Treatment of myofascial pelvic pain syndrome in women
- Leah K Moynihan, RNC, MSN
Leah K Moynihan, RNC, MSN
- Division of Urogynecology and Pelvic Floor Disorders
- Women & Infants Hospital of Rhode Island
- Eman Elkadry, MD, FACOG
Eman Elkadry, MD, FACOG
- Clinical Instructor
- Harvard Medical School
The treatment of myofascial pelvic pain syndrome (MPPS) is multimodal and tailored to the individual patient. The general approach is to determine the trigger and then block or reduce ongoing stimuli that lead to pain. Most women will require a formalized program that includes pharmacologic treatment, physical therapy, and psychotherapy .
This topic will discuss the treatment of MPPS. Few large randomized trials have evaluated therapy of this disorder. Our approach is based on data from a few small trials and observational studies, as well as clinical experience. Many of these studies evaluated treatment of nonpelvic myofascial pain, such as myofascial pain associated with the back, neck, shoulder, or jaw. A limitation of observational studies of pain treatment is that patients may improve because of a true treatment effect, or because the natural history of the disease includes improvement in symptoms over time, or because of the Hawthorne effect (ie, improvement in symptoms simply because the patient is in a clinical trial) .
The clinical manifestations and diagnosis of MPPS are reviewed separately. (See "Clinical manifestations and diagnosis of myofascial pelvic pain syndrome in women".)
Since identification and elimination of a specific trigger may not be possible, adjunctive therapies that provide symptom relief are also important in breaking the cycle of pain and urogenital dysfunction. Simple interventions such as meditation, progressive muscle relaxation, and attention to sleep hygiene can help to relieve physical and emotional tension.
PELVIC FLOOR PHYSICAL THERAPY
Primary treatment of MPPS involves manual myofascial release, stretching, and strengthening of affected areas via pelvic floor physical therapy (PFPT). Ideally, PFPT is performed by a physical therapist with specialized training in soft tissue manipulation and rehabilitation of the pelvis. (See "Pelvic floor physical therapy for management of myofascial pelvic pain syndrome in women".)
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- ADJUNCTIVE TREATMENT
- PELVIC FLOOR PHYSICAL THERAPY
- Trigger point injections
- Botulinum toxin injections
- DRUG TREATMENT
- Nonsteroidal antiinflammatory drugs
- Serotonin-norepinephrine reuptake inhibitors
- Pentosan polysulfate sodium
- Tricyclic antidepressants
- Vaginal treatments
- Skeletal muscle relaxants
- Vaginal estrogen
- Eye movement desensitization and reprocessing
- SACRAL NEUROMODULATION
- TREATMENT OF FLARES
- Bladder instillation
- Urinary analgesics
- Ice, heat, stretch/massage, exercise
- PATIENT COUNSELING
- SUMMARY AND RECOMMENDATIONS