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Pain Management Strategies and Alternative Therapies
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
The pelvis consists of bones, the ligaments that connect these bones, and the muscles that line their inner surfaces. The pelvic muscles play an important role in producing and maintaining pelvic pain. Piriformis and obturator internus muscles form part of the posterolateral wall while Levator ani is a broad muscular sheet of variable thickness attached to the internal surface of the pelvis and pelvic viscera. It forms the large portion of pelvic floor and consists of pubococcygeus, iliococcygeus and puborectalis and coccygeus muscles. The urethra, vagina and anus pass through the medial border of the two levator ani muscles. The pelvic floor acts as a support to the pelvic organs and has a vital role in urination and defecation as well as sexual function. Myofascial dysfunction of one or more of its muscles leads to disharmony of action and dysfunction resulting in urinary frequency, dysuria, feeling of incomplete void, dyspareunia, constipation and dyschezia. Most of these symptoms are integral parts of endometriosis-related pelvic pain conditions and often are unrecognized or misdiagnosed.
Anatomy of the Pelvis
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
This ligament is present on the pelvis aspect of the sacrotuberous ligament. Presented with a broad base by which it attaches to the side of the lower part of the sacrum and upper part of the coccyx, it narrows at its apex to attach to the ischial spine. It represents the degenerated part of the coccygeus muscle.
Hip Pain
Published in Benjamin Apichai, Chinese Medicine for Lower Body Pain, 2021
There are a number of soft tissues inserted in the coccyx. Levator ani at the apex is a group of three muscles including the pubococcygeus, the iliococcygeus, and the puborectalis. Levator ani forms the greater part of the pelvic floor.67 The coccygeus muscle arises from the ischium across the anterior aspect of the coccyx and the gluteus maximus across the posterior aspect.
G protein-coupled estrogen receptor (GPER/GPR30) levels in pelvic floor muscles and its association with estrogen status in female rabbits
Published in Gynecological Endocrinology, 2022
Sharet Y. Rodríguez-Jaimes, Guadalupe C. Hernández-Hernández, Laura G. Hernández-Aragón, Octavio Sánchez-García, Margarita Martínez-Gómez, Estela Cuevas-Romero, Francisco Castelán
The bulbospongiosus (Bsm) and pubococcygeus (Pcm) are pelvic floor muscles (PFM) that assist differentially in micturition of female rabbits, the former muscle at the voiding and the latter one at the storage [13]. The Bsm and Pcm express ERα and ERβ in connective tissue and myofibers [14]. The number of ERα and -β immunoreactive (ir) myonuclei increases in the Pcm of chronically-ovariectomized rabbits receiving or not exogenous estrogen, while the Bsm remains unchanged [15]. Estrogens prevent the ovariectomy-induced fall in contraction responses of Pcm and coccygeus muscles and protect only the Pcm response against hypoxia [16]. Furthermore, the reflex activation of the Pcm and Bsm during micturition is modulated differentially by estrogens in anesthetized rabbits [17]. Overall, the estrogen responsiveness of the PFM seems to be critical for assisting pelvic floor functions in rabbits.
Influence of psychiatric disorders and chronic pain on the surgical outcome in the patient with chronic coccydynia: a single institution’s experience
Published in Neurological Research, 2020
Kristopher A. Lyon, Jason H. Huang, David Garrett
Given the strong association of psychiatric disorders in patients suffering from coccydynia, it is reasonable to consider a neuroanatomic reason that may relate these variables. Closely associated with the coccyx, the coccygeal plexus arises from the ventral primary rami of the S4, S5, and Co1 nerve roots along with contributions from the sacral sympathetic trunk [18]. The coccygeal plexus then goes on to give rise to nerves that innervate the sacrococcygeal joint, anococcygeal ligament, sacrotuberous ligament, and inconsistently, the coccygeus muscle [19]. Overactivity of these nerves may lead to increased tension or spasm of the muscles or tendons taking their origin off the coccyx. Therefore, as part of the pre-operative workup, many patients often seek physical therapy to include intra-rectal digital massage of the levator ani, coccygeus, and pyriformis muscles with or without nerve blocks using corticosteroids or local anesthetics injected into this region [20].
Diabetic lumbosacral plexopathy: an unpredictable clinical entity
Published in Disability and Rehabilitation, 2023
Muhammad Faraz Jeddi, Roger Zebaze, Isabelle Urbano, Sarah Skinner, Vinamra Jain, Marc Budge
Initial MRI of the lumbosacral plexus showed diffusely increased T2 signal edema in iliacus, pectineus, obturator internus, and coccygeus muscles with corresponding signal changes in L3 & L4 roots, obturator, femoral and pudendal nerves. Imaging 7 months later showed partial resolution of changes with ongoing abnormal signal in the femoral nerve but reduction in muscle edema; there was some associated atrophy. Final imaging at 13 months showed new changes in the contralateral pelvis in an identical distribution (Figure 2).