Myofascial pain and pelvic floor dysfunction in IC

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Int Urogynecol J Pelvic Floor Dysfunct. 2010 Oct 26. [Epub ahead of print]
Myofascial pain and pelvic floor dysfunction in patients with interstitial cystitis.

Bassaly R, Tidwell N, Bertolino S, Hoyte L, Downes K, Hart S.
Department of Obstetrics and Gynecology, University of South Florida, 2 Tampa General Circle, 6th floor, Tampa, FL, 33606, USA

INTRODUCTION AND HYPOTHESIS
The objectives of this study are to investigate myofascial pain in patients with interstitial cystitis (IC) and to correlate myofascial exam findings with validated questionnaires.

METHODS
A retrospective chart review was performed on 186 patients with a diagnosis of IC from April 2007 to December 2008. Demographics, history and physical examination, and validated pelvic floor dysfunction questionnaire scores were extracted. The data was evaluated with SPSS for Windows using Spearman's rho, Mann-Whitney, and Kruskal-Wallis statistical analyses.

RESULTS
Myofascial pain was demonstrated in 78.3% of IC patients with at least one myofascial trigger point, and 67.9% of patients had numerous areas of trigger points. Mild correlations were seen with trigger points and scores from the PUF, PFDI-20, and PFIQ-7 questionnaires.

CONCLUSIONS
Myofascial pain is prevalent among IC patients and positively correlated with pelvic floor dysfunction scores. These findings support evaluation of pelvic floor myofascial pain in IC patients and suggest a possible benefit from pelvic floor therapy.

PMID: 20976441 [PubMed - as supplied by publisher]

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Editor's Commentary - Myofascial pain and pelvic floor dysfunction in patients with interstitial cystitis
Monday, 21 February 2011 | Philip M. Hanno, MD

BERKELEY, CA (UroToday.com) - Pelvic Floor Therapy Important Component of BPS/IC Care

Pelvic floor dysfunction, although associated with BPS/IC, is not typically part of the diagnostic criteria for this condition. Nevertheless, the literature suggests that BPS/IC patients have an increased prevalence of levator ani myofascial pain and that therapy directed at the pelvic floor may improve symptoms. Renee Bassaly and colleagues from the University of South Florida in Tampa examined the relationship between levator ani myofascial pain elucidated during physical examination and BPS/IC, and correlated the results with validated questionnaires assessing pelvic floor dysfunction.

In a retrospective review of 186 patients identified to have a diagnosis of BPS/IC, the authors reviewed baseline-validated questionnaires including the Pelvic Pain, Urgency, and Frequency (PUF) questionnaire, Pelvic Floor Distress Inventory Short Form 20 (PFDI-20), and the Pelvic Floor Impact Questionnaire Short Form 7 (PFIQ-7). All patients underwent evaluation for myofascial trigger points of the pelvic floor and rectus abdominis muscles as part of their initial examination.

Eighty-two of the patients had a documented diagnosis of BPS/IC and 104 were diagnosed upon presentation for evaluation at the center. Myofascial pain was identified in 78.5% of the patients. Six or more separately identifiable trigger points were found in 67.9% of patients. The most common locations were left-sided obterator internus, right-sided puborectalis, right-sided obturator internus, left-sided puborectalis, left-sided arcus tendineus, and left-sided iliococcygeus muscles. Only mild correlations (none greater than 0.3) were noted between myofascial trigger points and validated questionnaires.

While the PFIQ-7 scores were influenced by symptom duration, the PUF and PFDI-20 were not, suggesting that symptoms did not appear to be related to disease duration. Self-report of vulvar and back pain was noted to be the strongest indicator of the presence of myofascial pain. The same was not true of abdominal pain.

While there are inherent limitations of this retrospective study (not the least of which, as pointed out by the research team, is qualitative variation between exams and examiners), the results are interesting and point out the need for pelvic floor evaluation and consideration for pelvic floor therapy in this group of patients.