Pelvic floor myofascial pain in patients with symptoms of urinary tract infection

Int J Gynaecol Obstet. 2019 May;145(2):205-211. doi: 10.1002/ijgo.12784. Epub 2019 Mar 6.

Abstract

Objective: To correlate lower urinary tract symptoms typically associated with a urinary tract infection (UTI) with physical examination findings of pelvic floor myofascial pain (PFMP).

Methods: This retrospective review included all new patients presenting to a urogynecology clinic between August 2 and December 19, 2016. Patients completed validated questionnaires, had a catheterized urine specimen, and underwent pelvic examination. Associations between demographics, symptoms, urine culture, and PFMP were analyzed.

Results: We included 250 patients with urinary frequency (n=160, 64.0%), urgency (n=155, 62.0%), urgency incontinence (n=140, 56.0%), pelvic pain (n=43, 17.2%), and dysuria (n=25, 10.0%). PFMP was detected in 125 (50.0%) patients and culture-proven UTI in 15 (6.0%) patients. Demographics associated with PFMP were lower prolapse stage (P<0.001), age younger than 50 years (P<0.001), lower parity (P=0.028), and non-white ethnicity (P=0.003). Symptoms associated with PFMP were dysuria (adjusted odds ratio 4.13, 95% confidence interval 1.08-15.78), urgency/frequency (2.72, 1.47-5.04), and patient-reported pelvic pain (2.57, 1.08-6.12). These symptoms were independent predictors in multivariable logistic regression analysis.

Conclusions: Most patients had symptoms associated with UTI; however, culture-confirmed diagnosis was infrequent and PFMT was diagnosed in half of participants. Clinicians treating women with these symptoms are advised to examine the pelvic floor muscles.

Keywords: Dysuria; Female; Lower urinary tract symptoms; Myofascial pain; Pelvic floor; Pelvic pain; Urinary tract infection; Urinary urgency.

MeSH terms

  • Adult
  • Aged
  • Dysuria / epidemiology
  • Female
  • Humans
  • Middle Aged
  • Odds Ratio
  • Pelvic Floor / physiopathology*
  • Pelvic Pain / diagnosis*
  • Pelvic Pain / epidemiology
  • Pelvic Pain / urine
  • Retrospective Studies
  • Surveys and Questionnaires
  • Urinary Incontinence, Urge / epidemiology
  • Urinary Tract Infections / epidemiology