UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Clinical manifestations and diagnosis of myofascial pelvic pain syndrome in women

Authors
Eman Elkadry, MD, FACOG
Leah K Moynihan, RNC, MSN
Section Editor
Linda Brubaker, MD, FACS, FACOG
Deputy Editor
Kristen Eckler, MD, FACOG

INTRODUCTION

Myofascial pelvic pain syndrome (MPPS) is a source of chronic pelvic pain in women and men that is defined by short, tight, tender pelvic floor muscles that include palpable nodules or trigger points that cause referred pain. The pain can be continuous or episodic. MPPS can impact urinary, bowel, and sexual function. As pelvic pain is a common reason for women to seek health care and many women with chronic pelvic pain have some degree of MPPS, clinicians need to include this syndrome in the differential when evaluating women with pelvic pain.

Clinical manifestations and diagnosis of MPPS in women are reviewed here. Treatment of this condition and other causes of pelvic pain in women are reviewed separately.

(See "Treatment of myofascial pelvic pain syndrome in women".)

(See "Pelvic floor physical therapy for management of myofascial pelvic pain syndrome in women".)

(See "Evaluation of acute pelvic pain in women".)

                    

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Tue Apr 12 00:00:00 GMT 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Simons DG, Travell JG, Simons PT. Travell and Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual. Upper half of body., 2, Williams & Wilkins, Baltimore 1999. Vol 1.
  2. The 2015 EAU guidelines on chronic pelvic pain http://www.uroweb.org/guidelines/online-guidelines/ (Accessed on November 22, 2015).
  3. Jafri MS. Mechanisms of Myofascial Pain. Int Sch Res Notices 2014; 2014.
  4. Lavelle ED, Lavelle W, Smith HS. Myofascial trigger points. Anesthesiol Clin 2007; 25:841.
  5. Huguenin LK. Myofascial trigger points: the current evidence. Phys Ther Sport 2004; 5:2.
  6. Cummings M, Baldry P. Regional myofascial pain: diagnosis and management. Best Pract Res Clin Rheumatol 2007; 21:367.
  7. Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. Am Fam Physician 2002; 65:653.
  8. FitzGerald MP, Kotarinos R. Rehabilitation of the short pelvic floor. I: Background and patient evaluation. Int Urogynecol J Pelvic Floor Dysfunct 2003; 14:261.
  9. Prendergast SA, Weiss JM. Screening for musculoskeletal causes of pelvic pain. Clin Obstet Gynecol 2003; 46:773.
  10. Zondervan KT, Yudkin PL, Vessey MP, et al. The community prevalence of chronic pelvic pain in women and associated illness behaviour. Br J Gen Pract 2001; 51:541.
  11. Mathias SD, Kuppermann M, Liberman RF, et al. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol 1996; 87:321.
  12. Bedaiwy MA, Patterson B, Mahajan S. Prevalence of myofascial chronic pelvic pain and the effectiveness of pelvic floor physical therapy. J Reprod Med 2013; 58:504.
  13. Shah JP, Gilliams EA. Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome. J Bodyw Mov Ther 2008; 12:371.
  14. Spitznagle TM, Robinson CM. Myofascial pelvic pain. Obstet Gynecol Clin North Am 2014; 41:409.
  15. Kotarinos R. Myofascial pelvic pain. Curr Pain Headache Rep 2012; 16:433.
  16. Spitznagle TM. Musculoskeletal chronic pelvic pain.. In: Pelvic floor, Carriere B, Feldt C. (Eds), Georg Thieme Verlag, Stuttgart, Germany 2006. p.35.
  17. Prather H, Spitznagle TM, Dugan SA. Recognizing and treating pelvic pain and pelvic floor dysfunction. Phys Med Rehabil Clin N Am 2007; 18:477.
  18. Gerwin RD, Dommerholt J, Shah JP. An expansion of Simons' integrated hypothesis of trigger point formation. Curr Pain Headache Rep 2004; 8:468.
  19. Kuner R. Central mechanisms of pathological pain. Nat Med 2010; 16:1258.
  20. Mense S. The pathogenesis of muscle pain. Curr Pain Headache Rep 2003; 7:419.
  21. Hoffman D. Central and peripheral pain generators in women with chronic pelvic pain: patient centered assessment and treatment. Curr Rheumatol Rev 2015; 11:146.
  22. Weiss JM. Chronic pelvic pain and myofascial trigger points. The Pain Clinic 2000; 2:13.
  23. Weiss JM. Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol 2001; 166:2226.
  24. Rosenbaum TY, Owens A. The role of pelvic floor physical therapy in the treatment of pelvic and genital pain-related sexual dysfunction (CME). J Sex Med 2008; 5:513.
  25. Doggweiler-Wiygul R, Wiygul JP. Interstitial cystitis, pelvic pain, and the relationship to myofascial pain and dysfunction: a report on four patients. World J Urol 2002; 20:310.
  26. Roya Rezaee and Sheryl Kingsberg. Female Sexual Function and Dysfunction: Assessment and Treatment. In: Urogynecology and reconstructive pelvic surgery, 4, Mark D. Walters, Mickey M. Karram. (Eds), Saunders, Philadelphia 2015. p.87.
  27. Peters KM, Carrico DJ, Kalinowski SE, et al. Prevalence of pelvic floor dysfunction in patients with interstitial cystitis. Urology 2007; 70:16.
  28. Bassaly R, Tidwell N, Bertolino S, et al. Myofascial pain and pelvic floor dysfunction in patients with interstitial cystitis. Int Urogynecol J 2011; 22:413.
  29. Butrick CW. Interstitial cystitis and chronic pelvic pain: new insights in neuropathology, diagnosis, and treatment. Clin Obstet Gynecol 2003; 46:811.
  30. Itza F, Zarza D, Salinas J, et al. Turn-amplitude analysis as a diagnostic test for myofascial syndrome in patients with chronic pelvic pain. Pain Res Manag 2015; 20:96.
  31. Chen SM, Chen JT, Kuan TS, Hong CZ. Myofascial trigger points in intercostal muscles secondary to herpes zoster infection of the intercostal nerve. Arch Phys Med Rehabil 1998; 79:336.
  32. Shoskes DA, Berger R, Elmi A, et al. Muscle tenderness in men with chronic prostatitis/chronic pelvic pain syndrome: the chronic prostatitis cohort study. J Urol 2008; 179:556.
  33. Ingber MS, Peters KM, Killinger KA, et al. Dilemmas in diagnosing pelvic pain: multiple pelvic surgeries common in women with interstitial cystitis. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19:341.
  34. FitzGerald MP, Brensinger C, Brubaker L, et al. What is the pain of interstitial cystitis like? Int Urogynecol J Pelvic Floor Dysfunct 2006; 17:69.
  35. Dommerholt J, Grieve R, Hooks T, Layton M. A critical overview of the current myofascial pain literature - October 2015. J Bodyw Mov Ther 2015; 19:736.
  36. Simons DG. New views of myofascial trigger points: etiology and diagnosis. Arch Phys Med Rehabil 2008; 89:157.
  37. Bron C, Franssen J, Wensing M, Oostendorp RA. Interrater reliability of palpation of myofascial trigger points in three shoulder muscles. J Man Manip Ther 2007; 15:203.
  38. Gerwin RD, Shannon S, Hong CZ, et al. Interrater reliability in myofascial trigger point examination. Pain 1997; 69:65.
  39. Al-Shenqiti AM, Oldham JA. Test-retest reliability of myofascial trigger point detection in patients with rotator cuff tendonitis. Clin Rehabil 2005; 19:482.
  40. Kumbhare DA, Elzibak AH, Noseworthy MD. Assessment of Myofascial Trigger Points Using Ultrasound. Am J Phys Med Rehabil 2016; 95:72.
  41. Ballyns JJ, Shah JP, Hammond J, et al. Objective sonographic measures for characterizing myofascial trigger points associated with cervical pain. J Ultrasound Med 2011; 30:1331.
  42. Sikdar S, Ortiz R, Gebreab T, et al. Understanding the vascular environment of myofascial trigger points using ultrasonic imaging and computational modeling. Conf Proc IEEE Eng Med Biol Soc 2010; 2010:5302.
  43. Sikdar S, Shah JP, Gebreab T, et al. Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue. Arch Phys Med Rehabil 2009; 90:1829.
  44. Chen Q, Bensamoun S, Basford JR, et al. Identification and quantification of myofascial taut bands with magnetic resonance elastography. Arch Phys Med Rehabil 2007; 88:1658.
  45. Wytrążek M, Huber J, Lipiec J, Kulczyk A. Evaluation of palpation, pressure algometry, and electromyography for monitoring trigger points in young participants. J Manipulative Physiol Ther 2015; 38:232.
  46. Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990; 33:160.
  47. IASP Task Force on Taxonomy. Pain terms: a current list with definitions and notes on usage. In: Classification of chronic pain, Second Edition, Merskey M, Bogduk N. (Eds), IASP Press, Seattle, WA 1994. p.209.
  48. Loeser JD, Treede RD. The Kyoto protocol of IASP Basic Pain Terminology. Pain 2008; 137:473.
  49. Jarrell J, Giamberardino MA, Robert M, Nasr-Esfahani M. Bedside testing for chronic pelvic pain: discriminating visceral from somatic pain. Pain Res Treat 2011; 2011:692102.
  50. Mackenzie J. Symptoms and their interpretation, 2nd ed, Paul B Hoeber, New York 1913.
  51. Jarrell J, Arendt-Nielsen L. Quantitative sensory testing in gynaecology: improving preoperative and postoperative pain diagnosis. J Obstet Gynaecol Can 2013; 35:531.
  52. Stratton P, Khachikyan I, Sinaii N, et al. Association of chronic pelvic pain and endometriosis with signs of sensitization and myofascial pain. Obstet Gynecol 2015; 125:719.