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Transvaginal Mesh Complication and Relation to Myofascial Pelvic Pain Have Vaginal Mesh Complication? Read this article by Dr. Greg Vigna on Myofascial pelvic pain Like


NEW YORK, April 16 , 20 13 /PRNewswire-iReach/ -- There is little help in the way o f literature that pro vides guidance to wo men who suffer fro m chro nic pelvic pain. No t o nly is the literature sparse, it is inaccurate. Mo st literature o n pelvic pain, in fact, pays little attentio n to the nerves in the pelvis. Fro m my review o f the literature, mo st articles co mpletely igno re the pelvic nerves as the so urce o f pain in the female pelvis. Pelvic pain seco ndary to nerve injury has beco me increasingly reco gnized by the medical co mmunity as a pain generato r in the pelvis because o f the frequency o f do cumented nerve damage in the transvaginal mesh po pulatio n. A recent article titled the "Clinical manifestatio ns and diagno sis o f myo fascial pelvic pain syndro me in wo men" that I recently read in a usually very reliable medical jo urnal co mpletely o mits the nerves in the pelvis as a so urce o f pain. It is my belief the physicians sho uld think o f myo fascial pain syndro me as either 'primary myo fascial pain' that arises fro m the muscles themselves o r 'seco ndary myo fascial pain' that is referred fro m o ther pain-generating so urces. Patients who have received the transvaginal mesh suffer with myo fascial pain which may in fact be primary o r seco ndary. The nerve is the pelvis must be co nsidered as a so urce o f seco ndary myo fascial pain in the transvaginal mesh patient. There is risk o f co mpressio n o f the pudendal nerve fro m the arms o f the transvaginal mesh. There may also be damage to any o f the three terminal branches o f the pudendal nerve during the pro cedure itself independent o f the mesh caused by the tractio n o n the vagina during the transvaginal appro ach o f placing the mesh. Medical pro viders must be aware that bo th primary myo fascial pain and seco ndary myo fascial pain may o ccur at the same time and the issues o f neural co mpressio n sho uld no t be blindly igno red. By reco gnizing bo th primary and seco ndary myo fascial pain, a clinician is mo re likely to be successful in managing the pain caused by the vaginal mesh says Dr Greg Vigna , a medical do cto r and fo under o f m that o perates a Vaginal Me sh Co m plicat io n reso urce.

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The medical jo urnal "Up to Date" describes myo fascial pelvic pain syndro me (MPPS) "as a diso rder in which pelvic pain is attributed to sho rt, tight, tender pelvic flo o r muscles, usually with hypersensitive trigger po ints." These trigger po ints when pressed will cause pain that radiates. The article describes that the pain may o ccur in the pelvis, vagina, vulva, rectum, o r bladder. "Up to Date" describes MPPS as having urinary sympto ms such as pain, frequency o f urinatio n, and a sensatio n o f inco mplete emptying. Other described sympto ms include a sensatio n o f rectal fullness and pain with sexual interco urse.

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"Up to Date", in its descriptio n o f the differential diagno sis, fails to ackno wledge nerve co mpressio n as a co ntributo r o r cause o f myo fascial pain. Co ntrarily, pudendal neuralgia do es exist. The pudendal nerve arises fro m the spine (S2-4), enters the pelvis and has three terminal branches. These terminal branches can be damaged to gether, o r in iso latio n by a variety o f pro blems, including the transvaginal mesh pro cedure. The sympto ms o f pudendal neuralgia are well described. Pain is predo minately while sitting, ano rectal pain, sexual dysfunctio n, and in severe cases, inco ntinence. There may be frequency with urinatio n, sensatio n o f inco mplete emptying o f bo th bo wel and bladder, and pain with sexual interco urse. These sympto ms can mirro r the sympto ms o f MPPS as described abo ve. The nerve damage that o ccurs in pudendal neuralgia may be the actual cause o f the myo fascial pain in which case, I wo uld regard the myo fascial pain as seco ndary (to the nerve damage). When a clinician is trying to determine if myo fascial pain is fro m the muscles itself (primary) o r if referred fro m the nerves (seco ndary) diagno stic and therapeutic injectio ns may be useful. If the myo fascial pain evident during a clinical exam o f a new patient do es no t impro ve with physical therapy, bo to x, and/o r lo cal medicatio ns such as vaginal valium, the clinician must explo re o ther pain generato rs fo r the myo fascial pain such as fro m the nerves. A clinician sho uld then co nsider diagno stic and therapeutic nerve blo cks o f either the pudendal nerve itself o r any o ne o f the three terminal branches based o n the particular sympto ms the patient describes. This is do ne to clarify the actual pain generato r fo r the myo fascial pain. Once the pain generato r is identified, then surgical deco mpressio n can be co nsidered. The primary vs. seco ndary myo fascial pain that I am discussing is no t a new co ncept, but o ne that is well described in rehabilitatio n literature. When clinicians who care fo r patients with pelvic pain begin analyzing the pain generato rs and begin treating myo fascial pain as primary o r seco ndary, then there may be a viable so lutio n to the suffering caused by the t ransvaginal m e sh co m plicat io ns. Interested in previo us articles o n Life Care Planning Fo r Mesh Patients With Chro nic Pain , click here. Me dia Co nt act : Greg A. Vigna , M.D., J.D. Life Care So lutio ns Gro up, 8 8 8 -9 9 0 -9 410 , m News distributed by PR Newswire iReach: m

SOURCE Dr. Greg Vigna



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There is little help in the way of literature that provides guidance to women who suffer from chronic pelvic pain. Not only is the literatur...