distribution are inconsistent, no radiating pain, metastatic changes and diffuse, maintaining the same pain for years and years, not triggering or increasing pain after examination, and occurring when dealing with interpersonal relationships.
(b) Organic pelvic pain: pain is sharp, spastic, intermittent, can occur at any time, can be awakened by pain during sleep, radiates along the nerve distribution pathway, has typical pressure points, develops or improves quickly or becomes more intense, arises or intensifies after manual examination, is not affected by emotions.
Etiology.
1, gastrointestinal system constipation, irritable bowel syndrome, enteritis, intestinal diverticulitis.
2, urinary system urethritis, cystitis.
3, nerve, muscle ~ skeletal system pelvic floor tension myalgia, pear-shaped myositis syndrome, ventral hernia, rectus abdominis tendon sprain, myofasciitis.
4. Reproductive system: inflammation of reproductive organs, pelvic cysts, uterine fibroids, deformities of the reproductive tract, history of previous pelvic surgery, endometriosis, adenomyosis, pelvic stasis syndrome, cervical canal obstruction, residual ovarian syndrome.
Treatment requires a multidisciplinary and comprehensive approach, including surgery, drugs (gabapentin), physical therapy, psychotherapy, diet therapy, etc. The goal of treatment is to relieve pain, improve function and eliminate psychological barriers, but the treatment is not effective for those with long duration of disease
Descending perineum syndrome (DPS)
It is a pelvic floor disease, due to various causes of pelvic floor muscle degeneration and dysfunction, the patient’s perineum position is low in the quiet state, or during forceful defecation, the perineum descends more than the normal range, and the clinical manifestation is export constipation or fecal incontinence. In recent years, with the widespread use of fecal imaging, the number of reports on perineal descent syndrome has increased.
Perineal descent syndrome is a concomitant lesion of endorectal impaction or rectal prolapse. The main symptoms include a feeling of incomplete stool, anal swelling, difficulty in defecation, increased frequency of stool, pain in the perineum, partial sexual incontinence, some patients have a history of applying various laxatives, a few have mucus and blood stool, and a swelling prolapsing from the anus after defecation or walking.
Three, chronic prostatitis
The common symptoms can be summarized in the following five categories:
(1) urinary discomfort may appear frequent urethral burning, pain can be radiated to the head of the penis; early morning urethral orifice mucus mucus and pus secretion, cloudy urine or white flow after stool; severe end urinary hematuria and urinary retention or urinary difficulties can occur.
(2) Local symptoms Posterior urethra Discomfort in the perineum and anus, with a feeling of pressure or fullness, especially when squatting or defecating.
(3) Radiation pain The prostate or seminal vesicles are richly innervated by sympathetic nerves, when inflammation occurs, the internal tension of the gland increases, which can stimulate the sympathetic nerves and cause metastatic low back pain, which can radiate to the penis, testicles, scrotum, groin, perineum, abdomen, thighs, buttocks, rectum, etc.
(The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things. It is treated with drugs and warm water sitz baths.
IV. Pubic Nerve Compression
Also known as pubic canal syndrome, it is a rare cause of chronic pain where the pubic nerve located in the pelvis is truncated or compressed. The pain is significant and worsens when sitting. Other symptoms include genital numbness, erectile dysfunction, fecal incontinence and urinary incontinence. Typical pain is caused by sitting, relieved by standing, and disappears by lying down or sitting on a stool. If perineal pain is related to posture, it suggests ductal syndrome, which is the most valuable diagnostic basis.
In addition there is the problem of urinary and fecal incontinence. It needs to be differentiated from the more common chronic prostatitis/chronic pelvic pain syndrome or interstitial cystitis. Causes Pregnancy or accidents or incidental surgical accidents. Anatomical abnormalities can lead to PNE due to fusion of the pubic nerve into other anatomical structures or entrapment between the iliac nodes and the iliac sphenoid ligament.
Strenuous and prolonged bicycle riding, especially with an improperly shaped or positioned bicycle seat, can eventually thicken the iliac nodes and iliac spinal ligaments, which can trap the pudendal nerve between them and lead to PNE. treatment options include behavior modification, physical therapy, analgesics, pudendal nerve sealing, surgical nerve release, and the latest high-frequency pulse therapy.