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Chronic proctalgia and chronic pelvic pain syndromes:New etiologic insights and treatment options

World Journal of Gastroenterology 2011年第40期17卷 4447-4455页

作者： Giuseppe Chiarioni Corrado Asteria William E Whitehead Division of Gastroenterology of the University of Verona Azienda Ospedaliera Universitaria Integrata di Verona Valeggio sul Mincio Hospital 37067 Valeggio sul Mincio Verona Italy Department of Surgery and Orthopedics General Surgery Unit Azienda Ospedaliera Carlo Poma di Mantova Asola General Hospital 46041 Asola Mantova Italy Division of Gastroenterology and Hepatology Division of Urogynecology and Center for Functional Gastrointestinal and Motility Disorders University of North Carolina at Chapel Hill Chapel Hill NC 27599-7080 United States

This systematic review addresses the pathophysiology, diagnostic evaluation, and treatment of several chronic pain syndromes affecting the pelvic organs:chronic proctalgia, coccygodynia, pudendal neuralgia, and chronic pelvic pain. Chronic or recurrent pain in the anal canal, rectum, or other pelvic organs occurs in 7% to 24% of the population and is associated with impaired quality of life and high health care costs. However, these pain syndromes are poorly understood, with little research evidence available to guide their diagnosis and treatment. This situation appears to be changing:A recently published large randomized,controlled trial by our group comparing biofeedback, electrogalvanic stimulation, and massage for the treatment of chronic proctalgia has shown success rates of 85% for biofeedback when patients are selected based on physical examination evidence of tenderness in response to traction on the levator ani muscle-a physical sign suggestive of striated muscle tension. Excessive tension (spasm) in the striated muscles of the pelvic floor appears to be common to most of the pelvic pain syndromes. This suggests the possibility that similar approaches to diagnostic assessment and treatment may improve outcomes in other pelvic pain disorders.

关键词： Biofeedback Chronic pelvic pain Chronicproctalgia coccygodynia Levator ani syndrome Pudendal neuralgia

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Various Aetiologies of Non-Traumatic Coccydynia Cause Pain in the Posterior Sacrococcygeal Leg of the Pelvic Tripod: A Burden on the Healthcare Sector

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Open Journal of Orthopedics 2024年第7期14卷 334-353页

作者： Kumar Satya Nandivada Venkata Kiran Nadavinamani Shivanand Raghavendra Oommen Elsy Biju Bharadwaja Nikhil Nandivada Nandivada Vaishnavi Rizvi Usama Ahmed Krushi Orthopaedic Welfare Society Research Wing Visakhapatnam India

Introduction: Coccydynia, television disease, and coccygodynia are the different names given to this disabling disease, which can become chronic. It was described by Simson in 1859. Coccydynia means pain at the end of the vertebral column. Non-traumatic coccydynia is a diagnosis, which is never straightforward like traumatic coccydynia because the onset is unclear, and both the patient and the unaware clinician face many challenges in treating it on time and with accuracy. Coccyx was likened to a cuckoo bird’s beak as a curved bone of fused 3 to 5 vertebrae with remnant disc material in some rare cases, unfused segments, linear scoliosis or subluxations and deformities. Stress X-rays of the coccyx in the antero-posterior and lateral views in standing and sitting reveal the “Dynamic Instability” due to congenital coccygeal morphological, pathological and mechanical variations. Material and Methods: This is a complex study having retrograde data collected from online publications from various databases, like PubMed, Embase, and Cochrane Library and also antegrade data collected from 100 patients with their consent from patients in Adam and Eve Specialised Medical Centre-based at Abu Dhabi, UAE and data was processed in the research centre of Krushi Orthopaedic Welfare Society based in India between 2014-2024 following all guidelines of Helsinki and approved by the ethics board of Krushi Orthopaedic Welfare Society. Clinical Presentation: The coccyx is painful, with aches, spasms, and an inability to sit. This affects daily activities without any particular date of onset. The onset remains insidious for the non-traumatic variety of coccydynia. Aetiology and Patho Anatomy: Non-traumatic coccydynia can be caused by a myriad of reasons, like congenital morphological variations, acquired dynamic instabilities, and hidden trauma remaining quiescent to re-surface as a strain-induced pain. Radiological Presentations: Unless clarity is focused on these coccygeal views, the err

关键词： Coccydynia coccygodynia Pelvic Floor Chordoma Pilonidal Sinus Fused Sacrococcygeal Segment Non-Traumatic Coccydynia Entrapment of Coccygeal Nerves Dural Syndrome

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