Pelvic Floor and Urinary Distress in Women with Fibromyalgia

Abstract

Fibromyalgia (FM) patients were recently found to have more symptom burden from bothersome pelvic pain syndromes that women seeking care for pelvic floor disease at a urogynecology clinic. We sought to further characterize pelvic floor symptoms in a larger sample of FM patients using of validated questionnaires. Female listserv members of the Fibromyalgia Information Foundation completed an online survey of three validated questionnaires: the Pelvic Floor Distress Inventory 20 , the Pelvic Pain, Urgency and Frequency Questionnaire (PUF), and the Revised Fibromyalgia Impact Questionnaire (FIQR). Scores were characterized using descriptive statistics. Patients (n = 204 with complete data on 177) were on average 52.3 ± 11.4 years with a mean parity of 2.5 ± 1.9. FM severity based on FIQR score (57.2 ± 14.9) positively correlated with PFDI-20 total 159.08 ± 55.2 (r = .34, p <.001) and PUF total 16.54 ± 7 (r = .36, p <.001). Women with FM report significantly bothersome pelvic floor and urinary symptoms. Fibromyalgia management should include evaluation and treatment of pelvic floor disorders recognizing that pelvic distress and urinary symptoms are associated with more severe FM symptoms. Validated questionnaires, like the ones used in this study, are easily incorporated into clinical practice.Fibromyalgia (FM) is a common, debilitating disorder of widespread pain affecting an estimated 5 million persons in the United States (Lawrence et al., 2008). Similarly, chronic pelvic pain is estimated to affect at least 9 million women (Mathias, Kuppermann, Liberman, Lipschutz, & Steege, 1996), and 4 to 7 million women report bladder pain/ interstitial cystitis symptoms (Berry et al., 2011). Given that these three chronic pain syndromes are highly prevalent, it is not surprising that they often coexist. Indeed, people with FM often report numerous regional pain syndromes, including headaches, temporomandibular disorders, low back/neck pain, myofascial pain, irritable bowel, pelvic pain, and bladder pain (Adams & Denman, 2011;Arnold, Clauw, & McCarberg, 2011;Rodriguez, Afari, & Buchwald, 2009;Williams & Clauw, 2009 Clemens et al., 2014;Adams & Denman, 2011). Pelvic floor disorders negatively influence a woman's activities of daily living, sexual function, bowel and bladder function, and overall quality of life. Despite their high prevalence and negative impact, little known about the relationship between pelvic/bladder symptoms and FM severity. The purpose of this study was to characterize pelvic floor and urinary symptoms in patients with FM. A secondary aim was to describe the strength of the relationship between pelvic floor and urinary symptoms with the total impact of FM. HHS Public Access MATERIALS AND METHODS Design, Participants, and ProceduresThis study was a cross-sectional descriptive survey in women with FM. Five hundred female patients were contacted via e-mail and requested to complete an online "women's health survey" (SurveyMonkey, Inc., Palo Alto, CA Pelvic floor symptoms were measured using the PFDI-...

Pelvic floor dysfunction in women with fibromyalgia and control subjects: Prevalence and impact on overall symptomatology and psychosocial function

“…This could be possibly attributed to the fact that FIQR was collected via online blogs in women with greater level of awareness concerning their disease. Moreover, the significant positive correlation between FIQR and PFDI‐20 and PFIQ‐7 scores confirmed the previous findings reported by Jones et al This is an interesting outcome that highlights the significant additional impact caused by PFD symptoms on the overall burden experienced by patients with fibromyalgia.…”

“…The level of distress caused by PFD was significantly more pronounced in patients with fibromyalgia compared to the control group as shown by the PFDI‐20 outcome scores. In the study conducted by Jones et al, the total PFDI‐20 score in 177 patients with fibromyalgia was slightly higher (159 ± 55) than the total scores reported by our sample of patients with fibromyalgia (143 ± 5.7), with the greatest contribution to the total distress originating from the colorectal‐anal symptoms followed by genital prolapse and urinary symptoms . In another study, patients with genital prolapse symptomatology who self‐reported fibromyalgia scored a total of 145 ± 63 on the PFDI‐20 and 105 ± 84 on the PFIQ‐7 which were significantly higher compared to subjects reporting genital prolapse symptoms but not fibromyalgia .…”

“…The potential association between fibromyalgia and PFD is supported by several studies . Patients with fibromyalgia were shown to experience bothersome urinary tract symptoms and higher prevalence of pelvic organ prolapse, defecatory dysfunction, and sexual dysfunction compared to controls .…”

“…Additionally, history of fibromyalgia diagnosis was found to be relatively elevated among women who were referred to urogynecology clinic assessment . Also, PFD symptomatology were shown to be associated with significant distress in patients with fibromyalgia and significantly correlated with fibromyalgia severity . However, none of these studies evaluated the frequency of PFD symptomatology in fibromyalgia.…”

“…11 The potential association between fibromyalgia and PFD is supported by several studies. [12][13][14] Patients with fibromyalgia were shown to experience bothersome urinary tract symptoms and higher prevalence of pelvic organ prolapse, defecatory dysfunction, and sexual dysfunction compared to controls. 12,13 Additionally, history of fibromyalgia diagnosis was found to be relatively elevated among women who were referred to urogynecology clinic assessment.…”