Patients with Pelvic Floor Muscle Spasm Have a Superior Response to Pelvic Floor Physical Therapy at Specialized Centers.
OBJECTIVE
Chronic prostatitis/chronic pelvic pain syndrome is a common condition that often requires multimodal therapy. Patients with chronic pelvic pain syndrome have a high incidence of pelvic floor spasm, which can be treated with pelvic floor physical therapy. However, this is a specialized skill. We compared outcomes of pelvic floor physical therapy as part of multimodal therapy in patients with chronic pelvic pain syndrome between those treated at our institution and elsewhere.


METHODS
We identified patients from our chronic pelvic pain syndrome registry with pelvic floor spasm who were seen between 2010 and 2014 for more than 1 visit. Patient phenotype was assessed with the UPOINT system and symptom severity was determined by the National Institutes of Health CPSI. A 6-point decrease in CPSI was used to define patient improvement.


RESULTS
A total of 82 patients fit the study criteria. Mean age was 41.6 years (range 19 to 75) and median symptom duration was 24 months (range 3 to 240). Mean CPSI was 26.8 (range 10 to 41), the median number of positive UPOINT domains was 3 (range 1 to 6) and 27 patients (32.9%) were treated locally. At followup 9 patients had refused pelvic floor physical therapy, and 24 and 48 had undergone pelvic floor physical therapy elsewhere and at CCF, respectively. The mean change in CPSI was 1.11 ± 4.1 in patients who refused, -3.46 ± 6.7 in those treated elsewhere and -11.3 ± 7.0 in those treated at CCF (p <0.0001). Individual improvement was seen in 1 patient (11%) who refused, 10 (42%) treated elsewhere and 38 (79.2%) treated at CCF (p <0.0001). On multivariable analysis only physical therapy at CCF (OR 4.23, p = 0.002) and symptom duration (OR 0.52, p = 0.03) predicted improvement.


CONCLUSIONS
Pelvic floor physical therapy can be effective for chronic pelvic pain syndrome in patients with pelvic floor spasm. However, the outcome depends on specialty training and experience of therapists.
Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio. Electronic address: polacka@ccf.org.
Alan Scott
AS
Polackwich
Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
Jianbo
J
Li
Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
Daniel A
DA
Shoskes
D000293:Adolescent; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D059952:Pelvic Floor Disorders / Q000628:therapy*; D026741:Physical Therapy Modalities; D011472:Prostatitis / Q000628:therapy*; D012189:Retrospective Studies; D013035:Spasm / Q000628:therapy*; D055815:Young Adult
chronic pain; pelvic floor; physical therapy specialty; prostate; prostatitis