High-Density Surface Electromyography Assessment of Pelvic Floor Dysfunction in Women with Interstitial Cystitis/Bladder Pain Syndrome

Dias, Nicholas; Zhang, Chuan; Spitznagle, Theresa; Lai, H. Henry; Zhang, Yingchun

doi:10.1097/ju.0000000000001237

Cited by 14 publications

(9 citation statements)

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“…Its value was higher in patients than in healthy women during maximum contractions and relaxation, especially when compared with mature/parous healthy women. Like us, several other authors have observed an increased amplitude of the sEMG signal in muscle at rest in women with PFM-associated pelvic pain [16,17,48], which has traditionally been associated with an increased level of neural excitation [13]. However, unlike us, some authors have reported no differences in the amplitude of the signal during PFM contractions [18,49] or even lower values [16,17] when the patients were compared with healthy subjects.…”

Section: Discussionmentioning

confidence: 53%

Characterization of Pelvic Floor Activity in Healthy Subjects and with Chronic Pelvic Pain: Diagnostic Potential of Surface Electromyography

Albaladejo-Belmonte

Tarazona-Motes

Nohales-Alfonso

et al. 2021

Sensors

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Chronic pelvic pain (CPP) is a highly disabling disorder in women usually associated with hypertonic dysfunction of the pelvic floor musculature (PFM). The literature on the subject is not conclusive about the diagnostic potential of surface electromyography (sEMG), which could be due to poor signal characterization. In this study, we characterized the PFM activity of three groups of 24 subjects each: CPP patients with deep dyspareunia associated with a myofascial syndrome (CPP group), healthy women over 35 and/or parous (>35/P group, i.e., CPP counterparts) and under 35 and nulliparous (<35&NP). sEMG signals of the right and left PFM were recorded during contractions and relaxations. The signals were characterized by their root mean square (RMS), median frequency (MDF), Dimitrov index (DI), sample entropy (SampEn), and cross-correlation (CC). The PFM activity showed a higher power (>RMS), a predominance of low-frequency components (<MDF, >DI), greater complexity (>SampEn) and lower synchronization on the same side (<CC) in CPP patients, with more significant differences in the >35/P group. The same trend in differences was found between healthy women (<35&NP vs. >35/P) associated with aging and parity. These results show that sEMG can reveal alterations in PFM electrophysiology and provide clinicians with objective information for CPP diagnosis.

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Section: Discussionmentioning

confidence: 53%

Characterization of Pelvic Floor Activity in Healthy Subjects and with Chronic Pelvic Pain: Diagnostic Potential of Surface Electromyography

Albaladejo-Belmonte

Tarazona-Motes

Nohales-Alfonso

et al. 2021

Sensors

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“…Up to 85% of patients with interstitial cystitisbladder pain syndrome have pelvic floor hypertonicity 28,29 which can result in sexual dysfunction. Although bladder instillation improved participants' interstitial cystitis-bladder pain syndrome symptoms, neither bladder instillation with triamcinolone acetonide or bladder instillation without triamcinolone acetonide improved participants' rates of dyspareunia or sexual activity from the first to sixth bladder instillation.…”

Section: Discussionmentioning

confidence: 99%

Bladder Instillations With Triamcinolone Acetonide for Interstitial Cystitis–Bladder Pain Syndrome

Cardenas-Trowers

Abraham

Dotson

et al. 2021

Obstetrics &Amp; Gynecology

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OBJECTIVE: To evaluate the utility of adding triamcinolone acetonide to a standard bladder instillation solution for treatment of interstitial cystitis–bladder pain syndrome. METHODS: This was a single-center, randomized, double-blind trial that compared symptom response in women with interstitial cystitis–bladder pain syndrome who underwent six bladder instillations with triamcinolone acetonide or six instillations without. All instillation solutions contained heparin, viscous lidocaine, sodium bicarbonate, and bupivacaine. The primary outcome was the change in interstitial cystitis–bladder pain syndrome symptoms from the first to sixth bladder instillation between groups based on the total OLS (O'Leary-Sant Questionnaire) score. Assuming a 4.03-point or larger difference in the mean total OLS score from the first to sixth bladder instillation as compared between the groups, 64 participants were needed to show a significant difference with 80% power at the 0.05 significance level. RESULTS: From January 2019 to October 2020, 90 women were enrolled—45 per group; 71 (79%) completed all six bladder instillations. Randomization resulted in groups with similar characteristics. There was no difference between groups in the primary outcome (bladder instillation with triamcinolone acetonide: mean OLS change −6.7 points, 95% CI 4.6–8.8 and bladder instillation without triamcinolone acetonide: mean OLS change −5.8 points, 95% CI 3.4–8.1; P=.31). Women in both groups had improvement in their interstitial cystitis–bladder pain syndrome symptoms as indicated by a decrease in the total OLS score from the first to sixth bladder instillation. CONCLUSION: The addition of triamcinolone acetonide to a standard bladder instillation solution does not improve symptoms associated with interstitial cystitis–bladder pain syndrome. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT03463915.

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“…One would think that the pelvic oor spasm noted in these patient populations should be justi cation enough (as an antispastic agent) for the clinical assessment of baclofen. Indeed, targeting pelvic oor hypertonicity associated with chronic pelvic pain syndromes has been the strategy of mainstay therapies such as myofascial physical therapy [46][47][48][49] and new clinical research involving local injections of botulinum toxin with and without physical therapy [50][51][52] .…”

Section: Discussionmentioning

confidence: 99%

Systemic and Intrathecal Baclofen Produce Bladder Antinociception in Rats

Ness

Randich

et al. 2021

Preprint

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Background Baclofen, a clinically available GABAB receptor agonist, produces non-opioid analgesia in multiple models of pain but has not been tested for effects on bladder nociception. Methods A series of experiments examined the effects of systemic and spinally administered baclofen on bladder nociception in female anesthetized rats. Models of bladder nociception included those which employed neonatal and adult bladder inflammation to produce bladder hypersensitivity. Results Cumulative intraperitoneal dosing (1–8 mg/kg IP) and cumulative intrathecal dosing (10–160 ng IT) of baclofen led to dose-dependent inhibition of visceromotor responses (VMRs) to urinary bladder distension (UBD) in all tested models. There were no differences in the magnitude of the analgesic effects of baclofen as a function of inflammation versus no inflammation treatments. Hemodynamic (pressor) responses to UBD were similarly inhibited by IT baclofen as well as UBD-evoked excitatory responses of spinal dorsal horn neurons. The GABAB receptor antagonist, CGP 35348, antagonized the antinociceptive effects of IT baclofen on VMRs in all tested models but did not affect the magnitude of the VMRs by itself suggesting no tonic GABAB activity was present in this preparation. Tolerance to a seven day continuous IT infusion of baclofen was not observed. Conclusions These data provide support for a clinical trial of baclofen as a non-opioid treatment of human bladder pain.

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High-Density Surface Electromyography Assessment of Pelvic Floor Dysfunction in Women with Interstitial Cystitis/Bladder Pain Syndrome

Cited by 14 publications

References 0 publications

Characterization of Pelvic Floor Activity in Healthy Subjects and with Chronic Pelvic Pain: Diagnostic Potential of Surface Electromyography

Characterization of Pelvic Floor Activity in Healthy Subjects and with Chronic Pelvic Pain: Diagnostic Potential of Surface Electromyography

Bladder Instillations With Triamcinolone Acetonide for Interstitial Cystitis–Bladder Pain Syndrome

Systemic and Intrathecal Baclofen Produce Bladder Antinociception in Rats

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