Abstract
Chronic pelvic pain (CPP) is defined as chronic pain and inflammation in the pelvic organs for more than six months. There are wide ranges of clinical presentations, including pelvic pain, painful intercourse, irritable bowel syndrome, and pain during urinating. Chronic pelvic pain syndrome (CPPS) is a subdivision of CPP, and the pain syndrome may be focused within a single organ or more than one pelvic organ. As there is uncertain pathogenesis, no standard treatment is currently available for CPPS. Botulinum toxin A (BoNT-A) is a potent neurotoxin that blocks acetylcholine release to paralyze muscles. Intravesical BoNT-A injection can reduce bladder pain in patients with interstitial cystitis/bladder pain syndrome. BoNT-A injected into the pelvic floor muscles of women has also been reported to improve chronic pain syndrome. Due to the reversible effect of BoNT-A, repeated injection appears to be necessary and effective in reducing symptoms. Adverse effects of BoNT-A may worsen the preexisting conditions, including constipation, stress urinary incontinence, and fecal incontinence. This review summarizes the evidence of BoNT-A treatment for CPPS in animal studies and clinical studies regarding the therapeutic effects of BoNT-A for CPPS in female patients.
Highlights
Chronic pelvic pain (CPP) is chronic or persistent pain perceived in pelvic structures for more than six months with continuous or recurrent pelvic pain as well as with symptoms suggestive of the lower urinary tract, sexual, bowel, pelvic floor or gynecological dysfunction in men and women [1]
Chronic pelvic pain syndrome (CPPS) is a subdivision of CPP and the pain syndrome may be focused within a single organ or more than one pelvic organ, including bladder, urethra, vagina, rectum, anus and whole pelvic musculatures [1]
Botulinum toxin A (BoNT-A) injected into the pelvic floor musculature of women with CPPS has been reported to improve chronic pelvic pain symptoms and spasms of pelvic floor muscle (PFM) [14]
Summary
Chronic pelvic pain (CPP) is chronic or persistent pain perceived in pelvic structures for more than six months with continuous or recurrent pelvic pain as well as with symptoms suggestive of the lower urinary tract, sexual, bowel, pelvic floor or gynecological dysfunction in men and women [1]. CPPS of women can exhibit different symptoms, including dyspareunia, dysmenorrhea, dyschezia, and non-menstrual pelvic pain. PFMs spasm may result from a primary event on the pelvic floor musculatures or secondary to other diseases related to psychological or pathological disorders It is another significant problem that may decrease quality of life and increase health care costs. If medications fail to provide symptom relief, nonpharmacologic managements, such as nerve blocks, suprapubic transcutaneous electrical nerve stimulation, sacral neuromodulation, and injection with Botulinum toxin A (BoNT-A) should be considered to help treat CPPS. Many women with CPPS reported diminution of pelvic pain symptoms after BoNT-A injection. BoNT-A injected into the pelvic floor musculature of women with CPPS has been reported to improve chronic pelvic pain symptoms and spasms of PFMs [14]. This review will focus on the BoNT-A treatment in female CPPS, especially in PFMs pain, IC/BPS, and sexual pain syndrome
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