Transcript Document

Physiotherapy for Pelvic Pain and Dyspareunia with
Associated Muscular Spasm
O’Connell JG, O’Sullivan S,O’Reilly B,
Wiseman S, Khashan A.
Introduction
Chronic Pelvic Pain is thought to make up 10% of all gynaecology referrals. Non-relaxing pelvic floor dysfunction is underappreciated as one of
the main causes for chronic pelvic pain.
This study aims to assess the effectiveness of manual therapy performed by a specialist physiotherapist for the treatment of chronic pelvic pain,
dyspareunia and pelvic floor dysfunction in women who are found to have muscle spasm and tenderness on examination, in the absence of other
pelvic pathology.
Methods
We used questions from the validated International Pelvic Pain Society (IPPS) and Queensland Female Pelvic Floor (QFPF) questionnaires to assess
pain, sexual dysfunction and quality of life issues. These were filled prior to treatment and after discharge or on completion of six sessions of
therapy.
The Wilcoxon signed-rank test was used to compare the scores reported by the participants before and after treatment.
Fig 1: Factors associated with the onset of pain
Fig 2: Pre and Post Treatment Medians for the IPPSQ
Table 1:Results from the QFPFQ
QFPFQ scores for 17 full protocol
patients
Pre- treatment Median
Post – treatment Median
Possible
P- Value
Bladder Dysfunction
Bowel Dysfunction
Prolapse symptoms
12( 2-20)
7(4-11)
2(0-3)
4(1-14)
6(1-10)
0(0-1)
42
36
15
0.039
0.378
`0.074
Sexual Dysfunction
10(8-11)
3(0-6)
19
0.002
Total Queensland
Female pelvic floor score
27(19-41)
11(9-23)
112
0.004
Results:
Of 31 women recruited,17 completed post treatment questionnaires. Two were lost to follow up. 12 remained in treatment. The mean age was
33.7 (SD=8). Patients were asked factors they associated with the onset of their pain with their responses in Figure 1 above. Statistically
significant (P<.05) improvements were detected in 16 areas. These were found in intercourse pain and in sexual and bladder dysfunctions.
We found statistically significant reduction in all cycle associated pain variables with no change in prolapse or bowel symptoms which required
further physiotherapy treatment beyond the scope of this paper.
Final results of the QFPFQ scores are summarised in table1.
Conclusions:
Manual therapy techniques in physiotherapy may be an effective treatment for sexual and bladder dysfunction in patients with NRPFD.
Specialist physiotherapy for NRPFD associated pelvic pain and dyspareunia is an area which merits research and potentially a future randomised
control trial.
References
1. Apte et al 2012,Chronic female pelvic pan –Part 1:Clinical Pathoanatomy
and Examination of the pelvic region. Pain Practice,Vol 12, Issue 2, pp. 88-110
2.Reiter RC. A profile of women with chronic pelvic pain. Clinical obstetrics and
gynecology. 1990;33(1):130-6. Epub 1990/03/01.
3. Bailliere's Clinical Obstetrics and Gynaecology, Vol. 14, No. 3, pp.
389±402, 2000
Contact:
Wiseman.S,
Physiotherapy Department,
Cork University Maternity
hospital, Cork, Rep.of Ireland.
Tel. No: + 353- 214920567
Email:[email protected]