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Morsy H, Meister M, Spitznagle T, Scott C, Zhang T, Ghetti C, Chu C, Sutcliffe S, Lowder JL. A Pilot Randomized Controlled Trial of Vaginal Cryotherapy for the Treatment of Pelvic Floor Myofascial Pain. Int Urogynecol J 2024; 35:215-225. [PMID: 38133837 PMCID: PMC11232877 DOI: 10.1007/s00192-023-05692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/02/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic floor myofascial pain (PFMP) is a common but underrecognized component of chronic pelvic pain and pelvic floor disorders symptoms with limited, well-studied treatment modalities. Our objective was to determine the effect of vaginal cryotherapy on PFMP with palpation. METHODS Following a standardized PFMP screening examination, individuals with a pain score ≥4/10 in ≥1 of four muscle groups were invited to participate in a randomized controlled trial comparing patients undergoing vaginal cryotherapy with controls. Participants in both arms could choose to participate in a single in-office treatment; a 2-week, at-home daily treatment; or both. RESULTS Between March 2019 and September 2021, a total of 163 participants were enrolled and randomized: 80 to cryotherapy, and 83 to the control group. Sixty-three (28 cryotherapy; 35 controls) completed in-office treatment and 56 (32 cryotherapy; 24 controls) completed at-home therapy. In the in-office comparison, mean pain scores decreased significantly in both arms: cryotherapy (5.13 vs 4.10; p=0.02) and controls (5.60 vs 4.72; p<0.01), with a similar magnitude of reduction between arms (p=0.75). In the at-home comparison, mean pain scores decreased significantly in the cryotherapy arm (6.34 vs 4.75; p<0.01), and nonsignificantly in the control arm (5.41 vs 4.66; p=0.07), resulting in a nonsignificant difference between arms (p=0.14). CONCLUSIONS Pelvic floor myofascial pain with palpation improved following both a single cryotherapy session and 2 weeks of daily cryotherapy. Interestingly, pain scores also improved with room temperature therapy. Whether these findings reflect a therapeutic effect of both cold and room temperature intravaginal therapy or a placebo effect is unclear but should be explored in larger studies.
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Affiliation(s)
- Haidy Morsy
- Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University in St. Louis School of Medicine, MSC 8064-37-1005, 4901 Forest Park Avenue, COH, 10th Floor, St. Louis, MO, 63108, USA
- Geisinger, Wilkes Barre, PA, USA
| | - Melanie Meister
- Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Carter Scott
- Oregon Health Sciences University, Portland, OR, USA
| | - Tianyi Zhang
- Brown School, Washington University, St. Louis, MO, USA
- Department of Surgery, Division of Public Health Sciences, Washington University, St. Louis, MO, USA
| | - Chiara Ghetti
- Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University in St. Louis School of Medicine, MSC 8064-37-1005, 4901 Forest Park Avenue, COH, 10th Floor, St. Louis, MO, 63108, USA
| | - Christine Chu
- Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of North Carolina at Chapel-Hill, Chapel Hill, NC, USA
| | - Siobhan Sutcliffe
- Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University in St. Louis School of Medicine, MSC 8064-37-1005, 4901 Forest Park Avenue, COH, 10th Floor, St. Louis, MO, 63108, USA
- Department of Surgery, Division of Public Health Sciences, Washington University, St. Louis, MO, USA
| | - Jerry L Lowder
- Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University in St. Louis School of Medicine, MSC 8064-37-1005, 4901 Forest Park Avenue, COH, 10th Floor, St. Louis, MO, 63108, USA.
- Department of Surgery, Division of Public Health Sciences, Washington University, St. Louis, MO, USA.
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Carroll L, Sullivan CO, Doody C, Perrotta C, Fullen BM. Pelvic organ prolapse: Women's experiences of Accessing Care & Recommendations for improvement. BMC Womens Health 2023; 23:672. [PMID: 38114966 PMCID: PMC10729347 DOI: 10.1186/s12905-023-02832-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023] Open
Abstract
Up to 50% of women will develop pelvic organ prolapse (POP) over their lifetime. Symptoms include pain, bulge, urinary, bowel and sexual symptoms affecting all aspects of a woman's life.Many women with POP symptoms present initially to primary care settings. Research has shown these interactions are often unsatisfactory, with women reporting their health care professional (HCP) trivialized their symptoms or appeared to have poor knowledge about pelvic floor dysfunction (PFD).Aim The aim of this qualitative study was to explore experiences of younger women seeking treatment for POP and their recommendations for improvements.Methods Ethics approval was obtained (LS-21-01-Carroll-Ful). Women with POP were recruited from an online support group (n = 930 members). Inclusion criteria: adult women, diagnosed with POP and aware of their POP stage. Following informed consent, a demographic questionnaire, interview questions and the Central Sensitization Inventory (CSI) were forwarded. Semi-structured zoom audio-recorded interviews were conducted. Thematic analysis was undertaken; transcripts coded, and themes identified.Results Fourteen women aged 32-41, parity 1-3, with POP Grade 1-3 participated. Many women reported HCPs as dismissive or not appreciative of the impact of their condition. Others described interactions with HCPs who they felt listened, understood the impact of their POP, gave simple explanations, a positive prognosis and outlined a realistic treatment plan.Current antenatal education, post-partum care and primary HCP screening for PFD were identified by women as deficient. Many highlighted delays in accessing specialist care for POP. Women made several recommendations for improvements to the current model of care.Conclusions Increased focus on person-centred care, particularly emotional support, information and education may improve younger women's experiences when seeking care for POP.
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Affiliation(s)
- Louise Carroll
- University College Dublin School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland.
- University College Dublin Centre for Translational Pain Research, Dublin, Ireland.
- Tipperary University Hospital, Clonmel, Co. Tipperary, Clonmel, Ireland.
| | - Cliona O' Sullivan
- University College Dublin School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
| | - Catherine Doody
- University College Dublin School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
- University College Dublin Centre for Translational Pain Research, Dublin, Ireland
| | - Carla Perrotta
- University College Dublin School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
| | - Brona M Fullen
- University College Dublin School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
- University College Dublin Centre for Translational Pain Research, Dublin, Ireland
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Collins SA, O'Shea M, Dykes N, Ramm O, Edenfield A, Shek KL, van Delft K, Beestrum M, Kenton K. International Urogynecological Consultation: clinical definition of pelvic organ prolapse. Int Urogynecol J 2021; 32:2011-2019. [PMID: 34191102 DOI: 10.1007/s00192-021-04875-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/20/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This segment of Chapter 1 of the International Urogynecology Consultation (IUC) on pelvic organ prolapse (POP) reviews the literature on the clinical definition of POP with the intent of creating standard terminology. METHODS An international group containing nine urogynecologists and one university-based medical librarian performed a search of the literature using pre-specified search terms in PubMed, Embase, and Scopus. Publications were eliminated if not relevant to the clinical definition of POP, and those articles remaining were evaluated for quality using the Specialist Unit for Review Evidence (SURE). The resulting list of articles was used to inform a comprehensive review and creation of the clinical definition of POP. RESULTS The original search yielded 31,931 references, of which 167 were used by the writing group. Ultimately, 78 are referenced in the manuscript. CONCLUSIONS The clinical definition of POP for this review of the literature is: "anatomical prolapse with descent of at least one of the vaginal walls to or beyond the vaginal hymen with maximal Valsalva effort WITH the presence either of bothersome characteristic symptoms, most commonly the sensation of vaginal bulge, or of functional or medical compromise due to prolapse without symptom bother."
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Affiliation(s)
- Sarah A Collins
- Northwestern Feinberg School of Medicine, 250 E. Superior St. Suite 05-2113, Chicago, IL, 60611, USA.
| | - Michele O'Shea
- Department of Obstetrics and Gynecology, Duke University Health System, Raleigh, NC, USA
| | | | - Olga Ramm
- Division of Urogynecology, Department of Obstetrics and Gynecology, Kaiser Permanente East Bay, Alameda, CA, USA
| | - Autumn Edenfield
- Division of Urogynecology, Department of Obstetrics and Gynecology, Medical University of South Carolina, Mt Pleasant, SC, 29464, USA
| | - Ka Lai Shek
- Department of Obstetrics and Gynecology, Liverpool Hospital, University of Western Sydney, Liverpool, NSW, 2170, Australia
| | - Kim van Delft
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Molly Beestrum
- Northwestern Feinberg School of Medicine, 250 E. Superior St. Suite 05-2113, Chicago, IL, 60611, USA
| | - Kimberly Kenton
- Northwestern Feinberg School of Medicine, 250 E. Superior St. Suite 05-2113, Chicago, IL, 60611, USA
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McAlarnen LA, Ricci Goodman J, Sarwark A, Winder AD, Potkul RK, Liotta MR. Pelvic floor myofascial pain in gynecology oncology patients: A pilot study. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2021. [DOI: 10.1177/2284026520984412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Here we present a pilot study investigating the prevalence of pelvic floor myofascial pain in patients presenting to an academic tertiary care gynecologic oncology clinic. We describe patients’ responses to a pain survey including the pain disability index. Methods: An IRB approved prospective survey and chart review was conducted. Patients underwent standard physical exam maneuvers for detection of pelvic floor myofascial pain. Consented patients completed a pain survey and pain disability index on presentation to clinic. Statistical analysis included Chi square test and Mann Whitney test. Results: Twenty-nine percent (45/155) of patients exhibited pelvic floor myofascial pain, while 71% (110/155) did not. Of those with malignancy, 28% (16/57) had pelvic floor myofascial pain and 72% (41/57) did not. Patients with pelvic floor myofascial pain had a significantly higher rating of “pain right now” ( p = 0.001) and “usual level of pain during the past week” ( p = 0.003) than those without such pain. Patients with pelvic floor myofascial pain had significantly greater disability in family/home responsibilities ( p = 0.01), recreation ( p = 0.001), social activity ( p = 0.008), occupation ( p = 0.015), sexual behavior ( p = 0.025), and life support activities ( p = 0.007) compared to those without pelvic floor myofascial pain. Conclusion: Pelvic floor myofascial pain affects 28% of patients with malignancy. Routine incorporation of a myofascial exam can identity those with such pain, which can lead to improved quality of life in gynecologic oncology patients with pelvic floor disorders.
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Affiliation(s)
- Lindsey A. McAlarnen
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jean Ricci Goodman
- Department of Obstetrics and Gynecology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Anne Sarwark
- Department of Anesthesia, New York Medical College at Metropolitan Hospital, New York, NY, USA
| | - Abigail D. Winder
- Department of Obstetrics and Gynecology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Ronald K. Potkul
- Department of Obstetrics and Gynecology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Margaret R. Liotta
- Department of Obstetrics and Gynecology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
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Meister MR, Brubaker A, Sutcliffe S, Lowder JL. Effectiveness of Botulinum Toxin for Treatment of Symptomatic Pelvic Floor Myofascial Pain in Women: A Systematic Review and Meta-analysis. Female Pelvic Med Reconstr Surg 2021; 27:e152-e160. [PMID: 32301801 PMCID: PMC7793632 DOI: 10.1097/spv.0000000000000870] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aims of the study were to systematically review the literature and to synthesize the evidence for the effectiveness of botulinum toxin injection to the pelvic floor muscles for treating pelvic floor myofascial pain in female patients. METHODS This systematic literature search was performed in February 2018 and updated in September 2019. Articles were screened based on predefined criteria: (1) adult population, (2) female patients, (3) treatment of pelvic pain by transvaginal botulinum toxin injection into the pelvic floor, (4) published in English or English translation available, (5) study design including randomized controlled trials, cohort studies, and case series with more than 10 participants, and (6) quantitative report of pain scores. Nine studies were included in the primary analysis, and an unpublished study was included in a sensitivity analysis. A random effects model with robust variance estimation was used to estimate the pooled mean difference in patient-reported pain scores after botulinum toxin injection. RESULTS A statistically significant reduction in patient-reported pain scores was noted at 6 weeks after botulinum toxin injection (mean difference, 20.3; 95% confidence interval, 11.7-28.9) and continued past 12 weeks (mean difference, 19.4; 95% confidence interval, 14.6-24.2). Significant improvement was noted in secondary outcomes including dyspareunia, dyschezia, and quality of life. CONCLUSIONS This systematic review and meta-analysis support the conduct of future, large-scale randomized controlled trials to determine the efficacy and optimize administration of botulinum toxin injections for treatment of pelvic floor myofascial pain and associated symptoms in women.
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Affiliation(s)
- Melanie R Meister
- From the Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Kansas School of Medicine
| | - Allison Brubaker
- Department of Obstetrics & Gynecology, Washington University in St. Louis
| | - Siobhan Sutcliffe
- Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis
| | - Jerry L Lowder
- Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine & Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO
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