Pelvic floor PT improves pelvic pain, voiding symptoms

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Study findings serve as a reminder of the importance of prompt and direct physical therapy referrals for pelvic floor pain patients, researchers say.

Pelvic floor physical therapy improves pelvic pain and voiding symptoms in women, according to research presented at the AUA annual meeting.

“Consult any source about pressing issues in America and appropriate management of chronic pain is at the top of the list. Urologists are not isolated from this trend, and we see many patients with chronic pelvic pain who are debilitated by their symptoms,” presenting author Natalie Gaines, MD, of Beaumont Hospital in Royal Oak, MI, told Urology Times. “However, unlike back pain or chronic migraines, pelvic pain affects the ‘private’ area of patients’ lives-their bowel, urinary, and sexual functions-and may be underreported or ignored until symptoms are truly severe and long-standing.”

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Dr. Gaines and colleagues conducted a retrospective chart review comparing symptom scores at intake and discharge among 95 women who had reported chronic pelvic pain as their primary issue and were receiving pelvic floor physical therapy at a single center.

Women in the study were from 18 to 80 years of age (mean age of 47 years). Many of the women reported not only pain but also other symptoms, such as urinary frequency, urinary urgency, constipation, and difficulty initiating urination. More than 82% had tried pain medications for their symptoms, and 48% had undergone pelvic floor physical therapy prior to the study.

They reported their pain scores at each visit and completed the validated Pelvic Floor Distress Inventory Short Form 20 and Pelvic Floor Impact Questionnaire at their first and discharge visits.

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“Pain levels, as reported on a zero to 10 visual analog scale, decreased significantly between the first and last visits, from a mean of 5 to 3.5. And pain on the patient’s worst day also significantly improved, from a mean of 8 to 4.8,” Dr. Gaines said. “Distressful pelvic symptoms improved as measured by the [Pelvic Floor Distress Inventory Short Form 20], with significant and large improvements seen in urinary symptoms. And overall improvement in quality of life from pelvic floor physical therapy was noted on both validated questionnaires.”

While many urologists are already referring chronic pelvic pain patients to pelvic floor physical therapists, this study serves as a reminder of the importance of prompt and direct PT referrals for this group of patients.

“A majority of patients with chronic pelvic pain have levator myalgia, which is a musculoskeletal issue. Treatment with pain medications, in addition to the risk to the patient and the liability incurred by the physician, merely masks this issue and fails to treat the underlying cause,” Dr. Gaines said. “Physical therapy rehabilitates at the source of the pain and is a more appropriate treatment.”

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In the long term, chronic pain causes neural remodeling in the cerebral cortex and spinal cord. While physical therapy can still improve pain and quality of life for patients with long-standing pain, complete pain resolution may be limited due to this central remodeling, she said.

“Patients with pelvic pain due to levator spasm are best treated with physical therapy; however, the presentation can be subtle. Because levator spasm can cause a myriad of symptoms, including constipation, urinary hesitancy from voiding against a tensed pelvic floor, symptoms of bladder overactivity due to inability to effectively empty from this same process, and sexual pain and dysfunction, it is important to query for these symptoms even in patients who seem to have bladder-centric pain on initial evaluation,” Dr. Gaines said.

Research is needed to examine a longer duration follow-up to evaluate how long physical therapy is efficacious for these patients, or if patients would benefit from a “refresher” course of PT after 18 months or 3 years, according to Dr. Gaines.