title: Pelvic floor spasm as a cause of voiding dysfunction.
abstract: OBJECTIVE
  Pelvic floor disorders can present with lower urinary tract symptoms, bowel, sexual dysfunction, and/or pain. Symptoms of pelvic muscle spasm (nonrelaxing pelvic floor or hypertonicity) vary and can be difficult to recognize. This makes diagnosis and management of these disorders challenging. In this article, we review the current evidence on pelvic floor spasm and its association with voiding dysfunction.
  
  
  RESULTS
  To distinguish between the different causes of voiding dysfunction, a video urodynamics study and/or electromyography is often required. Conservative measures include patient education, behavioral modifications, lifestyle changes, and pelvic floor rehabilitation/physical therapy. Disease-specific pelvic pain and pain from pelvic floor spasm needs to be differentiated and treated specifically. Trigger point massage and injections relieves pain in some patients. Botulinum toxin A, sacral neuromodulation, and acupuncture has been reported in the management of patients with refractory symptoms.
  
  
  CONCLUSIONS
  Pelvic floor spasm and associated voiding problems are heterogeneous in their pathogenesis and are therefore often underrecognized and undertreated; it is therefore essential that a therapeutic strategy needs to be personalized to the individual patient's requirements. Therefore, careful evaluation and assessment of individuals using a multidisciplinary team approach including a trained physical therapist/nurse clinician is essential in the management of these patients.
authors.affiliation: aDepartment of Urology, Singapore General Hospital, Singapore bDepartment of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK.
authors.forename: Tricia L C
authors.initials: TL
authors.lastname: Kuo
authors.forename: L G
authors.initials: LG
authors.lastname: Ng
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Chapple
mesh_terms: D015670:Acupuncture Therapy; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D004599:Electric Stimulation Therapy / Q000379:methods; D004576:Electromyography; D006801:Humans; D008160:Lumbosacral Plexus; D009465:Neuromuscular Agents / Q000627:therapeutic use; D017773:Pelvic Floor / Q000503:physiopathology*; D059952:Pelvic Floor Disorders / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012307:Risk Factors; D013035:Spasm; D016896:Treatment Outcome; D014555:Urination Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D014563:Urodynamics; D014741:Video Recording
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A