Skip to main content

Advertisement

SpringerLink
Log in

A pilot trial of movement-based pelvic floor physical therapy to address pelvic floor myofascial pain and lower urinary tract symptoms

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

Pelvic floor myofascial pain (PFMP) is associated with lower urinary tract symptoms (LUTS). The objective of this study was to test movement-based pelvic floor physical therapy (PT) for patients with PFMP and LUTS. We hypothesized that movement-based PT designed to target PFMP would result in significant improvement in both PFMP and concomitant LUTS.

Methods

This pilot trial enrolled patients with moderate-to-severe PFMP on palpation who were referred to movement-based PT to diagnose and treat pelvic floor dysfunction in the context of body alignment and movement patterns. The primary outcome was change in Urogenital Distress Inventory (UDI) scores after PT. Factors associated with PT attendance were also measured. We aimed to enroll 55 participants to achieve 80% power to detect a difference in 11 points on the UDI scores with an alpha-level of 0.05, accounting for a 10% loss to follow-up. The sample size was increased to 65 owing to a higher-than-expected loss-to-follow-up rate.

Results

Sixty-five patients were enrolled and 62 analyzed. Thirty-eight (61.3%) attended PT, and 30 (48.4%) completed a follow-up PT Attendance (PTA) survey. Overall, UDI score and irritative, obstructive, and stress subscales (p<0.0001) improved in participants who attended PT as well as mean myofascial examination scores at each site.

Conclusions

Participants who attended movement-based PT demonstrated an improvement in LUTS. Future studies should extend our findings by: first, confirming whether the myofascial pain-directed elements of PT improved LUTS; second, investigating whether movement-based PT improves prolapse symptoms; and third, including a non-PT control arm to rule out the possible influence of a placebo effect and behavioral modifications on LUTS and PFMP.

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

References

  1. Meister M, Sutcliffe S, Badu A, et al. Pelvic floor myofascial pain severity and pelvic floor disorder symptom bother: is there a correlation? Am J Obstet Gynecol. 2019;221(3):235.

    Article  PubMed Central  Google Scholar 

  2. Meister MR, Sutcliffe S, Ghetti C, et al. Development of a standardized, reproducible screening examination for assessment of pelvic floor myofascial pain. Am J Obstet Gynecol. 2019;220(3):255.

    Article  Google Scholar 

  3. Sexton CC, Coyne KS, Kopp ZS, et al. The overlap of storage, voiding and postmicturition symptoms and implications for treatment seeking in the USA, UK, and Sweden: EpiLUTS. BJU Int. 2009;103:12–23.

    Article  PubMed  Google Scholar 

  4. Kalder M, Pantazis K, Dinas K, et al. Discontinuation of treatment using anticholinergic medications in patients with urinary incontinence. Obstet Gynecol. 2014;124(4):794–800.

    Article  CAS  PubMed  Google Scholar 

  5. Diokno A, Yuhico M. Preference, compliance and initial outcome of therapeutic options chosen by female patients with urinary incontinence. J Urol. 1995;154(5):1727–30.

    Article  CAS  PubMed  Google Scholar 

  6. Pons ME, Alvarez PR, Clota MP, Dilla T. Evaluation of women's preferences for the treatment of stress urinary incontinence using the paired comparisons method. Arch Esp Urol. 2007;60(2):147–54.

    Google Scholar 

  7. Burgio K. Update on behavioral and physical therapies for incontinence and overactive bladder: the role of pelvic floor muscle training. Curr Urol Rep. 2013;14(5):457–64.

    Article  PubMed  Google Scholar 

  8. FitzGerald MP, Anderson RU, Potts J, et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J Urol. 2009;182(2):570–80.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Spitznagle T, Cabelka C, Clinton S, Abraham K, Norton B. Diagnosis dialogue for women's health conditions: the process and proposed pelvic floor muscle diagnosis. J Womens Health Phys Ther. 2017;41(3):154–62.

    Article  Google Scholar 

  10. Wente K, Spitznagle TM. Movement-related urinary urgency: a theoretical framework and retrospective, cross-sectional study. J Womens Health Phys Ther. 2017;41(2):83–90.

    Article  Google Scholar 

  11. Spitznagle T, Robinson C. Myofascial pelvic pain. Obstet Gynecol Clin N Am. 2014;41(3):409–32.

    Article  Google Scholar 

  12. Sahrmann S, Azevedo DC, Van Dillen L. Diagnosis and treatment of movement system impairment syndromes. Braz J Phys Ther. 2017;21(6):391–9.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hungerford BA, Gilleard W, Moran M, Emmerson C. Evaluation of the ability of physical therapists to palpate intrapelvic motion with the Stork test on the support side. Phys Ther. 2007;87(7):879–87.

    Article  PubMed  Google Scholar 

  14. Shumaker SA, Wyman JF, Uebersax JS, et al. Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Qual Life Res. 1994;3:291–306.

    Article  CAS  PubMed  Google Scholar 

  15. Barber MD, Kuchibhatla MN, Pieper CF, Bump RC. Psychometric evaluation of 2 comprehensive condition-specific QOL instruments for women with pelvic floor disorders. Am J Obstet Gynecol. 2001;185(6):1388–95.

    Article  CAS  PubMed  Google Scholar 

  16. Brandt BA, Angun C, Coyne KS, et al. LUTS patient reported outcomes tool: linguistic validation in 10 European languages. Neurourol Urodyn. 2013;32:75–81.

    Article  PubMed  Google Scholar 

  17. Hawthorne C, Sansoni J, Hayes L, et al. Measuring patient satisfaction with health care treatment using the Short Assessment of Patient Satisfaction measure delivered superior and robust satisfaction estimates. J Clin Epidemiol. 2014;67(5):527–37.

    Article  PubMed  Google Scholar 

  18. Zoorab D, Higgins M, Swan K, et al. Barriers to pelvic floor physical therapy regarding treatment of high-tone pelvic floor dysfunction. Female Pelvic Med Reconstr Surg. 2017;23(6):444–8.

    Article  Google Scholar 

  19. Shannon MB, Genereux M, Brincat C, et al. Attendance at prescribed pelvic floor physical therapy in a diverse, urban urogynecology population. PM R. 2018;10(6):601–6.

    Article  PubMed  Google Scholar 

  20. Barber MD, Spino C, Janz NK, et al. The minimum important differences for the urinary scales of the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire. Am J Obstet Gynecol. 2009;200(5):508.

    Article  Google Scholar 

  21. Lukacz ES, Santiago-Lastra Y, Albo ME, Brubaker L. Urinary incontinence in women: a review. JAMA. 2017;318(16):1592–604.

    Article  PubMed  Google Scholar 

  22. Riemsma R, Hagen S, Kirschner-Hermanns R, Norton C, Wijk H, Andersson KE, Chapple C, Spinks J, Wagg A, Hutt E, Misso K, Deshpande S, Kleijnen J, Milsom I. Can incontinence be cured? A systematic review of cure rates. BMC Med. 2017;15(1):63. https://doi.org/10.1186/s12916-017-0828-2.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Van Leeuwen JH, Castro R, Busse M, Bemelmans BL. The placebo effect in the pharmacologic treatment of patients with lower urinary tract symptoms. Eur Urol. 2006;50(3):440–52.

    Article  PubMed  Google Scholar 

  24. Mangera A, Chapple CR, Kopp ZS, Plested M. The placebo effect in overactive bladder syndrome. Nat Rev Urol. 2011;8:495–503.

    Article  CAS  PubMed  Google Scholar 

  25. Hagan KA, Erekson E, Austin A, et al. A prospective study of the natural history of urinary incontinence in women. Am J Obstet Gynecol. 2018;218(5):502.

    Article  PubMed Central  Google Scholar 

  26. Heidler S, Deveza C, Temml C, et al. The natural history of lower urinary tract symptoms in females: analysis of a health screening project. Eur Urol. 2007;52(6):1744–50.

    Article  PubMed  Google Scholar 

  27. Sutcliffe S, Bradly CS, Clemens JQ, et al. Urological chronic pelvic pain syndrome flares and their impact: qualitative analysis in the MAPP network. Int Urogynecol J. 2015;26(7):1047–60.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Fullerton ME, Mwesigwa PJ, Tandel M, et al. Comparison of pelvic floor physical therapy attendance based on referring provider specialty. Female Pelvic Med Reconstr Surg. 2022;28(1):57–63.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Woodburn KL, Tran M, Casas-Puig V, et al. Compliance with pelvic floor physical therapy in patients diagnosed with high-tone pelvic floor disorders. Female Pelvic Med Reconstr Surg. 2021;27(2):94–7.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Dr. Meister was supported by an NIH Reproductive Epidemiology Training Grant (T32HD055172-08) and a Clinical and Translational Science Award held at Washington University in St. Louis (UL1 TR002345) for developing and conducting this study.

Author information

Authors and Affiliations

  1. Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine & Reconstructive Surgery, University of Kansas School of Medicine, 2000 Cambridge, Kansas City, MO, 66160, USA

    Melanie R. Meister

  2. Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis, St. Louis, MO, USA

    Siobhan Sutcliffe

  3. Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine & Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA

    Chiara Ghetti & Jerry L. Lowder

  4. Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine & Reconstructive Surgery, University of North Carolina, Chapel Hill, NC, USA

    Christine M. Chu

  5. Department of Physical Therapy, Washington University in St. Louis, St. Louis, MO, USA

    Theresa M. Spitznagle

Authors
  1. Melanie R. Meister
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Siobhan Sutcliffe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chiara Ghetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christine M. Chu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Theresa M. Spitznagle
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jerry L. Lowder
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

M.R. Meister: protocol development, data collection, data management, data analysis, manuscript writing/editing; Siobhan Sutcliffe: protocol development, data analysis, manuscript editing; Chiara Ghetti: protocol development, data collection, manuscript editing; Christine Chu: data collection, manuscript editing; Theresa Spitznagle: other: physical therapy intervention, manuscript editing; Jerry Lowder: protocol development, data collection, manuscript editing.

Corresponding author

Correspondence to Melanie R. Meister.

Ethics declarations

Conflicts of interest

None.

Additional information

Publisher’s note

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

Supplementary information

ESM 1

(DOCX 23 kb)

Rights and permissions

Springer Nature or its licensor 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

Meister, M.R., Sutcliffe, S., Ghetti, C. et al. A pilot trial of movement-based pelvic floor physical therapy to address pelvic floor myofascial pain and lower urinary tract symptoms. Int Urogynecol J 34, 1261–1270 (2023). https://doi.org/10.1007/s00192-022-05353-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-022-05353-9

Keywords

Search

Navigation