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Rapid Fire Oral Presentations 03: Disparities, Office Practice & Special Populations

Prevalence of Pelvic Floor Myofascial Pain in a Cohort Study of Adult Women

Friday, October 25, 2024
4:30 PM – 4:33 PM EDT
Location: Independence Ballroom A-D (Meeting Level 4)
Table 1. Distribution of Obturator internus and levator ani myofascial pain with palpation scores among 502 participants
Table 1 Distribution of OI and LA myofascial pain scores.docx
Table 2. Associations between demographic and clinical variables and pelvic floor myofascial pain (PFMP)
Table 2 Associations between demographic and clinical variables and pelvic floor myofascial pain.docx
Objectives: Pelvic floor myofascial pain (PFMP) is increasingly recognized in association with lower urinary tract symptoms (LUTS), including urinary urgency incontinence, overactive bladder, and interstitial cystitis/bladder pain syndrome (IC/BPS). Prevalence estimates of PFMP in clinical settings are reported as high as 85-87% in patients with chronic pelvic pain, IC/BPS, and other pelvic floor disorders, but prevalence in the general community-dwelling population is unknown. The RISE FOR HEALTH study, a regionally-representative population-based prospective cohort study conducted by the Prevention for Lower Urinary Tract Symptoms (PLUS) Research Consortium, included a survey and in-person assessment designed to capture social, physical and biological data potentially associated with bladder health. The objective of this study is to describe the prevalence of PFMP on muscle palpation in this population and examine factors associated with PFMP.

Methods: This was a planned sub-analysis of a subset of RISE participants (n=502) who enrolled in both the survey and in-person assessment. Pelvic floor muscle assessments included presence of prolapse, pelvic floor muscle strength, levator ani muscle attachment integrity (tear) and PFMP with palpation. Presence of pain with palpation in the obturator internus (OI) and levator ani (LA) was assessed bilaterally and reported using a numeric score of 0-10 (0=No pain, 1-3=Mild pain, 4-6=Moderate pain, 7-10=Severe pain); a discrete number was reported for each muscle assessment. Descriptive statistics (N (%)) were used for demographic and clinical characteristics of study participants and proportional odds logistic regression was used to examine correlates of OI and LA PFMP.

Results: The mean age of participants was 50.4±17.5 years. Most identified as cis-gendered female (98%) and non-Hispanic White (72%); 62% were overweight/obese, and 53% were vaginally parous. Over two-thirds had college or graduate-level education, almost two-thirds were employed, 24% retired, and 84% were insured. Less than half (45%) reported discussing bladder-related concerns with a healthcare provider and only 3% reported having a diagnosis of IC/BPS. Over half reported no pain with palpation in the OI and LA muscles, approximately 25% had mild-range pain in the OI and LA muscle groups while 9-13% reported moderate-to-severe pain in the OI muscles and 8-9% reported moderate-to-severe pain in the LA muscles (Table 1). Overweight body mass index (BMI) was the only factor associated with an increased odds of having pelvic floor myofascial pain with palpation (Table 2).

Conclusions: This study provides US population-based estimates of PFMP with palpation in adult community-dwelling women. While most had no PFMP in either the OI or LA muscles, a significant proportion had some degree of PFMP, and being overweight, but not obese, was associated with higher prevalence of PFMP. Future work will determine if there is an association between the presence or absence of PFMP with palpation and bladder health or LUTS.
Disclosure(s):
Melanie R. Meister, MD, MSCI: No relevant disclosure to display
Sara M. Elgayar, M.Sc.: No financial relationships to disclose
Colleen M. Fitzgerald, MD: No financial relationships to disclose
Cynthia S. Fok, MD MPH: No relevant disclosure to display
D. Yvette Lacoursiere, MD, MPH: No financial relationships to disclose
Kimberly Kenton, MD, MS: No relevant disclosure to display
Lisa Kane Low, PhD CNM FACNM FAAN: No financial relationships to disclose
Emily Lukacz, MD: No relevant disclosure to display
Gerald McGwin, M.S., PhD: No financial relationships to disclose
Jenna Norton, PhD, MPH: No relevant disclosure to display
Diane K. Newman, DNP: No financial relationships to disclose
Ariana L. Smith, MD: No relevant disclosure to display
Jean F. Wyman, PhD: No financial relationships to disclose
Siobhan Sutcliffe, PhD: No financial relationships to disclose
Jerry L. Lowder, MD, MSc: No financial relationships to disclose

    Rapid Fire Presenter(s)

  • Melanie R. Meister, MD, MSCI (she/her/hers)

    Associate Professor
    University of Kansas
    Overland Park, Kansas, United States

    Disclosure(s): No relevant disclosure to display

    • Co-Author(s)

  • SE

    Sara M. Elgayar, M.Sc. (she/her/hers)

    Biostatistician
    Division of Geriatrics and Palliative Care, University of Alabama at Birmingham
    Vestavia Hills, Alabama, United States

    Disclosure(s): No financial relationships to disclose

  • CF

    Colleen M. Fitzgerald, MD

    Professor
    Loyola University Chicago Stritch School of Medicine
    Maywood, Illinois, United States

    Disclosure(s): No financial relationships to disclose

  • CF

    Cynthia S. Fok, MD MPH (she/her/hers)

    Associate Professor Department of Urology
    University of Minnesota
    Minneapolis, Minnesota, United States

    Disclosure(s): No relevant disclosure to display

  • DL

    D. Yvette Lacoursiere, MD, MPH

    Professor and Vice Chair, Clinical Affairs
    UC San Diego
    La Jolla, California, United States

    Disclosure(s): No financial relationships to disclose

  • KK

    Kimberly Kenton, MD, MS

    Professor
    University of Chicago
    Chicago, Illinois, United States

    Disclosure(s): No relevant disclosure to display

  • LK

    Lisa Kane Low, PhD CNM FACNM FAAN

    Professor
    University of Michigan
    Ann Arbor, Michigan, United States

    Disclosure(s): No financial relationships to disclose

  • Emily Lukacz, MD

    Professor, Division Director Urogynecology
    University of California San Diego
    La Jolla, California, United States

    Disclosure(s): No relevant disclosure to display

  • GM

    Gerald McGwin, M.S., PhD

    Professor
    Department of Epidemiology, University of Alabama at Birmingham
    Birmingham, Alabama, United States

    Disclosure(s): No financial relationships to disclose

  • JN

    Jenna Norton, PhD, MPH

    Program Director
    NIH/NIDDK
    Bethesda, Maryland, United States

    Disclosure(s): No relevant disclosure to display

  • DN

    Diane K. Newman, DNP

    Adjunct Professor of Surgery
    University of Pennsylvania
    Berwyn, Pennsylvania, United States

    Disclosure(s): No financial relationships to disclose

  • Ariana L. Smith, MD (she/her/hers)

    Professor of Urology
    University of Pennsylvania
    Philadelphia, Pennsylvania, United States

    Disclosure(s): No relevant disclosure to display

  • JW

    Jean F. Wyman, PhD

    Professor and Cora Meidl Siehl Chair in Research Emerita
    University of Minnesota
    North Oaks, Minnesota, United States

    Disclosure(s): No financial relationships to disclose

  • SS

    Siobhan Sutcliffe, PhD

    Professor
    Washington University
    Saint Louis, Missouri, United States

    Disclosure(s): No financial relationships to disclose

  • Jerry L. Lowder, MD, MSc (he/him/his)

    Professor
    Washington University in St Louis School of Medicine
    St Louis, Missouri, United States

    Disclosure(s): No financial relationships to disclose