Skip to main content

Advertisement

SpringerLink
Log in

Are fascial strains involved in chronic pelvic pain syndrome? An exploratory matched case–control study

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Background

Chronic pelvic pain (CPP) and chronic pelvic pain syndrome (CPPS) do not have a definite cause, even if their impact on quality of life was demonstrated. Furthermore, there is evidence of myofascial dysfunctions in a large number of CPP/CPPS, so that the role of fascia can be hypothesized.

Methods

The aim of this exploratory matched case–control study was to assess whether fascial strains (FS) represent a factor associated with CPP/CPPS. The study followed the “Strengthening the Reporting of Observational Studies in Epidemiology” (STROBE) statement. We collected data from 189 subjects (cases: 58; controls: 131) who attended the clinic. The participants were managed through a 2:1 enrollment ratio. A standardized booklet requested for clinical information, previous FS and the following questionnaires: “National Institutes of Health Chronic Prostatitis Symptom Index” (NIH-CPSI), “Hospital Anxiety and Depression Scale” (HADS), “Fear Avoidance Belief Questionnaire” (FABQ). Each subject underwent a palpatory assessment to detect abnormal palpatory findings in the pelvic area.

Results

The analyses showed that episiotomy, genito-urinary infections and surgery had a significantly increased odds ratio (OR) of 4.13, 3.1 and 3.08, respectively. FS as a whole had a significantly raised OR: 2.22 (1.14 to 4.33). The analysis was adjusted for physical activity and for type of job and OR decreased to 1.94 (0.82 to 4.61), losing its significance (p = 0.129). A strong correlation between symptoms’ impact and CPP/CPPS was detected (rpbs = 0.710; p < 0.001) and a moderate one (0.3 < rpbs < 0.7; p < 0.001) was found considering anxiety, depression and abnormal palpatory findings.

Conclusion

This exploratory study suggests that FS could represent an etiological factor for developing CPP/CPPS. However, further research on fascial dysfunctions and relative implications in CPP/CPPS is needed for confirmation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author, [FDF], upon reasonable request.

References

  1. Fall M, Baranowski AP, Fowler CJ, Lepinard V, Malone-Lee JG, Messelink EJ, Oberpenning F, Osborne JL, Schumacher S (2004) European association of urology. EAU guidelines on chronic pelvic pain. Eur Urol 46(6):681–689. https://doi.org/10.1016/j.eururo.2004.07.030. (PMID: 15548433)

    Article  CAS  PubMed  Google Scholar 

  2. Engeler DS, Baranowski AP, Dinis-Oliveira P, Elneil S, Hughes J, Messelink EJ, van Ophoven A, Williams AC (2013) European association of urology. The 2013 EAU guidelines on chronic pelvic pain: is management of chronic pelvic pain a habit, a philosophy, or a science? 10 years of development. Eur Urol 64(3):431–439. https://doi.org/10.1016/j.eururo.2013.04.035. (Epub 2013 Apr 28. PMID: 23684447)

    Article  PubMed  Google Scholar 

  3. Polackwich AS, Shoskes DA (2016) Chronic prostatitis/chronic pelvic pain syndrome: a review of evaluation and therapy. Prostate Cancer Prostatic Dis 19(2):132–138. https://doi.org/10.1038/pcan.2016.8. (Epub 2016 Mar 8 PMID: 26951713)

    Article  CAS  PubMed  Google Scholar 

  4. Jarrell JF, Vilos GA, Allaire C, Burgess S, Fortin C, Gerwin R, Lapensee L, Lea RH, Leyland NA, Martyn P, Shenassa H, Taenzer P (2018) N.o 164-consensus guidelines for the management of chronic pelvic pain. J Obstet Gynaecol Can 40(11):e747–e787. https://doi.org/10.1016/j.jogc.2018.08.015. (PMID: 30473127)

    Article  PubMed  Google Scholar 

  5. Latthe P, Latthe M, Say L, Gülmezoglu M, Khan KS (2006) WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity. BMC Public Health 6(6):177. https://doi.org/10.1186/1471-2458-6-177. (PMID:16824213;PMCID:PMC1550236)

    Article  PubMed  PubMed Central  Google Scholar 

  6. Mathias SD, Kuppermann M, Liberman RF, Lipschutz RC, Steege JF (1996) Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol 87(3):321–327. https://doi.org/10.1016/0029-7844(95)00458-0. (PMID: 8598948)

    Article  CAS  PubMed  Google Scholar 

  7. Zondervan KT, Yudkin PL, Vessey MP, Dawes MG, Barlow DH, Kennedy SH (1999) Prevalence and incidence of chronic pelvic pain in primary care: evidence from a national general practice database. Br J Obstet Gynaecol 106(11):1149–1155. https://doi.org/10.1111/j.1471-0528.1999.tb08140.x. (PMID: 10549959)

    Article  CAS  PubMed  Google Scholar 

  8. Doiron RC, Tripp DA, Tolls V, Nickel JC (2018) The evolving clinical picture of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): a look at 1310 patients over 16 years. Can Urol Assoc J 12(6):196–202. https://doi.org/10.5489/cuaj.4876

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lamvu G, Carrillo J, Ouyang C, Rapkin A (2021) Chronic pelvic pain in women: a review. JAMA 325(23):2381–2391. https://doi.org/10.1001/jama.2021.2631. (PMID: 34128995)

    Article  PubMed  Google Scholar 

  10. Siqueira-Campos VME, Da Luz RA, de Deus JM, Martinez EZ, Conde DM (2019) Anxiety and depression in women with and without chronic pelvic pain: prevalence and associated factors. J Pain Res 16(12):1223–1233. https://doi.org/10.2147/JPR.S195317.PMID:31114304;PMCID:PMC6490234

    Article  Google Scholar 

  11. Benjamin M (2009) The fascia of the limbs and back–a review. J Anat 214(1):1–18. https://doi.org/10.1111/j.1469-7580.2008.01011.x. (PMID:19166469;PMCID:PMC2667913)

    Article  PubMed  PubMed Central  Google Scholar 

  12. Stecco A, Macchi V, Stecco C, Porzionato A, Ann Day J, Delmas V, De Caro R (2009) Anatomical study of myofascial continuity in the anterior region of the upper limb. J Bodyw Mov Ther 13(1):53–62. https://doi.org/10.1016/j.jbmt.2007.04.009. (Epub 2007 Jun 28 PMID: 19118793)

    Article  PubMed  Google Scholar 

  13. Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R (2012) The thoracolumbar fascia: anatomy, function and clinical considerations. J Anat 221(6):507–536. https://doi.org/10.1111/j.1469-7580.2012.01511.x. (Epub 2012 May 27. PMID: 22630613; PMCID: PMC3512278)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Tozzi P (2012) Selected fascial aspects of osteopathic practice. J Bodyw Mov Ther 16(4):503–519. https://doi.org/10.1016/j.jbmt.2012.02.003. (Epub 2012 Feb 26 PMID: 23036882)

    Article  PubMed  Google Scholar 

  15. Butrick CW (2009) Pelvic floor hypertonic disorders: identification and management. Obstet Gynecol Clin North Am 36(3):707–722. https://doi.org/10.1016/j.ogc.2009.08.011. (PMID: 19932423)

    Article  PubMed  Google Scholar 

  16. Bassaly R, Tidwell N, Bertolino S, Hoyte L, Downes K, Hart S (2011) Myofascial pain and pelvic floor dysfunction in patients with interstitial cystitis. Int Urogynecol J 22(4):413–418. https://doi.org/10.1007/s00192-010-1301-3. (Epub 2010 Oct 26 PMID: 20976441)

    Article  PubMed  Google Scholar 

  17. Kwon SY, Lee JN, Kim HT, Kim TH, Kim BW, Choi GS, Kwon TG (2014) Endopelvic fascia preservation during robot-assisted laparoscopic radical prostatectomy: does it affect urinary incontinence? Scand J Urol 48(6):506–512. https://doi.org/10.3109/21681805.2014.913259. (Epub 2014 Jul 10 PMID: 25008957)

    Article  PubMed  Google Scholar 

  18. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) STROBE initiative. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 335(7624):806–808. https://doi.org/10.1136/bmj.39335.541782.AD. (PMID: 17947786; PMCID: PMC2034723)

    Article  Google Scholar 

  19. Giubilei G, Mondaini N, Crisci A, Raugei A, Lombardi G, Travaglini F, Del Popolo G, Bartoletti R (2005) The Italian version of the national institutes of health chronic prostatitis symptom index. Eur Urol 47(6):805–811. https://doi.org/10.1016/j.eururo.2004.12.025. (Epub 2005 Jan 14 PMID: 15925077)

    Article  PubMed  Google Scholar 

  20. Iani L, Lauriola M, Costantini M (2014) A confirmatory bifactor analysis of the hospital anxiety and depression scale in an italian community sample. Health Qual Life Outcomes 5(12):84. https://doi.org/10.1186/1477-7525-12-84.PMID:24902622;PMCID:PMC4054905

    Article  Google Scholar 

  21. Monticone M, Baiardi P, Bonetti F, Ferrari S, Foti C, Pillastrini P, Rocca B, Vanti C, Zanoli G (2012) The Italian version of the fear-avoidance beliefs questionnaire (FABQ-I): cross-cultural adaptation, factor analysis, reliability, validity, and sensitivity to change. Spine Phila Pa 1976 37(6):E374–E380. https://doi.org/10.1097/BRS.0b013e31822ff5a7. (PMID: 22422439)

    Article  PubMed  Google Scholar 

  22. Tramontano M, Tamburella F, Dal Farra F, Bergna A, Lunghi C, Innocenti M, Cavera F, Savini F, Manzo V, D’Alessandro G (2021) International overview of somatic dysfunction assessment and treatment in osteopathic research: a scoping review. Healthcare (Basel) 10(1):28. https://doi.org/10.3390/healthcare10010028. (PMID:35052192;PMCID:PMC8775713)

    Article  PubMed  Google Scholar 

  23. Adstrum S, Hedley G, Schleip R, Stecco C, Yucesoy CA (2017) Defining the fascial system. J Bodyw Mov Ther 21(1):173–177. https://doi.org/10.1016/j.jbmt.2016.11.003. (Epub 2016 Nov 16 PMID: 28167173)

    Article  PubMed  Google Scholar 

  24. Schleip R, Jäger H, Klingler W (2012) What is “fascia”? A review of different nomenclatures. J Bodyw Mov Ther 16(4):496–502. https://doi.org/10.1016/j.jbmt.2012.08.001. (Epub 2012 Aug 22 PMID: 23036881)

    Article  PubMed  Google Scholar 

  25. Fan C, Guidolin D, Ragazzo S, Fede C, Pirri C, Gaudreault N, Porzionato A, Macchi V, De Caro R, Stecco C (2020) Effects of cesarean section and vaginal delivery on abdominal muscles and fasciae. Medicina (Kaunas) 56(6):260. https://doi.org/10.3390/medicina56060260

    Article  PubMed  Google Scholar 

  26. Bogduk N, Macintosh JE (1984) The applied anatomy of the thoracolumbar fascia. Spine (Phila Pa 1976) 9(2):164–170. https://doi.org/10.1097/00007632-198403000-00006. (PMID: 6729580)

    Article  CAS  PubMed  Google Scholar 

  27. Vleeming A, Pool-Goudzwaard AL, Stoeckart R, van Wingerden JP, Snijders CJ (1995) The posterior layer of the thoracolumbar fascia. Its function in load transfer from spine to legs. Spine (Phila Pa 1976) 20(7):753–758 (PMID: 7701385)

    Article  CAS  PubMed  Google Scholar 

  28. Brown SH, Ward SR, Cook MS, Lieber RL (2011) Architectural analysis of human abdominal wall muscles: implications for mechanical function. Spine (Phila Pa 1976) 36(5):355–362. https://doi.org/10.1097/BRS.0b013e3181d12ed7

    Article  PubMed  Google Scholar 

  29. Possover M, Forman A (2015) Pelvic neuralgias by neuro-vascular entrapment: anatomical findings in a series of 97 consecutive patients treated by laparoscopic nerve decompression. Pain Physician 18(6):E1139–E1143 (PMID: 26606029)

    Article  PubMed  Google Scholar 

  30. Shafik A (2002) Pudendal canal syndrome: a cause of chronic pelvic pain. Urology 60(1):199. https://doi.org/10.1016/s0090-4295(02)01604-7. (PMID: 12100963)

    Article  PubMed  Google Scholar 

  31. Origo D, Tarantino AG (2019) Osteopathic manipulative treatment in pudendal neuralgia: a case report. J Bodyw Mov Ther 23(2):247–250. https://doi.org/10.1016/j.jbmt.2018.02.016. (Epub 2018 Feb 17 PMID: 31103103)

    Article  CAS  PubMed  Google Scholar 

  32. Stecco A, Gesi M, Stecco C, Stern R (2013) Fascial components of the myofascial pain syndrome. Curr Pain Headache Rep 17(8):352. https://doi.org/10.1007/s11916-013-0352-9. (PMID: 23801005)

    Article  PubMed  Google Scholar 

  33. Kondrup F, Gaudreault N, Venne G (2022) The deep fascia and its role in chronic pain and pathological conditions: a review. Clin Anat 35(5):649–659. https://doi.org/10.1002/ca.23882. (Epub 2022 Apr 27 PMID: 35417568)

    Article  PubMed  Google Scholar 

  34. Bove GM (2008) Epi-perineurial anatomy, innervation, and axonal nociceptive mechanisms. J Bodyw Mov Ther 12(3):185–190. https://doi.org/10.1016/j.jbmt.2008.03.004. (PMID: 19083672; PMCID: PMC2610338)

    Article  PubMed  PubMed Central  Google Scholar 

  35. Langevin HM, Sherman KJ (2007) Pathophysiological model for chronic low back pain integrating connective tissue and nervous system mechanisms. Med Hypotheses 68(1):74–80. https://doi.org/10.1016/j.mehy.2006.06.033. (Epub 2006 Aug 21 PMID: 16919887)

    Article  PubMed  Google Scholar 

  36. Siltari A, Riikonen J, Murtola TJ (2021) Preservation of endopelvic fascia: effects on postoperative incontinence and sexual function - a randomized clinical trial. J Sex Med 18(2):327–338. https://doi.org/10.1016/j.jsxm.2020.11.003. (Epub 2020 Dec 23 PMID: 33358241)

    Article  PubMed  Google Scholar 

  37. Bergna A, Vismara L, Parravicini G, Dal Farra F (2020) A new perspective for somatic dysfunction in osteopathy: the variability model. J Bodyw Mov Ther 24(3):181–189. https://doi.org/10.1016/j.jbmt.2020.03.008. (Epub 2020 Mar 15 PMID: 32825986)

    Article  PubMed  Google Scholar 

  38. Dal Farra F, Aquino A, Tarantino AG, Origo D (2022) Effectiveness of myofascial manual therapies in chronic pelvic pain syndrome: a systematic review and meta-analysis. Int Urogynecol J. https://doi.org/10.1007/s00192-022-05173-x. (Epub ahead of print. PMID: 35389057)

    Article  Google Scholar 

  39. Anderson RU, Wise D, Sawyer T, Chan CA (2006) Sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: improvement after trigger point release and paradoxical relaxation training. J Urol 176(4):1534–1538. https://doi.org/10.1016/j.juro.2006.06.010. (discussion 1538–9 PMID: 16952676)

    Article  PubMed  Google Scholar 

  40. Kim DS, Jeong TY, Kim YK, Chang WH, Yoon JG, Lee SC (2013) Usefulness of a myofascial trigger point injection for groin pain in patients with chronic prostatitis/chronic pelvic pain syndrome: a pilot study. Arch Phys Med Rehabil 94(5):930–936. https://doi.org/10.1016/j.apmr.2012.12.011. (Epub 2012 Dec 21 PMID: 23262156)

    Article  PubMed  Google Scholar 

  41. Schulz KF, Grimes DA (2002) Case-control studies: research in reverse. Lancet 359(9304):431–434. https://doi.org/10.1016/S0140-6736(02)07605-5. (PMID: 11844534)

    Article  PubMed  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Author information

Author notes

  1. Daniele Origo and Fulvio Dal Farra contributed equally to the work.

Authors and Affiliations

  1. Research Department, SOMA Osteopathic Institute Milan, Viale Sarca 336 F, 20126, Milan, Italy

    Daniele Origo, Fulvio Dal Farra, Maria Federica Bruni, Andrea Catalano, Lorenzo Marzagalli & Irene Bruini

  2. Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy

    Fulvio Dal Farra

Authors
  1. Daniele Origo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fulvio Dal Farra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria Federica Bruni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrea Catalano
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lorenzo Marzagalli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Irene Bruini
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by DO, FDF, MFB, AC, LM and IB. Data analysis was done by FDF and IB. The first draft of the manuscript was written by FDF and DO and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fulvio Dal Farra.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Submission

This research has not been published previously and it is not under consideration for publication elsewhere.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Origo, D., Dal Farra, F., Bruni, M.F. et al. Are fascial strains involved in chronic pelvic pain syndrome? An exploratory matched case–control study. Int Urol Nephrol 55, 511–518 (2023). https://doi.org/10.1007/s11255-022-03448-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-022-03448-2

Keywords

Search

Navigation