SUFU 2021: Increased Pelvic Floor Tenderness Correlates With Urinary and Pelvic Pain Symptoms: Findings From the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Study

( Many patients with urologic chronic pelvic pain syndrome (UCPPS) have significant tenderness of the levator muscles with palpation (pelvic floor tenderness (PFT)). The prevalence of this finding and its correlation with urinary and pain symptoms has not been well studied. This study aimed to characterize the degree of PFT on examination in a large cohort of UCPPS patients and to correlate PFT findings with urologic and pain symptoms.

Participants underwent a standardized pelvic examination (PEX). Examiners palpated six locations in the pelvic floor examining the anterior and posterior levators and the obturator internus (OI) (bilaterally); in women vaginally and in men transrectally. Patients were assigned a score of 0 to 6 based on the number of sites with pain, split into low (0-1), mid (2,3,4,5), and high. The relationship between PFT and urologic and pelvic pain symptoms was examined using several validated questionnaires including the General-practice Users’ Perceived-need Inventory (GUPI), Brief Pain Index (BPI), AUA-SI, SF-12, ICSI, chronic pain syndromes, fibromyalgianess, and Hospital Anxiety and Depression Scale (HADS). 562 patients, 375 females, and 187 males were examined.

Diagnoses were IC/BPS (n=397), chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) (n=122), or both (n=34) conditions. A total of 107 patients were pseudoexfoliation (PEX) Low, 312 were PEX Mid and 143 PEX High. Patients in the PEX High group had increased pain symptoms on questionnaires, with pain interfering with general activity, work, and relationships. Increased urinary symptoms were noted on the GUPI urinary subscore and overall urinary severity composite score. PEX High patients reported worse quality of life and were more likely to have at least 2 chronic pain conditions, and higher depression and anxiety scores.

Presented by: Priyanka Gupta, Department of Urology, Robert Gallop, Department of Biostatistics, J. Quentin Clemens, Department of Urology, Henry Lai, Division of Urologic Surgery, Catherine Bradley, Claire Yang, Robert Moldwin, John Krieger, Tracy Spitznagle, Karl Kreder, Frank Tu, Siobhan Sutcliffe, Larissa Rodriguez, University of Michigan, University of Pennsylvania Perelman School of Medicine, University of Michigan, Washington University School of Medicine, University of Iowa, University of Washington, Northwell Center, Northwestern University, University of Southern California

Written by: Diane K. Newman, DNP, CRNP, FAAN, BCB-PMD, Nurse Practioner and Co-Director, Penn Center for Continence and Pelvic Health Adjunct Professor of Urology in Surgery during the 2021 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Winter Meeting.