Chronic Pelvic Pain

Treatment of the causes of chronic pelvic pain 

Neuropelveology is a discipline founded by Prof. Possover that focuses on diseases of the pelvic nerves and their diagnosis and treatment. In Neuropelveology, the more symptoms and dysfunctions, the easier and more reliable the diagnosis. If the parts of the body where the pain occurs do not correspond to its cause, this makes it very clear: The person suffering from the pain feels the pain in the nerve endings, i.e. in the pelvic organs or the corresponding areas of skin, yet the cause is to be found somewhere on the nerve pathways to the brain. The diagnosis is made in several steps, in which the type and cause of the pain (adhesions, endometriosis, inflammation or true nerve pain) are determined.

The pelvic nerves as origin for chronic pelvic pain or abdominal pain

Damage to the pelvic nerves can cause the following symptoms:

• The pain is highly localized, without accompanying vegetative symptoms.
• The pain is perceived as searing or an electrical pain.
• The pain occurs in the area of the skin covered by the sensitive fibers of a nerve root: in the lower abdomen, the groin and/or on the front side of the lower extremities, in the low back, buttocks, the genito-anal region and the back of the leg.
• The pain radiates from the main pain point downwards into the buttocks, genitals or even legs, but not upwards into the back.

Depending on the cause, this pain often intensifies during bowel movements, when sitting and during menstruation.

If these pains are caused by the pelvic nerves, they are usually caused by trauma, injury or irritation of the following nerves:

• genitofemoral nerve, which supplies parts of the thigh and the external sex organs (labia or scrotum).
• Nervus ilio-inguinalis, which supplies parts of the abdominal muscles and the groin.
• pudendal nerve (pudendal nerve), which is of particular importance for the function of the pelvic floor muscles, sphincter muscles and the entire genital, perineal and perianal region.

Radiculopathy can also cause pain, i.e. irritation or damage to the pelvic nerve roots. The pain is often accompanied by bladder/intestinal dysfunction such as bladder retention, constipation, irritable bladder, irritable bowel and erectile dysfunction.

Deep infiltrating endometriosis of the sciatic nerve

A special form of pelvic nerve pain is deep infiltrating endometriosis of the sciatic nerve. In this disease, unbearable sciatic pain occurs - cyclically with the period at the onset of the disease, which becomes permanent after only a few months. In addition, there are disruptions or loss of mobility of the foot. The disease grows deep in the sciatic nerve and gradually destroys it. Hormone therapies do not bring about a cure. A surgical intervention must be performed immediately before irreversible nerve damage occurs. This operation is performed with the help of laparoscopy.

Gentle diagnosis and therapy by means of laparoscopy

With the help of laparoscopy, the organic causes of chronic pelvic pain can be reliably and gently identified and treated. The known causes of pain are adhesions, endometriosis and inflammation of the pelvic organs, but also various other diseases. Through laparoscopic exploration of the pelvic nerves, irritations, compressions, injuries or tumours of the pelvic nerves can be diagnosed and treated minimally invasively. Neurosurgical procedures using laparoscopy are used:  

• Intrafascicular neurolysis, in which the constriction of the nerve and the pressure exerted by it are surgically removed.
• The partial removal (resection) of destroyed parts of the sciatic nerve when endometriosis of the sciatic nerve is present.
• Decompression (pressure relief) of the affected nerves
• Reconstruction of nerves after surgical injuries
• The removal (resection) of neurogenic pelvic tumours (swannomas, teratomas etc.) or orthopaedic pelvic tumours (oestochondrosarcoma)

Pain reduction through electrical stimulation of the nerve

In the case of irreversible damage to the nerves e.g. due to surgical injuries, or in the case of diseases affecting the nerves such as multiple sclerosis, Parkinson's, etc., the release of the nerves alone is not a solution. In such cases, neuromodulation is the method of choice. A micro-stimulation electrode is placed directly on the damaged nerve by laparoscopy using the so-called LION method. Electrical stimulation of the nerve with low frequency current leads to pain reduction. With a remote control, the patient can regulate the intensity of the current output independently. This method also enables the normal function of the nerves to be restored if the patient suffers not only from pain but also from functional disorders of the pelvic organs, such as irritable bladder, faecal or urinary incontinence, or from sexual disorders, such as erectile dysfunction in men or loss of libido in women.