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Myofascial dysfunction associated with chronic pelvic floor pain: Management strategies

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Abstract

Myofascial pain as a cause of chronic pelvic pain with or without pelvic organ pathology is well-documented in the literature. Causes of this pain are multifactorial, including specific pelvic organ pathologies, neuromuscular disorders, and psychologic causes. Management of this myofascial component of chronic pelvic pain involves a multidisciplinary approach including physicians, physical therapists, neurologists, and psychiatrists. Treatment strategies, including behavioral management, medications, physical therapy, trigger point injections, neuromodulation, botulinum toxin injection, and other lesser known treatment modalities, are discussed in detail in this article.

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References and Recommended Reading

  1. Sinaki M, Merritt JL, Stilwell GK: Tension myalgia of the pelvic floor. Mayo Clin Proc 1977, 52:717–722.

    PubMed  CAS  Google Scholar 

  2. Hetrick DC, Ciol MA, Rothman I, et al.: Musculo-skeletal dysfunction in men with chronic pelvic pain syndrome type III: a case control study. J Urol 2003, 170:828–831.

    Article  PubMed  Google Scholar 

  3. Moldwin RM, Kaye JD: Pelvic floor dysfunction in the painful bladder syndrome/interstitial cystitis population. Paper presented at the 2006 NIDDK International Symposium: Frontiers in Painful Bladder Syndrome and Interstitial Cystitis. Bethesda, MD; October 26–27, 2006.

  4. The International Pelvic Pain Society, Research Committee: Pelvic Pain Assessment Form. http://www.pelvicpain.org/pdf/frm_pain_questionnaire.pdf. Accessed July 30, 2007.

  5. Howard FM: Introduction. In Pelvic Pain—Diagnosis and Treatment. Edited by Howard FM, Perry CP, Carter JE, El-Minawi AM. Philadelphia: Lippincott Williams & Wilkins; 2000:477–492.

    Google Scholar 

  6. Prior A, Whorwell PJ, Faragher EB: Irritable bowel syndrome in the gynecological clinic. Survey of 798 new referrals. Dig Dis Sci 1989, 34:1820–1824.

    Article  PubMed  CAS  Google Scholar 

  7. Parsons CI, Dell J, Stanford EJ, et al.: The prevalence of interstitial cystitis in gynecological patients with chronic pelvic pain, as detected by intravescical potassium sensitivity. Am J Obstet Gynecol 2002, 187:1395–1400.

    Article  PubMed  Google Scholar 

  8. Eisenberg ER, Moldwin RM: Etiology: where does prostatitis stop and interstitial cystitis begin? World J Urol 2003, 21:64–69.

    Article  PubMed  Google Scholar 

  9. Peters AA, Van Dorst E, Jellis B, et al.: A randomized clinical trial to compare two different approaches in women with chronic pelvic pain. Obstet Gynecol 1991, 77:740–744.

    PubMed  CAS  Google Scholar 

  10. The Initial Management of Chronic Pelvic Pain. RCOG Guidelines. London: Royal College of Obstetricians and Gynaecologists; 2005.

  11. Hetrick DC, Glazer H, Liu YW, et al.: Pelvic floor electromyography in men with chronic pelvic pain syndrome: a case-control study. Neurourol Urodyn 2006, 25:46–49.

    Article  PubMed  Google Scholar 

  12. Clemens JQ, Nadler RB, Schaeffer AJ, et al.: Biofeedback, pelvic floor re-education and bladder training for male chronic pelvic pain syndrome. Urology 2000, 56:951–955.

    Article  PubMed  CAS  Google Scholar 

  13. Cornel EB, van Haarst E, Schaarsberg RWMB, et al.: The effect of biofeedback physical therapy in men with chronic pelvic pain syndrome type III. Eur Urol 2005, 47:607–611.

    Article  PubMed  Google Scholar 

  14. Lukban JC, Whitmore KF, Kellogg-Spadt S, et al.: The effect of manual physical therapy in patients with interstitial cystitis, high tone pelvic floor dysfunction and sacro-iliac dysfunction. Paper presented at the NIDDK Interstitial Cystitis and Bladder Research Symposium. Minneapolis, MN; October 19–20, 2000.

  15. Milburn A, Reiter RC, Rhomberg AT: Multidisciplinary approach to chronic pelvic pain. Obstet Gynecol Clin North Am 1993, 20:643–661.

    PubMed  CAS  Google Scholar 

  16. Howard FM: Chronic pain as a diagnosis. In Pelvic Pain-Diagnosis and Treatment. Edited by Howard FM, Perry CP, Carter JE, El-Minawi AM. Philadelphia: Lippincott Williams & Wilkins; 2000:493–500.

    Google Scholar 

  17. Zermann DH, Ishigooka M, Doggweiler R, et al.: Neurological insights into the etiology of genitourinary pain in men. J Urol 1999, 161:903–908.

    Article  PubMed  CAS  Google Scholar 

  18. Dunlap KT, Yu L, Fisch BJ, et al.: Polysomnographic characteristics of sleep disorders in chronic pelvic pain. Prim Care Update Ob Gyns 1998, 5:195.

    Article  PubMed  Google Scholar 

  19. Sator-Katzenschlager SM, Scharbert G, Kress HG, et al.: Chronic pelvic pain treated with gabapentin and amitriptyline: a randomized controlled pilot study. Wien Klin Wochenschr 2005, 117:761–768.

    Article  PubMed  CAS  Google Scholar 

  20. Howard FM: Abdominal wall and pelvic myofascial trigger points. In Pelvic Pain—Diagnosis and Treatment. Edited by Howard FM, Perry CP, Carter JE, El-Minawi AM. Philadelphia: Lippincott Williams & Wilkins; 2000:314–358.

    Google Scholar 

  21. Thiele GH: Coccydynia: cause and treatment. Dis Colon Rectum 1963, 6:422–436.

    Article  PubMed  CAS  Google Scholar 

  22. Weiss JM: Pelvic floor myofascial trigger points; manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol 2001, 166:2226–2231.

    Article  PubMed  CAS  Google Scholar 

  23. Anderson RU, Wise D, Sawyer T, et al.: Integration of myofascial trigger point release and paradoxical training treatment of chronic pelvic pain in men. J Urol 2005, 174:155–160.

    Article  PubMed  Google Scholar 

  24. Schmidt RA, Jonas U, Oleson KA, et al.: Sacral nerve stimulation for treatment of refractory urinary urge incontinence. Sacral Nerve Stimulation Study Group. J Urol 1999, 162:352.

    Article  PubMed  CAS  Google Scholar 

  25. Siegel S, Paszkiewicz E, Kirkpatrick C, et al.: Sacral nerve stimulation in patients with chronic intractable pelvic pain. J Urol 2001, 166:1742–1745.

    Article  PubMed  CAS  Google Scholar 

  26. Aboseif S, Tamaddon K, Chalfin S, et al.: Sacral neuromodulation as an effective treatment for refractory pelvic floor dysfunction. Urology 2002, 60:52–56.

    Article  PubMed  Google Scholar 

  27. Jarvis S, Abbott J, Lenart M, et al.: Pilot study of botulinum toxin type A in the treatment of chronic pelvic pain associated with spasm of the levator ani muscles. Aust N Z J Obstet Gynaecol 2004, 44:46–50.

    Article  PubMed  Google Scholar 

  28. Abbott JA, Jarvis SK, Lyons SD, et al.: Botulinum toxin type A for chronic pelvic pain and pelvic floor spasm in women. Obstet Gynecol 2006, 108:915–923.

    Article  PubMed  Google Scholar 

  29. Zermann D, Ishigooka M, Schubert J, et al.: Perisphincteric injection of botulinum toxin type A: a treatment option for patients with chronic prostatic pain? Eur Urol 2000, 38:393–399.

    Article  PubMed  CAS  Google Scholar 

  30. Thomson AJM, Jarvis SK, Lenart M, et al.: The use of botulinum toxin type A (BOTOX) as treatment for intractable chronic pelvic pain associated with spasm of the levator ani muscles. BJOG 2005, 112:247–249.

    Article  PubMed  Google Scholar 

  31. Chen R, Nickel JC: Acupuncture ameliorates symptoms in men with chronic prostatitis/chronic pelvic pain syndrome. Urology 2003, 61:1156–1159.

    Article  PubMed  Google Scholar 

  32. Capodice JL, Jin Z, Bemis DL, et al.: A pilot study on acupuncture for lower urinary tract symptoms related to chronic prostatitis/chronic pelvic pain. Chin Med 2007, 2:1.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. The Arthur Smith Institute of Urology, North Shore and Long Island Jewish Health System, 425 Lakeville Road, New Hyde Park, New York, NY, 11040, USA

    Arun K. Srinivasan

Authors
  1. Arun K. Srinivasan
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  2. Jonathan D. Kaye
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  3. Robert Moldwin
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Correspondence to Arun K. Srinivasan.

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Srinivasan, A.K., Kaye, J.D. & Moldwin, R. Myofascial dysfunction associated with chronic pelvic floor pain: Management strategies. Current Science Inc 11, 359–364 (2007). https://doi.org/10.1007/s11916-007-0218-0

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  • DOI: https://doi.org/10.1007/s11916-007-0218-0

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