Pelvic trauma and pudendal syndrome (post-traumatic pudendal syndrome)

Abstract

The pudendal syndrome can result from pelvic trauma but the link is difficult to prove. The study was intended to disentangle potentially linking elements of the post-traumatic pudendal syndrome, in particular perineodynia (perineal pain), one of the salient symptoms of the pudendal syndrome. Two case reports were used to illustrate the point. The study was based on 394 female patients of whom 216 (54.8%) had a history of pelvic trauma. Patients were further classified into mutually exclusive groups according to presence/absence of perineodynia and, for those with pelvic trauma, according to latency of pain appearance (pain before trauma, early onset, or late onset). Urge urinary incontinence, cystalgia, anal incontinence and proctalgia fugax were found statistically more frequent in the pelvic trauma group. Perineodynia visual analog score, NHI-CPSI score and Wexner’s score were also significantly greater in traumatic patients. The three pudendal syndrome clinical signs were significantly more present in pelvic trauma patients than in non-trauma subjects. In the three post-traumatic perineodynia groups with different latency, only minor significant symptoms frequency differences were observed but importantly urge incontinence, cystalgia, anal incontinence and proctalgia fugax remained more frequent than in the non-trauma perineodynia group for similar pain scores. Post-traumatic pudendal syndrome is a reality. Perineodynia, urge incontinence, anal incontinence, proctalgia fugax and cystalgia are the most frequently symptoms encountered. These findings recommend performing a detailed history search for any symptom of the pudendal syndrome and a comprehensive clinical examination including its three clinical signs after any significant pelvic trauma