Prevalence of Pelvic Floor Dysfunction in Patients with Interstitial Cystitis

doi:10.1016/j.urology.2007.02.067

Urology

Volume 70, Issue 1, July 2007, Pages 16-18

https://doi.org/10.1016/j.urology.2007.02.067 Get rights and content

Abstract

Objectives

To evaluate the prevalence of pelvic floor dysfunction in women with interstitial cystitis (IC).

Methods

Women with IC and pelvic pain were referred to the Beaumont Women’s Initiative for Pelvic Pain and Sexual Health program. A comprehensive patient history and pelvic examination were completed by a certified women’s health nurse practitioner.

Results

Seventy women with a mean age of 45 years were evaluated. Of these 70 women 87% had levator pain consistent with pelvic floor dysfunction. The mean levator pain score was 4.48 out of 10. Nearly two thirds of these women (64%) had their pain for 5 years or more, whereas one quarter (24%) had their pain for 1 to 3 years. Half of the women reported irritable bowel syndrome, and more than one third (36%) reported urge urinary incontinence.

Conclusions

Women with IC may have pelvic floor dysfunction, as noted in this population in which 87% had levator pain upon examination. If pelvic floor dysfunction is diagnosed in IC patients, then therapy targeting the pelvic floor musculature may be considered as part of a multimodality approach to treating IC.

Section snippets

Material and Methods

Seventy women diagnosed with IC by cystoscopy and hydrodistention and ongoing pelvic pain were referred to the Beaumont Women’s Initiative for Pelvic Pain and Sexual Health program. These women had been evaluated and treated by gynecologists, gastroenterologists, and other medical specialists without resolution of their pain. Our evaluation included a comprehensive history and a pelvic examination performed by a certified women’s health nurse practitioner. The pelvic examination included

Results

Seventy women with IC and pelvic pain were evaluated. The mean age was 45, with a standard deviation of 12 years. More than half of the women were married (65%), had more than 12 years of education (54%), were not working outside the home (52%), or were menopausal (55%). Nearly two thirds (64%) had their pain for 5 years or more, whereas one quarter (24%) had their pain for 1 to 3 years. The vast majority of the sample had levator pain (87%) and dyspareunia (71%). The average levator pain score

Comment

Despite significant research into possible causes and treatments for IC, results of treatment directed only at the bladder have been disappointing for both patients and clinicians. Researchers have begun to look at IC as a syndrome and have expanded their focus beyond the bladder to look for possible sources of IC symptoms. One such area of interest is the surrounding pelvic floor musculature. The primary support for the pelvic organs comes from the levator ani (levators) muscles. The levators

Conclusions

Our data demonstrate an association between IC and pelvic floor dysfunction in the majority of our IC patients, with 87% experiencing levator pain during pelvic examination. In patients with diagnosed or suspected IC, it is helpful to assess for levator pain at the ischial spines during a urologic examination to gather information about the pelvic floor musculature. Levator pain is quantified with a VAS, assessing the right and left sides separately because there is often discordance in the

References (8)

M.A. Pezzone et al.
A model of neural cross-talk and irritation in the pelvis: implications for the overlap of chronic pelvic pain disorders
Gastroenterology
(2005)
I.A. Oyama et al.
Modified Thiele massage as therapeutic intervention for female patients with interstitial cystitis and high-tone pelvic floor dysfunction
Urology
(2004)
A. Rosamilia
Painful bladder syndrome/interstitial cystitis
Best Pract Res Clin Obstet Gynecol
(2005)
J. Weiss
Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome
J Urol
(2001)

There are more references available in the full text version of this article.

Cited by (115)

Fibrin microthrombi in bladder urothelium after SARS-CoV-2 infection: Case report
2023, Urology Case Reports
A 45-year-old male with diabetes, hypertension and hyperlipidemia was referred to urology due to persistent symptoms of urinary frequency, urgency, nocturia, erectile dysfunction, and constant pain localized to the bladder, pelvis, and perineal area, 3–4 months after SARS-CoV-2 infection. A bladder biopsy showed urothelial mucosa and submucosa with hemorrhage and fibrin microthrombi in blood vessels. Hydrodistention of the bladder and pelvic floor physical therapy resolved symptoms, though bladder and pain symptoms returned upon reinfection with SARS-CoV-2. Urinalysis revealed elevated urinary interleukin-8, which may indicate localized bladder inflammation.
Myofascial Pelvic Pain: Best Orientation and Clinical Practice. Position of the European Association of Urology Guidelines Panel on Chronic Pelvic Pain
2023, European Urology Focus
Citation Excerpt :
This, along with other mechanisms, leads to establishment of nervous system sensitization (both central and peripheral) [2]. This relationship has been found not only in “chronic prostatitis” [19] but also in bladder pain syndrome (BPS) [20] and vulvar pain [21]. Awareness of and information on the role of myofascial pain in chronic pain syndromes is lacking among health care providers.
Despite the high prevalence of a myofascial pain component in chronic pelvic pain (CPP) syndromes, awareness and management of this component are lacking among health care providers.
To summarize the current state of the art for the management of myofascial pain in chronic primary pelvic pain syndromes (CPPPS) according to scientific research and input from experts from the European Association of Urology (EAU) guidelines panel on CPP.
A narrative review was undertaken using three sources: (1) information in the EAU guidelines on CPP; (2) information retrieved from the literature on research published in the past 3 yr on myofascial pelvic pain; and (3) expert opinion from panel members.
Studies confirm a high prevalence of a myofascial pain component in CPPPS. Examination of the pelvic floor muscles should follow published recommendations to standardize findings and disseminate the procedure. Treatment of pelvic floor muscle dysfunction and pain in the context of CPP was found to contribute to CPP control and is feasible via different physiotherapy techniques. A multidisciplinary approach is the most effective.
Despite its high prevalence, the myofascial component of CPP has been underevaluated and undertreated to date. Myofascial pain must be assessed in all patients with CPPPS. Treatment of the myofascial pain component is relevant for global treatment success. Further studies are imperative to reinforce and better define the role of each physiotherapy technique in CPPPS.
Pain and inflammation of the body’s muscle and soft tissues (myofascial pain) frequently occurs in pelvic pain syndromes. Its presence must be evaluated to optimize management for each patient. If diagnosed, myofascial pain should be treated.
The innervation of the bladder, the pelvic floor, and emotion: A review
2021, Autonomic Neuroscience: Basic and Clinical
Citation Excerpt :
Pelvic floor dysfunction (PFD) is often associated with OAB, BPS/IC, genitourinary pain, IBS, or pain of gynaecological origin (e.g. endometriosis, vulvar pain syndrome). In women (n = 70) with BPS/IC and pelvic floor dysfunction, half of these patients reported IBS, and more than one third reported urge urinary incontinence (Peters et al., 2007). In general, PFD is classified in hypertonic or hypotonic pelvic floors and extensively described by the ICS standardization committee and the International Urogynecological Association (IUGA)/international continence society (ICS) based on symptoms, signs and circumstances (Messelink et al., 2005; Bo et al., 2017).
The innervation of the pelvic region is complex and includes extensive neurologic pathways. The higher centres' organisation determining the pelvic floor and organs' function remains a challenge understanding the physiological and pain mechanisms. Psychological and emotional factors have a profound influence on the pelvic floor and organ dysfunction such as LUTS. LUTS are associated with stress, depression, and anxiety. Neuroception is a subconscious neuronal system for detecting threats and safety and might explain the permanent disturbance of higher brain centres maintaining functional urological and gastrointestinal disorders and sphincter dysfunction.
Pelvic-floor function, dysfunction, and treatment
2021, European Journal of Obstetrics and Gynecology and Reproductive Biology
Citation Excerpt :
In 30% of cases with BPS/IC, an association with PFDs was found associated [44]. Peters et al. showed levator ani pain with PFD in 87% of patients with BPS/IC [45]. In this study, (n = 70 women) 50% reported IBS and 36% urgency urinary incontinence.
The pelvic floor functions as a holistic entity. The organs, bladder, bowel, smooth and striated muscles, nerves, ligaments and other connective tissues are directed cortically and reflexly from various levels of the nervous system. Such holistic integration is essential for the system’s multiple functions, for example, pelvic girdle stability, continence, voiding/defecation, and sexuality. Pelvic floor dysfunction (PFD) is related to a variety of pelvic pain syndromes and organ problems of continence and evacuation. Prior to treatment, it is necessary to understand which part(s) of the system may be causing the dysfunction (s) of Chronic Pelvic Pain Syndrome (CPPS), pelvic girdle pain, sexual problems, Lower Urinary Tract Symptoms (LUTS), dysfunctional voiding, constipation, prolapse and incontinence. The interpretation of pelvic floor biomechanics is complex and involves multiple theories. Non-surgical treatment of PFD requires correct diagnosis and correctly supervised pelvic floor training.
The aims of this review are to analyze pelvic function and dysfunction. Because it is a holistic and entirely anatomically based system, we have accorded significant weight to the Integral Theory’s explanations of function and dysfunction.
Painful Bladder Syndrome/Interstitial Cystitis and High Tone Pelvic Floor Dysfunction
2021, Obstetrics and Gynecology Clinics of North America
“The Overactive Pelvic Floor (OPF) and Sexual Dysfunction” Part 1: Pathophysiology of OPF and Its Impact on the Sexual Response
2021, Sexual Medicine Reviews
Overactive pelvic floor (OPF) muscles are defined as muscles that do not relax, or may even contract, when relaxation is needed, for example, during micturition or defecation. Conditions associated with OPF are multifactorial and include multiple possible etiologies and symptom complexes. The complex interplay between biological and psychosocial elements can lead to the persistence of OPF symptoms along with psychological and emotional distress.
(1) To review and contextualize, from a pathophysiologic perspective, the evidence for OPF, (2) to provide an overview of common clinical presentations and comorbidities of OPF, and (3) to discuss the effect of OPF on sexual function in men and women.
Review of the updated literature on the pathophysiology of OPF was carried out. OPF-associated conditions were overviewed, with special emphasis on the impact on sexual function in men and women.
Individuals with suspected OPF often present with a combination of gastrointestinal, gynecological, musculoskeletal, sexual, and urological comorbidities, mostly accompanied by psychoemotional distress. In both women and men, sexual function is significantly impaired by OPF and genitopelvic pain penetration disorders are often the primary manifestation of this condition. Women with OPF report less sexual desire, arousal, and satisfaction; more difficulty reaching orgasm; lower frequencies of intercourse; more negative attitudes toward sexuality; and more sexual distress than women without sexual pain. The most frequently reported sexual dysfunctions in men with OPF include erectile dysfunction, premature ejaculation, and ejaculatory pain.
The complex pathophysiology of OPF involving multisystemic comorbidities and psychosocial factors emphasize the importance of a biopsychosocial assessment for guiding effective and personalized management.
Padoa A, McLean L, Morin M, et al. “The Overactive Pelvic Floor (OPF) and Sexual Dysfunction” Part 1: Pathophysiology of OPF and Its Impact on the Sexual Response. Sex Med 2021;9:64–75.

View all citing articles on Scopus

¹: K.M. Peters is a paid consultant and funded investigator for Medtronics and Advanced Bionics.

View full text

Adult urologyPrevalence of Pelvic Floor Dysfunction in Patients with Interstitial Cystitis

Abstract

Objectives

Methods

Results

Conclusions

Section snippets

Material and Methods

Results

Comment

Conclusions

Gastroenterology

Urology

Best Pract Res Clin Obstet Gynecol

J Urol

Adult urology
Prevalence of Pelvic Floor Dysfunction in Patients with Interstitial Cystitis