Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.
Int J Clin Pract. 2021 Aug;75(8):e14350. doi: 10.1111/ijcp.14350. Epub 2021 May 24.
Deep infiltrative endometriosis (DIE) may cause pelvic pain and thus negatively affect the function of different structures. We hypothesised that women with DIE may have dysfunctions of the pelvic floor muscles (PFMs) and lower limb muscles (LLMs).
This cross-sectional study included 160 women (80 with DIE under hormonal treatment and 80 women without DIE), who were assessed to determine the presence of pelvic symptoms (dysmenorrhea, chronic pelvic pain [CPP], deep/penetration dyspareunia, dysuria, dyschezia and vulvodynia), PFM function (PERFECT scheme, presence of hypertonia and trigger points, and muscle contraction and relaxation), abdominal muscle pain (Carnett's test) and muscle shortening in LLM (Thomas, Pace and Ober tests).
Women with DIE presented more CPP (30% vs 5%; P < .001), dysuria (12.5% vs 3.75%; P = .043) and dyschezia (47.5% vs 2.5%; P < .001) than the control group. Moreover, they had higher PFM hypertonia (28.75% vs 13.75%; P = .02), weaker PFM contraction (36.35% vs 2.5%; P < .001), and incomplete PFM relaxation (45% vs 13.75%; P < .001). Women with DIE had a higher rate of positive results in the Carnett's test (21.25% vs 2.5%; P < .001) than the control group. Moreover, they had a higher frequency of shortening of the anterior thigh (30% vs 10% in both LLM; P < .001), piriformis (16.25% vs 6.25%; P < .001) and iliotibial band muscles (bilateral; P < .001). Multivariate analysis revealed that the presence of pain increased the risk of PFM hypertonia (OR = 3.73 [1.26-11.07]; P = .018) and caused difficulty in PFM relaxation (OR = 2.98 [1.01-9.37]; P = .049).
Women with DIE exhibited a greater number of pelvic symptoms and greater PFM/LLM dysfunction than those in the control group. Pain was associated with PFM hypertonia and difficulty in PFM relaxation.
深部浸润型子宫内膜异位症（DIE）可能引起盆腔疼痛，从而对不同结构的功能产生负面影响。我们假设 DIE 患者的盆底肌（PFMs）和下肢肌（LLMs）可能存在功能障碍。
本横断面研究纳入了 160 名女性（80 名接受激素治疗的 DIE 患者和 80 名无 DIE 患者），评估了她们是否存在盆腔症状（痛经、慢性盆腔疼痛[CPP]、深部/穿透性性交痛、排尿困难、排便困难和外阴痛）、PFMs 功能（PERFECT 方案、是否存在肌肉紧张和触发点、肌肉收缩和放松）、腹部肌肉疼痛（Carnett 试验）和 LLM 肌肉缩短（Thomas、Pace 和 Ober 试验）。
与对照组相比，DIE 患者更易出现 CPP（30% vs 5%；P<0.001）、排尿困难（12.5% vs 3.75%；P=0.043）和排便困难（47.5% vs 2.5%；P<0.001）。此外，DIE 患者的 PFMs 紧张度更高（28.75% vs 13.75%；P=0.02）、PFMs 收缩力更弱（36.35% vs 2.5%；P<0.001）、PFMs 放松不完全（45% vs 13.75%；P<0.001）。DIE 患者 Carnett 试验阳性结果的发生率（21.25% vs 2.5%；P<0.001）也高于对照组。此外，DIE 患者大腿前侧（30% vs 对照组 10%；双侧；P<0.001）、梨状肌（16.25% vs 对照组 6.25%；P<0.001）和阔筋膜张肌（双侧；P<0.001）缩短的发生率更高。多变量分析显示，疼痛的存在增加了 PFMs 紧张度（OR=3.73[1.26-11.07]；P=0.018）和 PFMs 放松困难的风险（OR=2.98[1.01-9.37]；P=0.049）。
与对照组相比，DIE 患者的盆腔症状更多，PFMs/LLMs 功能障碍更严重。疼痛与 PFMs 紧张和 PFMs 放松困难有关。
