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Fibromyalgia and Chronic Pelvic Pain in Women

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By Celeste Cooper

A study published in December 2015 is reported by some to be the first to associate fibromyalgia (FM) and chronic pelvic pain (CPP); however, I know others have made the connection because I live with both and I have been writing on the subject for quite some time. But, it is encouraging that physicians and others are taking note. It’s important to the understanding of pelvic floor pain, urinary distress and fibromyalgia. European urologists suggest assessment of overlapping disorders, including fibromyalgia, in the 2014 Guidelines on Chronic Pelvic Pain, which is significant because awareness will bring about a better understanding on all commonly known overlapping disorders and others agree.

Pelvic disorders not only cause pain, they also contribute to loss of intimacy, anxiety, depression, and unwarranted guilt. We may not all experience the same CPP, but we do experience the same effects:  interruption in normal healthy sexual relationships, difficulty sleeping, and disruption to our quality of life.

The Complexity of Chronic Pelvic Pain
Chronic pelvic pain can develop following acute or chronic irritation due to various causes, including:

  • Vulvodynia
  • Interstitial cystitis (also known as painful bladder syndrome)
  • Reproductive organ problems – painful menstrual periods, pain associated with uterine fibroids, ovulation, ovarian cysts, uterine tissue abnormalities, reproductive organ abnormalities, and pregnancy related problems.
  • Pelvic inflammatory disease
  • Pelvic congestion
  • Chronic infection
  • Sterile cystitis (urgency, frequency, urinating through the night, painful urination, bladder pain, pressure in pelvic area, lower abdomen and back,  bladder spasm and other symptoms in the absence of infection)
  • Vaginitis (inflammation of the vagina)
  • Uretheritis (inflammation of the tube that carries urine out of the bladder when you urinate)
  • Rectal pain
  • Myofascial trigger points in the pelvic bowl muscles and attachments that mimic symptoms of vaginitis, uretheritis, and cause rectal and other pelvic floor pain
  • Urethra and rectal sphincter dysfunction
  • Irritable bowel syndrome
  • Scar tissue
  • Cancer

Pelvic floor muscle function, bladder and bowel function are an integral part of our daily physiological functioning. This lends to an urgency in understanding and treating problems appropriately.

Show and Tell
Chronic pelvic pain and FM share overlapping abnormalities, such as:

  • Allergies
  • Autonomic nervous system disruption
  • Centralization of pain
  • Chronic fatigue syndrome (CFS)
  • Immune system involvement
  • Joint Hypermobility
  • Migraine
  • Myofascial pain from myofascial trigger points
  • Sicca syndrome (explained by my rheumatologist as Sjogren’s Syndrome without antibodies)
  • Sleep disruption
  • Systemic lupus erythematosus
  • Temporomandibular joint disorder
  • Trauma, emotional and physical

Therapies
Like FM, CPP can be constant or come and go in flares. Symptoms can range from mild to severe and can fluctuate in intensity. That’s why it is important to identify perpetuating factors to both CPP and FM. They can perpetuate each other. Managing known overlapping disorders, paying attention to posture, mental well-being, sleep problems, and other things we have identified is important. The more overlapping conditions that exist, the more complex the clinical picture, but this is not a reason your physician or you should give up. We can contribute to unraveling the kinks by indentifying and managing aggravating factors that are within our control. Other things to help include:

  • Acupuncture
  • Biofeedback
  • Bladder retraining
  • Dietary assessment
  • Intravaginal and perineum transcutaneous electrical nerve stimulation (TENS).
  • Myofascial therapy including both manual therapy and/or intravaginal trigger point injections
  • Neuromodulation
  • Nerve blocks
  • Management of sacral joint dysfunction
  • Ultrasound therapy
  • Home therapy for pelvic floor muscles and intravaginal modalities, as well as therapy under the guidance and supervision of a urogyenologlogist or specialized therapist
  • Meditation and relaxation therapy
  • Medications, probiotics for the bladder and topical analgesics

Many do not understand the role of trigger points in CPP or their role as peripheral pain generators in FM. Some may suggest traditional therapies, such as Kegel exercise, which worsens symptoms until and unless trigger points are successfully treated and muscles and attachments are returned to their normal resting length. Coexisting conditions with myofascial components, such as piriformis syndrome, spinal disease, etc., can cause a host of pain referral patterns. They are not in our head; they are in our pelvis and surrounding structures, and they are treatable.

Specialists
I understand this may be a difficult topic to discuss with your doctor, but it is imperative that you have the right treatment. There are physicians who specialize in urogynecology (a gynecologist with advanced training in female urology). Some gynecologists (doctors that specialize in women’s health conditions) can also share valuable resources to physical therapists that specialize in urogynecological therapy. Don’t suffer needlessly. Use the information here to be proactive in your care.

Resources and References:

Chung JH, et al. The association between overactive bladder and fibromyalgia syndrome: A community survey. Neurourol Urodyn. 2012 Jun 5. doi: 10.1002/nau.22277.

D. Engeler (chair), A.P. Baranowski, J. Borovicka, A. Cottrell, P. Dinis-Oliveira, S. Elneil, J. Hughes, E.J. Messelink, A. van Ophoven, Y. Reisman, A.C. de C. Williams

Guidelines on Chronic Pelvic Pain. European Association of Urology 2014. (pg. 43) https://uroweb.org/wp-content/uploads/26-Chronic-Pelvic-Pain_LR.pdf

Jones KD, et al. Pelvic Floor and Urinary Distress in Women with Fibromyalgia. Pain Manag Nurs. 2015 Dec;16(6):834-40. doi: 10.1016/j.pmn.2015.06.001. Epub 2015 Aug 8.

Moldwin RM, Fariello JY. 2013. Myofascial trigger points of the pelvic floor; Associations with urological pain syndromes and treatment strategies including injection therapy.  Curr Urol Rep Aug 14

Neziri AY, et al. Correlation between altered central pain processing and concentration of peritoneal fluid inflammatory cytokines in endometriosis patients with chronic pelvic pain. Reg Anesth Pain Med. 2014. [Apr 1 Epub ahead of print.]

Schrepf A, et al. Inflammation and Symptom Change in Interstitial Cystitis or Bladder Pain Syndrome: A Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network Study. Urology. 2016 Apr;90:56-61. doi: 10.1016/j.urology.2015.12.040. Epub 2016 Jan 6.

Staud R. Cytokine and immune system abnormalities in fibromyalgia and other central sensitivity syndromes. Curr Rheumatol Rev. 2015;11(2):109-15.

Wallace DJ, et al. Cytokine and chemokine profiles in fibromyalgia, rheumatoid arthritis and systemic lupus erythematosus: a potentially useful tool in differential diagnosis.

Rheumatol Int. 2015 Jun;35(6):991-6. doi: 10.1007/s00296-014-3172-2. Epub 2014 Nov 7.

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(11-12):504-510.

Choung RS1, Herrick LM, Locke GR 3rd, Zinsmeister AR, Talley NJ. Irritable bowel syndrome and chronic pelvic pain: a population-based study. J Clin Gastroenterol. 2010 Nov-Dec;44(10):696-701. doi: 10.1097/MCG.0b013e3181d7a368.

Chung JH, Kim SA, Choi BY, Lee HS, Lee SW, Kim YT, Lee TY, Moon HS. The association between overactive bladder and fibromyalgia syndrome: A community survey. Neurourol Urodyn. 2012 Jun 5. doi: 10.1002/nau.22277.

Jarrell J 2009. Demonstration of cutaneous allodynia in association with chronic pelvic pain. J Vis Exp 23(28).pii 1232. doi 10.3791/1232

Jones KD, Maxwell C, Mist SD, King V, Denman MA, Gregory WT. Pelvic Floor and Urinary Distress in Women with Fibromyalgia. Pain Manag Nurs. 2015 Dec;16(6):834-40. doi: 10.1016/j.pmn.2015.06.001. Epub 2015 Aug 8.

Kaya S, Hermans L, Willems T et al. 2013. Central sensitization in urogynecological chronic pelvic pain: a systematic literature review. Pain Physician. 16(4):291-308.

Moldwin RM, Fariello JY. 2013. Myofascial trigger points of the pelvic floor; Associations with urological pain syndromes and treatment strategies including injection therapy.  Curr Urol Rep Aug 14

Neziri AY, Bersinger NA, Andersen OK et al. Correlation between altered central pain processing and concentration of peritoneal fluid inflammatory cytokines in endometriosis patients with chronic pelvic pain. Reg Anesth Pain Med. 2014. [Apr 1 Epub ahead of print.]

Schrepf A1, O’Donnell MA2, Luo Y3, Bradley CS4, Kreder KJ3, Lutgendorf SK5. Inflammation and Symptom Change in Interstitial Cystitis or Bladder Pain Syndrome: A Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network Study. Urology. 2016 Apr;90:56-61. doi: 10.1016/j.urology.2015.12.040. Epub 2016 Jan 6.

Staud R1. Cytokine and immune system abnormalities in fibromyalgia and other central sensitivity syndromes. Curr Rheumatol Rev. 2015;11(2):109-15.

Tu CH, Niddam DM, Yeh TC et al. 2013. Menstrual pain is associated with rapid structural alterations in the brain. Pain. [May 18 Epub ahead of print].

Wallace DJ1, Gavin IM, Karpenko O, Barkhordar F, Gillis BS. Cytokine and chemokine profiles in fibromyalgia, rheumatoid arthritis and systemic lupus erythematosus: a potentially useful tool in differential diagnosis.

Rheumatol Int. 2015 Jun;35(6):991-6. doi: 10.1007/s00296-014-3172-2. Epub 2014 Nov 7.


Celeste Cooper, RN, is a frequent contributor to ProHealth.  She is an advocate, writer and published author, and a person living with chronic pain. Celeste is lead author of Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain and Broken Body, Wounded Spirit, and Balancing the See Saw of Chronic Pain (a four book series). She spends her time enjoying her family and the rewards she receives from interacting with nature through her writing and photography. You can learn more about Celeste’s writing, advocacy work, helpful tips, and social network connections at CelesteCooper.com.

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