Sacral Neuromodulation
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Sacral Neuromodulation
Sacral nerve stimulation (SNS) also termed sacral neuromodulation (SNM), is a minimally invasive surgical procedure in which a device (pulse generator) is implanted in the body. The device delivers mild electrical pulses, resulting in continuous electrical stimulation of the sacral spinal nerves (usually sacral spinal nerve 3). It is an example of neuromodulation. Sacral nerve stimulation is used to treat various pelvic disorders, including urinary incontinence, urinary urgency, urinary frequency, urinary retention, overactive bladder, fecal incontinence, constipation, and low anterior resection syndrome. Indications SNS may be indicated if non surgical treatments do not work. SNS has been used for many different pelvic conditions. Sometimes more than one indicated condition coexists. For example, pelvic pain might be combined with bladder, bowel, or sexual dysfunction. * Bladder dysfunction ** Urinary incontinence ** Overactive bladder. ** Urinary urgency ** Urinary freque ...
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Minimally Invasive Surgery
Minimally invasive procedures (also known as minimally invasive surgeries) encompass surgical techniques that limit the size of incisions needed, thereby reducing wound healing time, associated pain, and risk of infection. Surgery by definition is invasive, and many operations requiring incisions of some size are referred to as ''open surgery''. Incisions made during open surgery can sometimes leave large wounds that may be painful and take a long time to heal. Advancements in medical technologies have enabled the development and regular use of minimally invasive procedures. For example, endovascular aneurysm repair, a minimally invasive surgery, has become the most common method of repairing abdominal aortic aneurysms in the US as of 2003. The procedure involves much smaller incisions than the corresponding open surgery procedure of open aortic surgery. Interventional radiologists were the forerunners of minimally invasive procedures. Using imaging techniques, radiologists ...
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Neurogenic Bowel Dysfunction
Neurogenic bowel dysfunction (NBD) is reduced ability or inability to control defecation due to deterioration of or injury to the nervous system, resulting in fecal incontinence or constipation. It is common in people with spinal cord injury (SCI), multiple sclerosis (MS) or spina bifida. The gastrointestinal tract (GI tract) has a complex control mechanism that relies on coordinated interaction between muscular contractions and neuronal impulses (nerve signals). Fecal incontinence or constipation occurs when there is a problem with normal bowel functioning. This could be for a variety of reasons. The normal defecation pathway involves contractions of the colon which helps mix the contents, absorb water and propel the contents along. This results in feces moving along the colon to the rectum. The presence of stool in the rectum causes reflexive relaxation of the internal anal sphincter ( rectoanal inhibitory reflex), so the contents of the rectum can move into the anal canal. This ...
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Spinal Cord Injury
A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. It is a destructive neurological and pathological state that causes major motor, sensory and autonomic dysfunctions. Symptoms of spinal cord injury may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cord below the level of the injury. Injury can occur at any level of the spinal cord and can be ''complete'', with a total loss of sensation and muscle function at lower sacral segments, or ''incomplete'', meaning some nervous signals are able to travel past the injured area of the cord up to the Sacral S4-5 spinal cord segments. Depending on the location and severity of damage, the symptoms vary, from numbness to paralysis, including bowel or bladder incontinence. Long term outcomes also range widely, from full recovery to permanent tetraplegia (also called quadriplegia) or paraplegia. Complications c ...
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Meningomyelocele
Spina bifida (SB; ; Latin for 'split spine') is a birth defect in which there is incomplete closing of the spine and the membranes around the spinal cord during early development in pregnancy. There are three main types: spina bifida occulta, meningocele and myelomeningocele. Meningocele and myelomeningocele may be grouped as spina bifida cystica. The most common location is the lower back, but in rare cases it may be in the middle back or neck. Occulta has no or only mild signs, which may include a hairy patch, dimple, dark spot or swelling on the back at the site of the gap in the spine. Meningocele typically causes mild problems, with a sac of fluid present at the gap in the spine. Myelomeningocele, also known as open spina bifida, is the most severe form. Problems associated with this form include poor ability to walk, impaired bladder or bowel control, accumulation of fluid in the brain, a tethered spinal cord and latex allergy. Some experts believe such an allergy can b ...
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Multiple Sclerosis
Multiple sclerosis (MS) is an autoimmune disease resulting in damage to myelinthe insulating covers of nerve cellsin the brain and spinal cord. As a demyelinating disease, MS disrupts the nervous system's ability to Action potential, transmit signals, resulting in a range of signs and symptoms, including physical, cognitive disability, mental, and sometimes psychiatric problems. Symptoms include double vision, vision loss, eye pain, muscle weakness, and loss of Sensation (psychology), sensation or coordination. MS takes several forms, with new symptoms either occurring in isolated attacks (relapsing forms) or building up over time (progressive forms). In relapsing forms of MS, symptoms may disappear completely between attacks, although some permanent neurological problems often remain, especially as the disease advances. In progressive forms of MS, bodily function slowly deteriorates once symptoms manifest and will steadily worsen if left untreated. While its cause is unclear, ...
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Pudendal Nerve Entrapment
Pudendal nerve entrapment is an uncommon, chronic pelvic pain condition in which the pudendal nerve (located in the pelvis) is entrapped and compressed. There are several different anatomic locations of potential entrapment (see Anatomy). Pudendal nerve entrapment is an example of nerve compression syndrome. Pudendal neuralgia refers to neuropathic pain along the course of the pudendal nerve and in its distribution. This term is often used interchangeably with ''pudendal nerve entrapment''. However, it has been suggested that the presence of symptoms of pudendal neuralgia alone should not be used to diagnose pudendal nerve entrapment. That is because it is possible to have all the symptoms of pudendal nerve entrapment, as per the diagnostic criteria specified at Nantes in 2006, without actually having an entrapped pudendal nerve. The pain is usually located in the perineum, and is worsened by sitting. Other potential symptoms include genital numbness, sexual dysfunction, bladd ...
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Levator Ani Syndrome
Levator ani syndrome is a condition characterized by burning pain or tenesmus of the rectal or perineal area, caused by spasm of the levator ani muscle.Levator Syndrome, by Parswa Ansari, MD 7/2014, Merck Manuals The genesis of the syndrome is unknown; however, inflammation of the arcus tendon is a possible cause of levator ani syndrome. Signs and symptoms Symptoms include a dull ache more often to the left 2 inches above the anus or higher in the rectum and a feeling of constant rectal pressure or burning. The pain may last for 30 minutes or longer, and is usually described as chronic or intermittent with prolonged periods, in contrast to the brief pain of the related disorder proctalgia fugax. Pain may be worse when sitting than when standing or lying. Precipitating factors include extended sitting, defecation, stress, sexual intercourse, childbirth, and surgery. Palpation of the levator ani muscle may find tenderness. Cause Levator ani syndrome is characterized by pain ...
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Interstitial Cystitis
Interstitial cystitis (IC), a type of bladder pain syndrome (BPS), is chronic pain in the Urinary bladder, bladder and pelvic floor of unknown cause. Symptoms include urinary urgency, feeling the need to urinate right away, urinary frequency, needing to urinate often, bladder pain (pain in the organ) and pain with sex. IC/BPS is associated with depression (mood), depression and lower quality of life. Some of those affected also have irritable bowel syndrome and fibromyalgia. The cause of interstitial cystitis is unknown. While it can, it does not typically run in a family. The diagnosis is usually based on the symptoms diagnosis of exclusion, after ruling out other conditions. Typically the urine culture is negative. Ulceration or inflammation may be seen on cystoscopy. Other conditions which can produce similar symptoms include overactive bladder syndrome, overactive bladder, urinary tract infection (UTI), sexually transmitted infections, prostatitis, endometriosis in females ...
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Bladder Pain Syndrome
Interstitial cystitis (IC), a type of bladder pain syndrome (BPS), is chronic pain in the bladder and pelvic floor of unknown cause. Symptoms include feeling the need to urinate right away, needing to urinate often, bladder pain (pain in the organ) and pain with sex. IC/BPS is associated with depression and lower quality of life. Some of those affected also have irritable bowel syndrome and fibromyalgia. The cause of interstitial cystitis is unknown. While it can, it does not typically run in a family. The diagnosis is usually based on the symptoms after ruling out other conditions. Typically the urine culture is negative. Ulceration or inflammation may be seen on cystoscopy. Other conditions which can produce similar symptoms include overactive bladder, urinary tract infection (UTI), sexually transmitted infections, prostatitis, endometriosis in females, and bladder cancer. There is no cure for interstitial cystitis and management of this condition can be challenging. ...
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Chronic Pelvic Pain
Pelvic pain is pain in the area of the pelvis. Acute pain is more common than chronic pain. If the pain lasts for more than six months, it is deemed to be chronic pelvic pain. It can affect both the male and female pelvis. Common causes in include: endometriosis in women, bowel adhesions, irritable bowel syndrome, and interstitial cystitis. The cause may also be a number of poorly understood conditions that may represent abnormal psychoneuromuscular function. The role of the nervous system in the genesis and moderation of pain is explored. The importance of psychological factors is discussed, both as a primary cause of pain and as a factor which affects the pain experience. As with other chronic syndromes, the biopsychosocial model offers a way of integrating physical causes of pain with psychological and social factors. Terminology Pelvic pain is a general term that may have many causes, listed below. The sub-categorical term urologic chronic pelvic pain syndrome (UCPPS) is an ...
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Hirschsprung's Disease
Hirschsprung's disease (HD or HSCR) is a birth defect in which nerves are missing from parts of the intestine. The most prominent symptom is constipation. Other symptoms may include vomiting, abdominal pain, diarrhea and slow growth. Most children develop signs and symptoms shortly after birth. However, others may be diagnosed later in infancy or early childhood. About half of all children with Hirschsprung's disease are diagnosed in the first year of life. Complications may include enterocolitis, megacolon, bowel obstruction and intestinal perforation. The disorder may occur by itself or in association with other genetic disorders such as Down syndrome or Waardenburg syndrome. About half of isolated cases are linked to a specific genetic mutation, and about 20% occur within families. Some of these occur in an autosomal dominant manner. The cause of the remaining cases is unclear. If otherwise normal parents have one child with the condition, the next child has a 4% risk o ...
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Fecal Urgency
Fecal urgency (also termed bowel urgency, rectal urgency or defecation urgency) is a medical symptom where there is a sudden, strong need to defecate that is difficult to defer. The difference between fecal urgency and urge fecal incontinence is that in fecal urgency the person usually has enough time to reach a toilet and there is no involuntary leakage of stool. In urge fecal incontinence, there is a sudden, strong urge to defecate (fecal urgency), and the person has little or no ability to prevent defecation. Fecal urgency warning time is the length of time from the first sensation of need to defecate until voluntary defecation or incontinence. Fecal urgency is associated with conditions such as irritable bowel syndrome, inflammatory bowel disease, diabetes, pelvic floor dysfunction, and previous radiotherapy directed at the pelvis or rectum. It may also occur after certain surgical procedures such as stapled trans-anal rectal resection Stapled trans-anal rectal resection (S ...
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