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Reinnervation after childbirth—a new paradigm for sensory bowel symptoms?
  1. MARTIN QUINN
  1. Department of Obstetrics & Gynaecology
  2. Hinchingbrooke Hospital
  3. Huntingdon, PE29 6NT, UK
  4. martin.quinn{at}hbhc-tr.anglox.nhs.uk

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Visceral hypersensitivity has been identified as a significant feature in a proportion of patients with irritable bowel syndrome.1 Reinnervation following a difficult intrapartum episode may be an important contributory factor. Many benign pelvic symptoms may be interpreted as pain or discomfort in response to touch (allodyniae or hyperalgesiae), including chronic pelvic pain, deep dyspareunia, urinary urgency, tampon discomfort, dysmenorrhoea, etc. Premature and prolonged maternal voluntary efforts in the second stage of labour appear to be significant aetiological features in women presenting with these clusters of sensory pelvic symptoms that include laparoscopically-negative pelvic pain.1 Malpresentations, big babies, operative vaginal delivery, and excessive uterine activity may also contribute to the primary visceral denervation. Reinnervation has been demonstrated in the uterus, though an interval of five to ten years precedes the onset of sensory pelvic symptoms.2Similar patterns of reinnervation have been demonstrated in the vulva3 and may occur in other pelvic viscera.

Anecdotal reports suggest that women treated with tolterodine tartrate (Detrusitol, Pharmacia, New Jersey) for irritative bladder symptoms, experience some improvement in sensory bowel symptoms—for example, faecal urgency and incomplete emptying. Precise questions about a woman's intrapartum history, medium term reinnervation, and different receptor systems may help to account for the neuropathic hypersensitivity that is such a feature of some forms of irritable bowel syndrome.

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