International Urogynecology Journal

, Volume 30, Issue 11, pp 1829–1834 | Cite as

Severity and bother of prolapse symptoms in women with pelvic floor myofascial pain

  • Alison M. Dixon
  • Colleen M. FitzgeraldEmail author
  • Cynthia Brincat
Original Article


Introduction and hypothesis

Our aim was to assess severity and bother of pelvic organ prolapse (POP) in women with pelvic floor myofascial pain (PFMP).


We conducted a retrospective chart review assessing new patients within a hospital-based multispecialty group from January 2010 through September 2014 using the International Classification of Diseases, 9th edition, diagnosis codes for POP. Data from Pelvic Organ Prolapse Quantification (POP-Q) system assessment, Pelvic Floor Distress Inventory-20, (PFDI-20), and clinical assessment of pelvic floor muscles were collected.


Of 539 patients identified with POP, 174 (32%) had PFMP on physical exam. The mean stage of prolapse in those with PFMP was 2 [standard deviation (SD) ± 0.93] vs 3 (SD ± 0.80) in those without pain. There was a difference in the presence of prolapse beyond the hymen, with 98 (56%) of those with PFMP having their most dependent point above the hymen (Ba, Bp, or C) and 276 (76%) of those without PFMP having their most dependent point beyond the hymen (p = .000). Women with PFMP were predominantly white, had less-advanced prolapse, and more reported pain or discomfort (adjusted p value = .011, prolapse beyond the hymen p = .000, PFDI -20 p = .003).


One in three women with a diagnosis of POP were found to have PFMP. On average, when pain was present, women had a lower stage of prolapse and were more severely bothered by their pelvic floor symptoms. Although limited by its nature as a retrospective analysis, this study suggests alternative etiologies, and thereby treatments, for symptom bother in women with mild prolapse.


Pelvic organ prolapse Pelvic floor myofascial pain 



The project described was supported in part by the Loyola Clinical Research Office (CRO) at Loyola University Chicago, Health Sciences Division, 2160 S. First Ave., Center for Translational Research and Education, Room 253, Maywood, IL, 60153, USA. The work is the responsibility of the authors and does not necessarily represent the views of the CRO.

Compliance with ethical standards

Conflicts of interest



  1. 1.
    Ghetti C, Gregory WT, Edwards SR, Otto LN, Clark AL. Pelvic organ descent and symptoms of pelvic floor disorders. Am J Obstet Gynecol. 2005;193(1):53–7.CrossRefGoogle Scholar
  2. 2.
    Adams K, Gregory WT, Osmundsen B, Clark A. Levator myalgia: why bother? Int Urogynecol J. 2013;24(10):1687–93.CrossRefGoogle Scholar
  3. 3.
    Sammarco AG, Swenson CW, Kamdar NS, Kobernik EK, DeLancey JOL, Nallamothu B, et al. Rate of pelvic organ prolapse surgery among privately insured women in the United States, 2010-2013. Obstet Gynecol. 2018;131(3):484–92.CrossRefGoogle Scholar
  4. 4.
    Ellerkmann RM, Cundiff GW, Melick CF, Nihira MA, Leffler K, Bent AE. Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol. 2001;185(6):1332–7; discussion 7-8.CrossRefGoogle Scholar
  5. 5.
    Mathias SD, Kuppermann M, Liberman RF, Lipschutz RC, Steege JF. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol. 1996;87(3):321–7.CrossRefGoogle Scholar
  6. 6.
    Montenegro ML, Mateus-Vasconcelos EC, Rosa e Silva JC, Nogueira AA, Dos Reis FJ, Poli Neto OB. Importance of pelvic muscle tenderness evaluation in women with chronic pelvic pain. Pain Med. 2010;11(2):224–8.CrossRefGoogle Scholar
  7. 7.
    Reiter RC, Gambone JC. Nongynecologic somatic pathology in women with chronic pelvic pain and negative laparoscopy. J Reprod Med. 1991;36(4):253–9.PubMedGoogle Scholar
  8. 8.
    Adams K, Osmundsen B, Gregory WT. Does fibromyalgia influence symptom bother from pelvic organ prolapse? Int Urogynecol J. 2014;25(5):677–82.CrossRefGoogle Scholar
  9. 9.
    Kinman CL, Lemieux CA, Agrawal A, Gaskins JT, Meriwether KV, Francis SL. The relationship between age and pelvic organ prolapse bother. Int Urogynecol J. 2017;28(5):751–5.CrossRefGoogle Scholar
  10. 10.
    Dunivan GC, Cichowski SB, Komesu YM, Fairchild PS, Anger JT, Rogers RG. Ethnicity and variations of pelvic organ prolapse bother. Int Urogynecol J. 2014;25(1):53–9.CrossRefGoogle Scholar
  11. 11.
    Lewicky-Gaupp C, Brincat C, Trowbridge ER, Delancey JO, Guire K, Patel DA, et al. Racial differences in bother for women with urinary incontinence in the establishing the prevalence of incontinence (EPI) study. Am J Obstet Gynecol. 2009;201(5):510 e1–6.CrossRefGoogle Scholar
  12. 12.
    Tu FF, Fitzgerald CM, Kuiken T, Farrell T, Harden RN. Comparative measurement of pelvic floor pain sensitivity in chronic pelvic pain. Obstet Gynecol. 2007;110(6):1244–8.CrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  • Alison M. Dixon
    • 1
  • Colleen M. Fitzgerald
    • 1
    Email author
  • Cynthia Brincat
    • 2
  1. 1.Department of Obstetrics and GynecologyLoyola University Medical CenterMaywoodUSA
  2. 2.Department of Obstetrics and GynecologyRush University Medical CenterChicagoUSA

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