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Updated: Jul 2, 2025

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A Treatment Algorithm for High-Tone Pelvic Floor Dysfunction.

Michele Torosis1, Erin Carey, Kristin Christensen

  • 1Department of Obstetrics and Gynecology and the Department of Urology, UCLA, and Cedars-Sinai Medical Center, Los Angeles, California; the Department of Obstetrics and Gynecology, UNC, Chapel Hill, North Carolina; the Department of Urology, Vanderbilt, Nashville, Tennessee; the Department of Obstetrics and Gynecology, University of Chicago, Chicago, and Kotarinos Physical Therapy, Lake Zurich, Illinois; Washington University in St. Louis, the Division of Urologic Surgery, Departments of Surgery and Anesthesiology, and the Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri; the Department of Urology, Virginia Mason, Seattle, Washington; and Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas.

Obstetrics and Gynecology
|February 22, 2024
PubMed
Summary

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This summary is machine-generated.

Pelvic floor physical therapy (PFPT) is the recommended first-line treatment for high-tone pelvic floor dysfunction (HTPFD). A stepwise approach is advised, with PFPT followed by other therapies if needed for managing this neuromuscular disorder.

Area of Science:

  • Urology
  • Gynecology
  • Physical Therapy

Background:

  • High-tone pelvic floor dysfunction (HTPFD) is a common neuromuscular disorder affecting 80% of women with chronic pelvic pain.
  • It is characterized by non-relaxing pelvic floor muscles, leading to urinary, defecatory, sexual, and pain symptoms.
  • Current management lacks uniformly accepted clinical guidelines.

Purpose of the Study:

  • To establish evidence- and consensus-based clinical practice guidelines for HTPFD management.
  • To develop a consensus treatment algorithm for HTPFD.

Main Methods:

  • A three-round Delphi method was employed with 11 national experts in HTPFD.
  • Surveys were administered anonymously online between September and December 2021.
  • Experts rated evidence-based statements on HTPFD treatment to reach consensus.

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Main Results:

  • A consensus treatment algorithm was developed, recommending a stepwise approach.
  • Pelvic floor physical therapy (PFPT) is universally agreed upon as the first-line treatment.
  • Second-line options include injections, muscle relaxants, and cognitive behavioral therapy; third-line is Onabotulinumtoxin A; fourth-line is sacral neuromodulation.
  • Limited access to PFPT is a significant barrier, with at-home and virtual options recommended as alternatives.

Conclusions:

  • A stepwise, multi-line treatment approach is recommended for HTPFD.
  • PFPT should be the initial treatment offered to patients.
  • Guidelines are essential for consistent and effective HTPFD management.