Pelvic Floor Dysfunction in Bladder Pain Syndrome

  • Mauro Cervigni
  • Franca Natale


Many patients with Bladder pain syndrome have concomitant Hypertonic pelvic floor dysfunction (HPFD), with a prevalence of 50–87 %. In such patients voiding dysfunction is frequently associated with other pain disorders, such as Irritable bowel syndrome, Inflammatory bowel disease, Fibromyalgia and Vulvodynia

HPFD is due to an afferent autonomic bombardment that may enhance and maintain a guarding reflex, a viscero-muscular reflex that increases the tone of the pelvic floor during routine daytime activity. This condition causes a hypertonus of the pelvic floor.

Clinical evaluation includes an observation of pelvic floor muscle activity during the process of squeezing and relaxation; a cotton swab (Q-tip) test for vulvodynia; evaluation of the pelvic floor tone and identification of the active trigger points. Muscle activity should be measured using a perineometer or an electromyography probe. Urodynamics should always be performed to evaluate the alterations of voiding phase.

The pelvic floor therapy should be considered as a first-line treatment before any other systemic or intravesical medication. Other treatment include the following: Sacral Neuromodulation which is not yet an approved method for the treatment of other pelvic disorders, but data supporting its benefit are emerging; Posterior tibial nerve stimulation that shows positive effect on pelvic pain management refractory to other previous treatments but the lack of a control study suggests that further studies are needed to confirm its real efficacy; the Trigger point injection that has the objective of deactivating the trigger point; and the Botulin toxin therapy causes muscle relaxation due to direct antinociceptive activity that causes a secondary decrease in central sensitization.


Irritable Bowel Syndrome Pelvic Floor Pelvic Floor Muscle Trigger Point Myofascial Pain 
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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyCatholic UniversityRomeItaly
  2. 2.Department of UrogynecologyS. Carlo-IDI HospitalRomeItaly

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