Pelvic floor hypertonicity in women with pelvic floor disorders: A case control and risk prediction study

Abstract

Aim Myofascial pelvic pain is a chronic and debilitating condition, sometimes associated with pelvic floor disorders (PFD) such as urinary incontinence, defecatory dysfunction or pelvic organ prolapse. Our aim was to identify risk factors in women with PFD and hypertonic pelvic floor, compared to controls without hypertonicity. Methods Case control study (2009‐2017) of patients with PFD and a diagnosis of hypertonic pelvic floor. Cases were matched with patients who presented with the same PFD but without pelvic floor hypertonicity. Postoperative patients with hypertonic pelvic floor were matched with patients who underwent surgery for the same PFD but did not develop pain. Risk factors were compared between groups. Results Ninety‐five cases were matched; 71% had urogynecologic surgery as a possible trigger for myofascial pain. Most were post‐menopausal. Overall, case patients were younger than controls (mean 54 vs 59, P = 0.002). Multivariate logistic regression identified risk factors of younger age (OR 1.45, 95%CI 1.04‐2.07), history of depression (OR 3, 95%CI 1.03‐9.09), musculoskeletal spine injury (OR 4.32, 95%CI 1.01‐21.26) and transobturator midurethral sling (OR 8.36, 95%CI 2.68‐31.32). Retropubic midurethral sling was protective against pelvic floor hypertonicity (OR 0.37, 95%CI 0.15‐0.86). A clinical prediction model including depression, endometriosis, irritable bowel, spine injury and type of midurethral sling was developed to estimate the probability for myofascial pain after urogynecologic surgery. Conclusions Specific risk factors predispose women with PFD to chronic pelvic floor hypertonicity. Knowledge of these can help with patient counselling and choice of midurethral sling prior to PFD surgery.

Urinary Incontinence in Women: Modern Methods of Physiotherapy as a Support for Surgical Treatment or Independent Therapy

“…The improper PFM tonus leads to many disfunction [29,40]. Research indicates that increased tone of PFMs can prolong delivery course, while simultaneously favoring greater damage within them [41,42].…”

“…Research indicates that increased tone of PFMs can prolong delivery course, while simultaneously favoring greater damage within them [41,42]. PF hypertonicity frequently occurs in women with chronic pelvic pain [40], but may also leads to incontinence caused by increased intra-abdominal pressure. It is known that the persistent state of excessive muscle tension leads to a weakening of their strength and endurance.…”

Depression, anxiety, and stress in women with urinary incontinence with or without myofascial dysfunction in the pelvic floor muscles: A cross‐sectional study

“…In this study, despite the fact that MD was not associated with depression, it is important to highlight higher rates were seen within the MD groups when compared to the CG and higher rates in both groups in the severe levels of depression. One study evaluated the predicted risk of developing hypertonia and myofascial pain within the PFM in women with UI and/or pelvic organ prolapse and found that depression was associated with hypertonia in these women 9 …”

“…It is unclear the combination of MD and psychological symptoms within women with UI. It is hypothesized that emotional aspects may drive towards a hypertonic PFM, as there has been demonstrated a greater tension within these muscles in women who are experiencing a high level of psychological stress 8 and increased risk of developing hypertonic PF in depressed women 9 . Understanding the association between UI and muscular/psychological aspects is essential as it might be considered that the emotional state of women with UI and MD may be different from those of women with UI without MD.…”

“…It is hypothesized that emotional aspects may drive towards a hypertonic PFM, as there has been demonstrated a greater tension within these muscles in women who are experiencing a high level of psychological stress 8 and increased risk of developing hypertonic PF in depressed women. 9 Understanding the association between UI and muscular/ psychological aspects is essential as it might be considered that the emotional state of women with UI and MD may be different from those of women with UI without MD. Also, there is scant data in the literature for MD, and this might be the reason why MD is often underdiagnosed; the lack of a proper diagnosis may not target appropriate treatment, since mistreatment may generate increased muscle tension.…”