Levator myalgia: why bother?

Adams, Kerrie; Gregory, W. Thomas; Osmundsen, Blake; Clark, Amanda

doi:10.1007/s00192-013-2089-8

Cited by 30 publications

(33 citation statements)

References 16 publications

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“…In the absence of an accepted definition of MPP 9 , the diagnosis required (1) ≥ 3 months of non-cyclic CPP unrelated to bladder fill state, and (2) NRS pain score ≥ 4/10 in 2 of 5 pelvic floor muscles (bilateral puborectalis, obturator internus and midline perineal body) tested by applying 2 kg pressure with a gloved index finger to the relaxed muscle belly 10 . In addition to general subject exclusions (Appendix), healthy subjects were stringently screened to exclude any disorders commonly comorbid with pelvic pain (Appendix).…”

Section: Methodsmentioning

confidence: 99%

Autonomic Testing in Women with Chronic Pelvic Pain

et al. 2016

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Purpose Determine if abnormal autonomic nervous system (ANS) innervation of the bladder underlies interstitial cystitis/bladder pain syndrome (IC/BPS) differently than other chronic pelvic pain (CPP). Material and Methods IRB approved protocol, 134 subjects enrolled, 3 excluded, 39 healthy controls (HC), 36 IC/BPS, 14 myofascial pelvic pain (MPP), 42 IC/BPS plus MPP. ANS evaluations: deep breathing, Valsalva maneuver, tilt table test (TTT), and sudomotor test (evaluates for autonomic neuropathy (AN)). A modified validated composite autonomic laboratory score was applied. Results IC/BPS group 47.5 (21, 78) yrs was older than HC 34 (20, 75)yrs (p=0.006), MPP group 33 (22, 56)yrs (p=0.004), and IC/BPS plus MPP 38 (18, 64)yrs (p= 0.03). BMI was not significantly different among groups, but the MPP and IC/BPS plus MPP groups had a higher BMI than HC (p=0.03 and p= 0.05 respectively). Cardiovascular and adrenergic indexes did not differ among groups. TTT showed more orthostatic intolerance (OI) in all CPP groups. TTT diagnoses (orthostatic hypotension, postural tachycardia syndrome -POTS, reflex syncope) occurred rarely. Baseline heart rate (HR) was higher in all CPP groups (p=0.004). All MPP groups showed significantly more clearcut AN (defined as sweat score ≥ 3) compare to HC (HC vs IC/BPS plus MPP p= 0.007; HC vs MPP p = 0.03). Conclusions Some CPP types show an autonomic neuropathy, and some show vagal withdrawal. In all types, orthostatic intolerance likely reflects cenral sensitization and perhaps catastrophization. Some of these findings suggest novel therapeutic targets.

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Section: Methodsmentioning

confidence: 99%

Autonomic Testing in Women with Chronic Pelvic Pain

et al. 2016

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“…However, these patients do have physical examination findings of PFMP. Patients who present with urinary and other pelvic floor symptoms would benefit from an examination of their pelvic floor muscles during initial assessment . The findings of PFMP require a different treatment approach than the findings of UTI .…”

Section: Discussionmentioning

confidence: 99%

Pelvic floor myofascial pain in patients with symptoms of urinary tract infection

Wolff

Joyce

Brincat

et al. 2019

Intl J Gynecology & Obste

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Objective To correlate lower urinary tract symptoms typically associated with a urinary tract infection (UTI) with physical examination findings of pelvic floor myofascial pain (PFMP). Methods This retrospective review included all new patients presenting to a urogynecology clinic between August 2 and December 19, 2016. Patients completed validated questionnaires, had a catheterized urine specimen, and underwent pelvic examination. Associations between demographics, symptoms, urine culture, and PFMP were analyzed. Results We included 250 patients with urinary frequency (n=160, 64.0%), urgency (n=155, 62.0%), urgency incontinence (n=140, 56.0%), pelvic pain (n=43, 17.2%), and dysuria (n=25, 10.0%). PFMP was detected in 125 (50.0%) patients and culture‐proven UTI in 15 (6.0%) patients. Demographics associated with PFMP were lower prolapse stage (P<0.001), age younger than 50 years (P<0.001), lower parity (P=0.028), and non‐white ethnicity (P=0.003). Symptoms associated with PFMP were dysuria (adjusted odds ratio 4.13, 95% confidence interval 1.08–15.78), urgency/frequency (2.72, 1.47–5.04), and patient‐reported pelvic pain (2.57, 1.08–6.12). These symptoms were independent predictors in multivariable logistic regression analysis. Conclusions Most patients had symptoms associated with UTI; however, culture‐confirmed diagnosis was infrequent and PFMT was diagnosed in half of participants. Clinicians treating women with these symptoms are advised to examine the pelvic floor muscles.

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“…Currently, there is no accepted definition or standardized means of examination for the presence of MPP. 15 We included subjects into the MPP group when they reported at least 3 months of non-cyclic CPP unrelated to bladder filling or emptying and a minimum NRS pain score of at least 4 out of 10 using 2kg pressure applied with the index finger onto at least 2 of 5 examined pelvic floor TPs. Pelvic floor TPs included bilateral levator ani (puborectalis) and obturator internus muscles and a single midline perineal assessment (Figure 1).…”

Section: Methodsmentioning

confidence: 99%

The Pelvis and Beyond

Sanses

Chelimsky

McCabe

et al. 2016

The Clinical Journal of Pain

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OBJECTIVE To determine the feasibility of a detailed pain sensitivity assessment using body wide musculoskeletal tender points (TPs) in women with different types of chronic pelvic pain (CPP) and compare phenotypic differences. METHODS Seventy women with CPP and 35 healthy women underwent musculoskeletal evaluation of TPs in the pelvic floor, abdomen, groin, inner thigh, and all 18 fibromyalgia (FM) TPs. Subjects scored elicited pain on a numeric rating scale (NRS). Tender point pain scores were used for intergroup comparison and intragroup correlation. RESULTS Women with CPP were grouped as having either bladder pain syndrome (BPS, n=24) or myofascial pelvic pain (MPP, n=11) singularly or both concomitantly (BPS+MPP, n=35). Tender point pain scores for all evaluations were higher in women with CPP compared to healthy women (p<0.001). Women with BPS+MPP had elevated TP pain for each evaluation compared to women with BPS alone. Pelvic floor and FM TP scores correlated strongly in the MPP group, moderately in the BPS+MPP group, and weakly in the BPS alone group. While some moderate and strong correlations between different body locations were present in all three groups, only the BPS+MPP group showed moderate to strong correlations between all body TPs. CONCLUSIONS Detailed musculoskeletal evaluation of women with CPP is feasible and well tolerated. Careful phenotyping differentiated BPS, MPP, and BPS+MPP groups. Attending to the differences between these groups clinically may lead to more effective treatment strategies and improved outcomes for patients with CPP.

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Levator myalgia: why bother?

Abstract: Levator myalgia is a prevalent condition in urogynecology practice, and is associated with approximately 50% greater bother in urinary, defecatory, and prolapse symptoms.

Cited by 30 publications

References 16 publications

Autonomic Testing in Women with Chronic Pelvic Pain

Autonomic Testing in Women with Chronic Pelvic Pain

Pelvic floor myofascial pain in patients with symptoms of urinary tract infection

The Pelvis and Beyond

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