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Innervation of the Levator Ani and Coccygeus Muscles of the Female Rat

Author:

Ronald E. Bremer,1 Matthew D. Barber,2 Kimberly W. Coates,3
Paul C. Dolber,1,4 And Karl B. Thor1,4,5*

1Research Services, Veterans Affairs Medical Center, Durham, North Carolina
2Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio
3Department of Obstetrics and Gynecology, Scott and White Clinic, Temple, Texas
4Department of Surgery, Duke University Medical Center, Durham, North Carolina
5Dynogen Pharmaceuticals, Inc., Durham, North Carolina

Abstract
In humans, the pelvic floor skeletal muscles support the viscera. Damage to innervation
of these muscles during parturition may contribute to pelvic organ prolapse and urinary
incontinence. Unfortunately, animal models that are suitable for studying parturition-induced
pelvic floor neuropathy and its treatment are rare. The present study describes the
intrapelvic skeletal muscles (i.e., the iliocaudalis, pubocaudalis, and coccygeus) and their
innervation in the rat to assess its usefulness as a model for studies of pelvic floor nerve
damage and repair. Dissection of rat intrapelvic skeletal muscles demonstrated a general
similarity with human pelvic floor muscles. Innervation of the iliocaudalis and pubocaudalis
muscles (which together constitute the levator ani muscles) was provided by a nerve (the
“levator ani nerve”) that entered the pelvic cavity alongside the pelvic nerve, and then
branched and penetrated the ventromedial (i.e., intrapelvic) surface of these muscles. Innervation
of the rat coccygeus muscle (the “coccygeal nerve”) was derived from two adjacent
branches of the L6-S1 trunk that penetrated the muscle on its rostral edge. Acetylcholinesterase
staining revealed a single motor endplate zone in each muscle, closely adjacent to the
point of nerve penetration. Transection of the levator ani or coccygeal nerves (with a 2-week
survival time) reduced muscle mass and myocyte diameter in the iliocaudalis and pubocaudalis
or coccygeus muscles, respectively. The pudendal nerve did not innervate the intrapelvic
skeletal muscles. We conclude that the intrapelvic skeletal muscles in the rat are similar to
those described in our previous studies of humans and that they have a distinct innervation
with no contribution from the pudendal nerve. Anat Rec Part A 275A:1031–1041, 2003.
© 2003 Wiley-Liss, Inc.

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Help? Yes please

Author:

This shouldn’t take too long to grasp but I understand it may take a little while to actually put it into motion… Not used to having help hey? Well I wasn’t either, never needed any. But once I realised I could get more out of my day by learning “Yes please”, it got easier to say it. In fact I ask for help now. I even leave things on the floor if its a bad day (just push it aside with my foot, it’ll be dealt with later) because I realise it means more capacity to do other things and LESS PAIN. Of course this only applies if you have help… Continue Reading

Facebook

Author:

Since my accident many things, like facebook, have taken on a new meaning. It’s a great way to socialise (actually, let me be honest, its a great distraction) especially if you can’t get out easily. And the best thing is you can choose to participate as much or as little as you are able to. Continue Reading

Diagnosis: Physiotherapy at the Women’s

Author:

It felt like a miracle and took all of about 15 minutes for the physiotherapist (at the chronic pelvic pain clinic at the Women’s here in Melbourne Australia) to give me her French infused explanation that my pain was most probably coming from my Pudendal Nerve (yes, a name, I had a name!). It took another 15mins for her to put me in on my back (I never lay on my back as it was too painful) and apply a pressure/postural technique that switched my pain off! (Yes, OFF… calm, silence, stillness, roar gone, no spasm, quiet, peace)… unbelievable but this is true.

I won’t go into much detail about how I felt, there really isn’t any way of explaining the relief of having a roaring pain that’s been halting your soul for 4.5 years, identified, clarified, acknowledged, manipulated with a single finger’s pressure point. I can’t explain how it felt to finally know (not hope or dream) that I will eventually become the best I can and that I finally found a practitioner and therapy that was going to help me. I could almost see my issue in the palm of my hand (before I was in limbo and had to come up with my own names, I won’t write them here!!).

What I will describe though, is the language, empathy, understanding and thorough explanations that I have had during my appointments so that anyone else in the same situation will know exactly where they need to go (Actually I’d be surprised if you were still reading! Taxi!! Physiotherapy Department, 1st floor Grattan Street & Flemington Road Parkville VIC).

My conversations have gone something like this:
Me: I haven’t told anyone this but there’s this short denim skirt I have and whenever I wear it I have a less painful day…
Physiotherapist leaves and comes back with a pregnancy/baby pressure belt that is adjustable either side. Et voila, a support for the pelvis adjustable to my requirements which was not so tight over my implant and uninjured side.

Me: In winter, I’m sure it hurts more to walk because my boots are heavier than shoes and I’m wearing a heavy coat.
Physiotherapist: Yes, weight is pressure for the nerve.

Me: I’m on fire today, I have all this burning, like fireworks going on.
Physiotherapist: lies me prone, applies pressure to a pressure point, fire put out instantly. This is a flare up.

Me: I feel like I have my finger stuck in a power point, I have a surge up my spine, the rattle of a tram or car drives me crazy, and don’t scare me or I’ll drop, my legs get weak and I can’t move….
Physiotherapist: Sensory pain.

Physiotherapist: How is your pain now?
Me: My pain is good now.
Physiotherapist: Laughs… but doesn’t really find this funny. Pain is never good.

So now when I have a physiotherapy appointment, instead of blank stares when I attempt to describe the fine details of my pain and activities I get clear descriptions for every point I make, in fact I even get a diagram and descriptive explanation, drawings referencing my insides, url links, and best of all, solutions in the form of techniques to release my pain, positions to release my entrapped nerve, even my husband gets attention, empathy for the difficulty he endures, he is shown the pressure points and techniques so he can help as accurately as possible (therefore finally finding peace for himself!!). I even had an explanation about my extracted ligament and septum, she’d seen it happen with trauma (pregnancy or birth) to the hips.

Finding this wonderful therapist leaves me in a very positive position too. I never had options before, I was told: go home and make yourself comfortable, but now I can calm my pain and I still have further treatments to explore depending on how I progress and this is thanks to the few specialists that have insisted on researching and learning about peripheral neuralgia and not ignored it leaving it a psychological condition or the more general we don’t know with back pain.

Read more about The Women‘s Physiotherapy Department.

Related Posts
My pre pain life…
My family, Theo, Origin of Image & Zephyr…
The big bang injury…
The way relief started…
The way relief continued…
Building Blocks…
Next stop: Traditional Chinese Medicine…
Soula’s PN Weather Update…
My practitioners

My list of practitioners

Author:

The most supported I’ve felt is when I’ve come across a practitioner who listens and wants to work with me specifically. I mean really take note of what’s going on and want to learn themselves too. Chronic pain is still so difficult to understand, and of course I can’t recommend or even suggest that my experience might be a solution for someone else but I can provide the contact details for ‘team Soula’.

Stage 1: The Search
Dr Harry Crock, retired
Mr Roy Carey, East Melbourne
Professor Michael Quinn The Women’s, The Royal Women’s Hosptial, Parkville
Pond Massage Water Wellness P/L, Collingwood
Pam Frost, Massage therapist, Inspiral Bodywork, Fitzroy

Stage 2: Implant
Dr Kathy Yu, Melbourne Sports Medicine Centre, Melbourne
Pam Frost, Massage therapist, Yoga Healing Centre, Fitzroy
Professor Teddy, Neurosurgeon, Precision Neurosurgery, Melbourne
Marilyn Lock, Knowbody Studios (Holistic physiotherapy), East Melbourne
Pam Frost, Massage therapist, Inspiral Bodywork, Fitzroy

Stage 3: Diagnosis
(All stage 2 practitioners)
Robert Postlethwaite, Psychiatrist, Freemasons Medical Centre, East Melbourne
The Women’s – Anne Florence Plante, Physiotherapist, RWH Physiotherapy department, chronic pelvic pain clinic
Dr Peter Courtney, Melbourne Pain Group, Glen Waverley
Pam Frost, Massage therapist, Inspiral Bodywork, Fitzroy

Stage 4: Treatment
Dr Peter Courtney, Melbourne Pain Group, Glen Waverley
The Women’s – Anne Florence Plante, Physiotherapist, RWH Physiotherapy department, chronic pelvic pain clinic
Raffaele Vavala, Traditional Chinese Medicine, 4a Mitchell Street Northcote
Pam Frost, Massage therapist, Inspiral Bodywork, Fitzroy

Related Posts
My pre pain life…
My family, Theo, Origin of Image & Zephyr…
The big bang injury…
The way relief started…
The way relief continued…
Diagnosis: Physiotherapy at The Women’s…
Building Blocks…
Next stop: Traditional Chinese Medicine…
Soula’s PN Weather Update…
My practitioners

The car

Author:

I don’t like the car… or other transport. I would be a passenger for a quick trip (cushions galore and my experienced husband driving) and wonder what all the pain was 18-24 hours later. Well once that happened a few hundred times* I pieced it together didn’t I. The car is intolerable. I’m down to two trips a week and actually, I prefer to avoid it all together.

*Insurance snoops, I’m being sarcastic here… a necessity for chronic pain!

Trial and error

Author:

Oh how many times have I had an injection, operation, procedure, great massage, brilliant half an hour and instantly thought I would be back at work in no time? I have a great five minutes and I’m off, it’s happened so many times. What a suck!

But that sort of thinking has been a great survival mechanism for me because with neuropathic pain, I realised I had to be brave, I had to accept there was going to be more pain and there are really only two choices, cope or not! Continue Reading

Head rest

Author:

I always try and use the head rest in the car (as well as my few thousand pillows). I find the more I rest my head the more I can cope with a car ride and also have less pain afterwards. In fact, rest your head anywhere you can, it’s a huge weight off an injured back.

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Definitions of pain

What is Pudendal Neuralgia (PN)?
Most simply put PN is Carpal Tunnel in the pelvis/buttocks. Compression of the Pudendal Nerve occurs after trauma to the pelvis and is aggravated with pressure. The pain is often described as a toothache like pain, with spasms, sensations of tingling, numbness, or burning. It can be very debilitating.

What is Neuropathic pain?
Neuropathic pain is the result of an injury or malfunction in the peripheral or central nervous system. The pain is often triggered by an injury, but this injury may or may not involve actual damage to the nervous system. More…

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