1. 2022;25;E1315-E1322Pelvic Floor Myofascial Pain Might Influence Treatment Outcome of Interstitial Cystitis/Bladder Pain Syndrome: A Prospective Study
   Prospective Study
   Hann-Chorng Kuo, MD, Wei-Chuan Chang, MS, Wan-Ru Yu, MS, and Fei-Chi Chuang, MD.

BACKGROUND: In patients with interstitial cystitis or bladder pain syndrome (IC/BPS), 85% were found to have pelvic floor myofascial pain (PFMP) and hypertonicity (PFH). However, they physicians are not typically trained to consider or assess PFMP as a contributing factor to patients’ IC/BPS symptoms.

OBJECTIVE: This study aimed to explore the relationship between PFMP and treatment outcomes in women with IC/BPS.

STUDY DESIGN: A prospective study.

SETTING: Department of Urology, Medical Center, Hualien, Taiwan.

METHODS: Patients with IC/BPS who received any type of treatment were prospectively enrolled. They underwent vaginal digital examination at baseline. PFMP severity was quantified on the visual analog scale (VAS). Subject assessment items included O’Leary-Sant symptom score (OSS), Global Response Assessment (GRA), and Beck’s anxiety inventory. Object assessment items included bladder computed tomography (CT), urodynamic parameters, maximum bladder capacity, and grade of glomerulation.

RESULTS: A total of 65 women with IC/BPS (mean age, 57.1 ± 11.3 years) were enrolled in the study. Patients with more severe PFMP had significantly higher rate of dyspareunia (P = 0.031); more comorbidities (P = 0.010); higher number of PFMP sites (P < 0.001); and higher OSS (P = 0.012). PFMP severity was not significantly correlated with bladder conditions, whether subjective or objective. Moreover, PFMP severity (VAS) was significantly negatively associated with the GRA score.

LIMITATIONS: There was a small sample size and short follow-up duration, the patients in this study are all women, and the applicability to other populations is uncertain.

CONCLUSION: PFMP might affect the subjective results of IC/BPS treatment but not the bladder condition. Therefore, in the future treatment of patients with IC/BPS, digital vaginal examinations of pelvic floor muscles should be performed and focused more on the PFM-related conditions, and necessary PFM treatments, such as the vaginal pelvic floor muscle message, should be scheduled.

KEY WORDS: Interstitial cystitis/bladder pain syndrome, bladder pain, pelvic floor muscle, myofascial pain, trigger point, pelvic muscles hypertonicity, vaginal examination