Differences in Pelvic Floor Morphometry for Women with Persistent Pelvic Pain and Deep Infiltrating Endometriosis-A
Erin M Nesbitt-Hawes1,2, Hans Peter Dietz3, William L Ledger4,5
1Discipline of Women's Health, School of Clinical Medicine, UNSW Sydney, Sydney, NSW, Australia. e.nesbitt-hawes@unsw.edu.au.
Introduction And Hypothesis:
This study is aimed at describing the morphometry of the pelvic floor for a large population of women with persistent pelvic pain (PPP) compared with those without pain.
Methods:
A prospective cross-sectional study was performed between January 2013 and November 2015, recruiting women attending a general gynaecology clinic. Demographic data were collected and translabial four-dimensional ultrasound (4DUS) was performed on all participants. Morphometric assessment of pelvic floor muscles was undertaken at rest, with contraction and Valsalva, and analysed by an assessor blinded to demographic details.
Results:
Of the 747 participants, 469 (62.8%) had PPP and 278 (37.2%) reported no pelvic pain. Levator hiatal (LH) area (14.4 vs 18.6 cm2, p = 0.009) and left-right (LR) diameter (3.9 vs 4.1 cm, p = 0.019) were smaller for women with PPP in the Valsalva assessment than in participants with no pain. For women who were currently requiring treatment for pelvic pain (158 out of 747, 21.2%) compared with those not having treatment, there were differences in LH area and LR diameter in all phases of movement; at rest (11.4 vs 12.8 cm2, p = 0.017; 3.6 vs 3.8 cm2, p = 0.038), Valsalva (13.6 vs 16.4 cm2, p = < 0.001, 3.8 vs 4.2 cm2, p = 0.001) and contraction (9.3 vs 10.4 cm2, p = 0.021, 3.3 vs 3.6 cm2, p = 0.006). For women with deep infiltrating endometriosis (DIE), smaller LH areas were seen on rest and Valsalva (adjusted mean 11.89 vs 12.75 cm2, p = 0.015, 15.13 vs 16.98 cm2, p = 0.002) but not contraction (10.05 vs 10.48 cm2, p = 0.161) than in women without endometriosis.
Conclusion:
Pelvic floor morphometry differs for women when comparing groups with PPP and no pain, particularly in the group of patients currently receiving treatment for their PPP, as well as the subgroup of DIE even when adjusting for confounding variables such as mode of delivery, age and prolapse. This supports the hypothesis that women with PPP have different PFM characteristics from women without pain symptoms. This study reports on mean measurements with likely overlapping distribution groups; therefore, we are unable to give a diagnostic criterion or measurement that could be used for the ultrasound assessment of women with PPP. Further research could stratify severity using validated assessments and compare clinical examination findings with the results seen on ultrasound.
