Chronic pelvic pain affects a significant number of women, with a prevalence, which is described to be between 5,7% and 26,6% worldwide. Although the etiology of chronic pelvic pain is mostly multifactorial. One source of pain seems to be the presence of myofascial trigger points, which, however, are often overlooked or ignored. There is evidence, that women with pelvic floor symptoms often experience pain and have positive trigger points upon pelvic floor examination. However, the correlation of these findings has not yet been systematically examined and sufficiently understood.  
The aim of this study is to examine the correlation between myofascial trigger points and pelvic floor symptoms using a standardized pelvic floor examination method and a validated pelvic floor questionnaire.

The study was performed in the outpatient urogynecological department of our clinic. Study participants underwent a standardized physical examination assessing myofascial trigger points in different muscle groups including pubococcygeous, iliococcygesous, obturator as well as at the bladder base.  In addition, pelvic floor muscle tone was assessed.  Participants also filled out the standardized German version of the Australian pelvic floor questionnaire, which consists of a total of 43 questions regarding bladder-, bowel- and sexual function as well as prolapse symptoms. The questionnaire provides a scoring system for each category (0-10) as well as a total score (0-40). Demographic data was retrieved from the patients’ medical records. Statistical analysis was performed using the Mann-Whitney-U test and chi-squared or exact Fisher’s test. All evaluations were done using the statistical software R.

A total of 110 women were included in the study. Mean age was 55.9 (SD ± 17) years. Pelvic floor muscle tone was assessed as normal in 71 (64.5%) and high in 39 (35.5%) of the participants. The mean score of the pelvic floor questionnaire was 8.23 (SD ± 3.94). The overall questionnaire score showed a significant correlation with pain at all muscle groups (except bladder base). All four domain scores (bladder, bowel, prolapse and sexual function) were significantly correlated with painful trigger points in different muscle groups. Age was not significantly correlated with pain or pelvic floor symptoms, except from sexual function, where the correlation was negative (p<0.001). A significant correlation could also be found between high pelvic floor muscle tone and the overall questionnaire score (p<0.001) as well as the bladder function score (p<0.001) and various pain scores of the different groups. Table 1 shows an overview of the most important findings.

The existence of myofascial pelvic floor trigger points seems to be reflective of pelvic floor symptoms, as assessed with a standardized pelvic floor questionnaire.

Further research in order to examine and understand the mechanism of this correlation may help in the diagnosis and also offer more effective therapeutic options.

Continence 2S2 (2022) 100266
DOI: 10.1016/j.cont.2022.100266