Health Organization for Pudendal Education

Does any procedure actually do decompression of the inferior rectal nerve branch? It has determined that is where my problem is - not in Alcock's Canal or in the SS/ST ligaments. From my MRI with Dr. Potter, I have scarring around this nerve, but Alcock's and SS/ST appear fine. I've been to Dr. Ansell and another neurosurgeon and both say that their procedure does not go into this area to decompress due to the risk of damaging the nerve and incontinence. Dr. Ansell suggested Lyrica and the other physician suggested neuromodulation. There has got to be some physician that decompresses this nerve at this level! Can anyone offer any suggestions? I'm really feeling hopeless right now - I'm also wondering if this is the reason that so many people that have had TG/TIR surgery have not been fully healed - they also may have entrapments in the distal nerves.

Hi Scaredgal,
You can contact Dr. Hibner and see what is input is.To my understanding the rectal nerve branches mostly out of the Alcock's Canal and is generally addressed.But sometimes,it branches out before it enters the Alcock's Canal.I believe that is your case.
Dr. Bautrant told me that my rectal branch was in the Alcock's Canal and looked fine.

It is rather surprising that Dr. Ansell told you that he couldn't decompress the Rectal branch of the Pudendal Nerve.

I would definitely agree with you that the distal branches of the Pudendal Nerve need to be addressed by all surgeons in order to get better surgical results.

Best Regards,
Ali

Thanks, Ali for your quick reply. I actually have an appointment with Dr. Hibner (in June - too long of a wait!). Dr. Ansell looked at my MRI report and said that the areas (perirectal fat planes with scar tissue) was not addressed with his TG surgery - he said that to do surgery on me would be strictly "exploratory". The other neurosurgeon I went to said pretty much the same thing - except offered to do what I believe as he described was the TIR approach and insertion of the neuromodulator that would block the pain signal going down to the rectal nerve. Maybe it's not the inferior rectal nerve but further down - I don't know....

I'm wondering if either Dellon or Aszmann address the rectal nerve? Seems they are doing a lot of research on the dorsal nerve. Also, from reading the literature, it seems Shafik did a lot of research on the distal rectal nerve - but I understand he is no longer practicing? Does anyone follow his protocol?

I have a call into Dr. Hibner's office as I have already sent him my MRI report. I'm sure hoping for a positive response. I just can't believe I have to wait so long to see him....

Hi Scaredgal,
You can also contact his son Ali Shafik in Egypt and I do believe that he does follow his father's protocol.Could a Colon and Rectal surgeon address this issue by any means?You can also contact the Nantes team and see what their input is on the inferior rectal branch.

But I am hopeful that Dr. Hibner should be able to help you.

To my knowledge,Dr. Aszmann only adresses the dorsal nerve.

Best of luck,
Ali

Hi Ali,

That is a good idea about contacting either Shafik's son or the Nantes team - do you have any idea how I would go about locating their contact information? Also, the neurosurgeon I spoke to yesterday suggested a gastro evaluation - a colonoscopy to rule out any rectal problems (other than PN), But I'm sure from the symptoms, it's PN. Also, I do not want to go through the colonoscopy as I fear a flare from this procedure since it's the rectal nerve that is the issue....

I sure hope I hear back from Dr. Hibner's office... and I hope it's positive.

Hi Scaredgal,
As far as the Nantes team is concerned,you can either contact Judy on pelvicpainuk or Greg from Tipna.As far as Dr. Ahmed's son Ali Shafik is concerned his contact link is as follows.

http://www.alishafik.com/

Best of luck,
Ali

PS
I just hope that you do get a positive response from Dr. Hibner.

Hi Scaredgal,


Would you mind posting your entire dictated 3Tesla MRI report under the MRI/MRN section? The forum may be able to help you sift through it, as it can indeed be complicating.


Best regards,

AM

Hi Ali,
Thanks for the contact info!

Hi A's Mommy - yes, I need to do this - I'm at work today and hopefully will get around to doing that either this weekend or early next week. My report is at home.

Hey Scaredgal, check out this website http://www.pudendal.com/ Dr. Shafik talks about a trans-perineal approach to access the AC, and it appears that it is for nerve compression, because dr marvel told me he would do this for me.
Ill email you as well.
Gregg

scaredgal wrote:Does any procedure actually do decompression of the inferior rectal nerve branch? It has determined that is where my problem is - not in Alcock's Canal or in the SS/ST ligaments. From my MRI with Dr. Potter, I have scarring around this nerve, but Alcock's and SS/ST appear fine. I've been to Dr. Ansell and another neurosurgeon and both say that their procedure does not go into this area to decompress due to the risk of damaging the nerve and incontinence. Dr. Ansell suggested Lyrica and the other physician suggested neuromodulation. There has got to be some physician that decompresses this nerve at this level! Can anyone offer any suggestions? I'm really feeling hopeless right now - I'm also wondering if this is the reason that so many people that have had TG/TIR surgery have not been fully healed - they also may have entrapments in the distal nerves.

Gregg, I did not know Dr. Marvel performs the trans-perineal approach sometimes but I think that's great if we have a US doc who will do this now. I don't know of any others who do. Please keep us posted on how this works out for you.