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EMG with the use of St. Mark electrodes

EMG with the use of St. Mark electrodes

Electroneuromyography (ENMG) and electrostimulation


Chronic pelvic pain, urinary and fecal incontinence – the nightmare one can live with. Well, "live" might not be the right word... exist.Agonizing pulling or burning sensations, shooting pains, frequent urination, urinary incontinence, and profound depression. A handful of painkillers that don't work anyway. A million tests and no clear diagnosis.

Electroneuromyography (ENMG) and electrostimulation

This was the reality for many patients of Dr. Dilanyan's Clinic until they ended up in the hands of our highly skilled physicians.

Our Pelvic Pain Treatment Center specializes in the diagnosis and effective therapy of this incredibly complex and multifaceted pathology. We explore all pathways and variants of your problem, identify the main cause, and eliminate it.

There is a separate article on the pathophysiology of pelvic pain (click HERE to read it), and now we will focus on diagnostics

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Diagnostic methods are numerous, but they all work only in combination. It is impossible to make a diagnosis based solely on ultrasound or neurography. Often, the reason for the development of chronic pelvic pain or incontinence is a disruption in the function of peripheral nerve fibers innervating the pelvic floor.

Stimulating electroneuromyography of pelvic nerves is an integral part of the search for the deep causes of your problem!

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A 5-channel electroneuromyograph at Dilanyan's Clinic

This technique requires high-tech equipment, which is not available in all clinics. But we can proudly say that it is available at Dr. Dilanyan's Clinic.

A state-of-the-art 5-channel electroneuromyograph allows us to reliably detect disorders of pelvic innervation in general and the pudendal nerve in particular – an important nerve responsible for the sensitivity and motor activity of the organs and muscles of the pelvic floor.

So what is stimulatory electroneuromyography?

Let's break it down. Explaining the essence of this complex and high-tech investigation in simple terms is not easy, but we'll try:

The essence of the work of nerve fibers and neuromuscular transmission lies in the propagation of electrical impulses. Any nerve pathology entails a disruption in transmission. Inflammation, compression, swelling, herpetic lesions, atrophy, or trauma - all these conditions disrupt the speed of transmission. And following that, functionality suffers.

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We can find and localize any such disruption. And that means there's a diagnosis! And where there's a diagnosis, there's treatment, relief, and healing!


The Center for Pelvic Pain Treatmentat Dilanyan's Clinic has exceptionally precise equipment capable of detecting any pathology in nerve conduction.

What is the essence of the study?

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Electroneuromyography

Electrodes are placed on the skin or mucous membrane at the site of the most superficial passage of nerves, through which a weak electrical stimulus is applied. The doctor records the impulse conduction velocity, muscle contraction, and reflex response time.

In other words, we stimulate the nerve with electricity, observe and interpret its reaction to this stimulation.

There are indicators of normal conduction velocity. If the nerve reacts to the stimulus slower than it should, it is inflamed, compressed, or damaged.Moreover, conduction velocity can indicate how severe this damage is and how to deal with it.

Previously, conventional surface electrodes were used for this purpose, but their accuracy left much to be desired. This method is suitable for superficial muscles and nerves. But what about examining those hidden deep inside the body? How can we determine their function quickly, accurately, and painlessly?

Indications for performing EMG of pelvic floor muscles

Chronic pelvic pain syndrome in men and women
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Urinary and fecal incontinence
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Chronic constipation
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Back pain
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Decreased or absent sensitivity during sexual intercourse
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Impotence
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Pudendal neuralgia
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Relevant types of stimulation EMG of pelvic floor muscles

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With the help of St. Mark electrodes – stimulating and recording EMG.
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Needle electrodes – an invasive method using disposable needle electrodes.
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Interferential surface electrodes – used for very superficial, skin-level examination.

What are Saint Mark electrodes?

This is truly a brilliant invention that guarantees diagnostic accuracy. They were created primarily for performing transrectal and transvaginal examinations.Conductive elements are applied to a glove, run along the palm, and end at the fingertip of the doctor.

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The complexity of the neurography of pelvic muscles lies in the fact that the points of examination are not located on the body's surface. Access to each of them is obtained by palpation, or in other words, by feeling. After precisely identifying the required muscle, the neurophysiologist applies an electric discharge and records the response.

Needle electrodes
Needle electrodes

are used to assess pelvic muscles at rest, during tension, and to determine their bioelectrical activity. A fine needle is inserted directly into the tissue, and through it, an electrical impulse is delivered and recorded. The use of needle electrodes allows for internal intervention on each specific muscle, but this method is invasive.

Interferential surface electrodes
Interferential surface electrodes

 are used for completely superficial - cutaneous examination.

As a rule, all three techniques are used. Thus, the neurophysiologist obtains the most accurate and complete picture of neuromuscular transmission.

Preparation for Electroneuromyography (ENMG)

Neuromuscular conduction studies do not require any special preparation. You can eat and drink, exercise, and shower as usual. The patient just needs to ensure rectal cleansing before the procedure, which can be done using a microclyster. Otherwise, you can maintain your usual lifestyle.

What will I feel during stimulatory ENMG?

Testing is always performed on two opposing branches of the nerve and takes a total of 15-20 minutes.

The delivery of the electric impulse is not felt as an electric shock. There is no need to fear overly intense manifestations. You will rather feel uncontrolled muscle contraction, which is usually not perceived as painful by the patient.

Only needle electromyography may cause some discomfort, but even with this method, you will only feel a skin puncture. Unpleasant, but quite bearable.

Who performs the diagnosis?

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Oksana Yuryevna Fomenko - Doctor of Functional Diagnostics

The examination is conducted by Dr. Oksana Yuryevna Fomenko, a doctor of functional diagnostics, neurophysiologist, professor, doctor of medical sciences, and a top-ranked specialist in ENMG of the pudendal nerve and pelvic neurophysiology. Oksana Yuryevna is the most well-known and recognized expert in the field of chronic pelvic pain syndrome. She is the author of numerous articles in prestigious medical publications, manuals, and examination and treatment protocols for chronic pelvic pain syndrome.

The invaluable experience of our specialist allows for the most accurate assessment of the work of pelvic floor muscles and nerves. This means that the source of the problem will be identified.

Who should not undergo electroneuromyography?

The procedure is not performed in cases of inflammation in the examination area, but this restriction is lifted after a course of treatment.

There are no absolute contraindications since the electrical impact is very localized and does not spread throughout the body. The examination is carried out with caution in patients with a cardiac pacemaker, epilepsy, and in pregnant women. To do this, you need to obtain consultation and permission from a specialist.

Why Dr. Dilanyan's Clinic?

The Pelvic Pain Treatment Center is not just about accurate diagnosis. It's about support from the first meeting with the doctor to complete healing.

If you have despaired of finding the cause, undergone numerous tests, but still have no diagnosis, turn to our Pelvic Pain Treatment Center at Dilanyan's Clinic.

You can schedule an appointment by phone:

+374 55 17 0303

Or choose a convenient date and time yourself —

through the online form on the website.

We have extensive experience and specialization in treating this complex and understudied pathology. We take pride in our results, we understand how tired you are of pain and limitations, and we handle your condition with the utmost care. And we will truly help restore your health and regain lost functions.

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