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

Abstract

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.