Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Providence Health Care/St Paul's Hospital Physiotherapy Department, Vancouver, British Columbia, Canada.
Neurourol Urodyn. 2019 Feb;38(2):696-702. doi: 10.1002/nau.23896. Epub 2018 Dec 21.
Myofascial pelvic pain is a chronic and debilitating condition, sometimes associated with pelvic floor disorders (PFD) such as urinary incontinence, defecatory dysfunction or pelvic organ prolapse. Our aim was to identify risk factors in women with PFD and hypertonic pelvic floor, compared to controls without hypertonicity.
Case control study (2009-2017) of patients with PFD and a diagnosis of hypertonic pelvic floor. Cases were matched with patients who presented with the same PFD but without pelvic floor hypertonicity. Postoperative patients with hypertonic pelvic floor were matched with patients who underwent surgery for the same PFD but did not develop pain. Risk factors were compared between groups.
Ninety-five cases were matched; 71% had urogynecologic surgery as a possible trigger for myofascial pain. Most were post-menopausal. Overall, case patients were younger than controls (mean 54 vs 59, P = 0.002). Multivariate logistic regression identified risk factors of younger age (OR 1.45, 95%CI 1.04-2.07), history of depression (OR 3, 95%CI 1.03-9.09), musculoskeletal spine injury (OR 4.32, 95%CI 1.01-21.26) and transobturator midurethral sling (OR 8.36, 95%CI 2.68-31.32). Retropubic midurethral sling was protective against pelvic floor hypertonicity (OR 0.37, 95%CI 0.15-0.86). A clinical prediction model including depression, endometriosis, irritable bowel, spine injury and type of midurethral sling was developed to estimate the probability for myofascial pain after urogynecologic surgery.
Specific risk factors predispose women with PFD to chronic pelvic floor hypertonicity. Knowledge of these can help with patient counselling and choice of midurethral sling prior to PFD surgery.
肌筋膜盆腔疼痛是一种慢性且使人虚弱的疾病，有时与盆腔器官脱垂（pelvic organ prolapse，POP）等盆底功能障碍（pelvic floor disorders，PFD）相关，如尿失禁、排便功能障碍或 POP。我们的目的是确定患有 PFD 和高张力盆底的女性与无高张力的对照组之间的危险因素。
2009 年至 2017 年对患有 PFD 和高张力盆底诊断的患者进行病例对照研究。病例组与出现相同 PFD 但无盆底高张力的患者相匹配。高张力盆底手术后患者与接受相同 PFD 手术但未出现疼痛的患者相匹配。比较各组之间的危险因素。
95 例病例相匹配；71%有妇科泌尿科手术可能是引发肌筋膜疼痛的诱因。大多数为绝经后妇女。总体而言，病例组患者比对照组年轻（平均 54 岁比 59 岁，P=0.002）。多变量逻辑回归确定了年轻（OR 1.45，95%CI 1.04-2.07）、抑郁史（OR 3，95%CI 1.03-9.09）、肌肉骨骼脊柱损伤（OR 4.32，95%CI 1.01-21.26）和经闭孔尿道中段吊带（OR 8.36，95%CI 2.68-31.32）是危险因素。经耻骨后尿道中段吊带是盆底高张力的保护因素（OR 0.37，95%CI 0.15-0.86）。开发了一个包含抑郁、子宫内膜异位症、肠易激综合征、脊柱损伤和尿道中段吊带类型的临床预测模型，以估计妇科泌尿科手术后肌筋膜疼痛的可能性。
特定的危险因素使患有 PFD 的女性易患慢性盆底高张力。了解这些因素有助于在 PFD 手术前对患者进行咨询和选择尿道中段吊带。
