Reduced Pelvic Muscle Strength, Urinary Dysfunction Often Accompany Fibromyalgia, Study Suggests

Reduced Pelvic Muscle Strength, Urinary Dysfunction Often Accompany Fibromyalgia, Study Suggests

Women with fibromyalgia (FM) show reduced strength in the pelvic muscles, which correlates with urinary dysfunction and worse quality of life, a study reports.

The study, “Lower urinary tract symptoms and perineal function in women with and without fibromyalgia: a cross-sectional study” was published in the journal Clinical Rheumatology.

Fibromyalgia was first defined by the American College of Rheumatology in 1990 as a “chronic and widespread pain of musculoskeletal origin.” But a review from 2010 highlighted the importance of looking at symptoms other than pain. Women with FM also experience fatigue and reduced muscle strength.

Researchers in Brazil hypothesized that reduced muscle strength would extend to pelvic floor muscles — those controlling over the bladder and bowel — but few studies have investigated the link between FM and urinary symptoms, such as incontinence.

To test their hypothesis, researchers collected data from 126 women — 62 FM patients (mean age 46) and 64 controls (mean age 42) — between March 2015 and October 2016. The participants were followed at the outpatient physical therapy department and rheumatology clinic of a teaching hospital. Over half the women were married and 50 percent had children.

Pelvic function was evaluated using perineometry and vaginal palpation.  In perineometry, a device measures the pressure of the vaginal walls when they are squeezed, whereas in vaginal palpation the clinician aims to assess muscle contraction, endurance, repetition, and fast contractions (termed the PERFECT method).

The impact of urinary incontinence on patients’ quality of life was evaluated by the King’s Health Questionnaire (KHQ).

Sixty-five percent of women with FM reported lower urinary tract symptoms (LUTS) compared with 26.6 percent of controls. The symptoms included urinary leakage, increased urination frequency, nocturia (excess urination at night) and urinary urgency. Perineometry and vaginal palpation revealed that FM patients had worse function of the pelvic floor muscles.

Forty percent of women with FM sought medical help and relied on treatments, compared to 29.4% of controls. Only 8.1% of FM patients enrolled in physical therapy, compared to 11.8% of controls.

Women with FM scored higher in all the domains of the KHQ questionnaire, which shows that they have a poorer quality of life perception compared to controls.

Researchers estimated that FM patients were five times more likely to develop LUTS relative to controls. However, smoking and pregnancy also influenced these symptoms.

Overall, “the present study showed that there is a relation between FM and LUTS,” researchers said. “Women with FM present worse [pelvic floor] function and higher rate of LUTS with negative impact on their quality of life.”