Levator myalgia: why bother?

Int Urogynecol J. 2013 Oct;24(10):1687-93. doi: 10.1007/s00192-013-2089-8. Epub 2013 Apr 11.

Abstract

Introduction and hypothesis: We report the prevalence of levator myalgia (LM) and describe symptom bother and comorbidities associated with this examination finding.

Methods: We performed a cross-sectional study of patients referred to urogynecology practices: a private practice (COMM) and a tertiary university-based practice (UNIV). We identified within our population a subset of patients with LM and a reference group without LM. The primary outcome was to report the prevalence of LM within a urogynecology referral population. Our secondary outcomes include mean Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) scores, medication use, medical co-morbidities, and presence of vulvodynia.

Results: The prevalence of LM was 24% at the UNIV detected on 5,618 examinations and 9% at the COMM based on 946 examinations. Women with LM were significantly younger: mean age 56.8 years vs 65.5 (p < 0.001). There was no difference in mean parity (2.3), BMI (28.2 kg/m(2)), and race (94% white). Patients with LM reported significantly higher mean symptom bother scores (PFDI, PFIQ; p = <0. 001) related to prolapse, defecatory dysfunction, and urinary symptoms. Women with LM were more likely to report a diagnosis of fibromyalgia (OR 4.4 [1.7, 11.0]), depression (OR 1.8 [1.2, 2.7]), a history of sexual abuse (OR 2.4 [1.3, 4.7]), and use narcotic pain medications (OR 2.5 [1.2, 5.2]).

Conclusions: Levator myalgia is a prevalent condition in urogynecology practice, and is associated with approximately 50% greater bother in urinary, defecatory, and prolapse symptoms.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anus Diseases / diagnosis*
  • Anus Diseases / epidemiology*
  • Comorbidity
  • Cross-Sectional Studies
  • Depression / epidemiology
  • Fecal Incontinence / epidemiology
  • Female
  • Humans
  • Middle Aged
  • Myalgia / diagnosis*
  • Myalgia / epidemiology*
  • Pain / diagnosis*
  • Pain / epidemiology*
  • Pelvic Organ Prolapse / epidemiology
  • Prevalence
  • Urinary Incontinence / epidemiology

Supplementary concepts

  • Levator syndrome