Characterization of Bladder and Pelvic Floor Dysfunction in Women With Chronic Pelvic Pain

Abstract

Objective: The purpose of this study was to elucidate the link between voiding dysfunction and lower urinary tract symptoms (LUTSs) associated with chronic pelvic pain (CPP). Study Design: Retrospective cohort study. Background: Although a gynecologic etiology is the most common cause of pelvic pain, there exists a population of patients for which these diagnoses have been ruled out, which extremely limits their diagnostic and therapeutic options. Methods and Measures: A total of 105 consecutive female patients who underwent video urodynamics for evaluation of CPP between January 2010 and December 2015 participated in the study. Following urodynamics, patients with LUTSs and associated CPP were divided into 3 urodynamic diagnostic categories post hoc and compared with standard questionnaires and urodynamic findings across each group. Results: Mean age of the cohort was 53 ± 16.60 years, and mean body mass index was 26.05 ± 5.45 kg/m2. Of the 105 patients, 50 patients were found to have detrusor overactivity, 41 patients had detrusor underactivity, and 14 patients were found to have dysfunctional voiding. The patients with detrusor overactivity had lower bladder capacity, as well as earlier desires to void, compared with the other groups. A total of 79% of patients with dysfunctional voiding and 7.4% of patients with detrusor underactivity had discordant electromyogram activity. Conclusions: In addition, preliminary data show that many of the patients may have underlying pelvic floor muscle dysfunction leading to their LUTS. Given the discordant therapy for LUTS versus CPP, this study presents the preliminary work to demonstrate muscular skeletal dysfunction associated with LUTS.