SAN DIEGO -- When managing a patient with chronic pelvic pain, consider a referral to a physical therapist, Dr. James C. Lukban recommended at a meeting sponsored by the International Pelvic Pain Society.
A regimen of physical therapy exercises and manipulations--including myofascial release, joint mobilization, muscle strengthening and stretching, and "reeducating" tight, tender muscles--resulted in significantly improved sexual function and voiding ability in 16 women with interstitial cystitis, dyspareunia, and dysuria, reported Dr. Lukban of the Graduate Hospital of Philadelphia.
At baseline the patients' dyspareunia scores were a mean of 2.72 on a scale of 0-5, suggesting some restriction of sexual intercourse due to pain, according to Dr. Lukban.
After a mean of approximately nine visits to a physical therapist, the mean score of those patients was 0.875, indicating a virtually normal sex life.
Nine patients returned to pain-free intercourse.
Before and after their course of physical therapy, the patients also completed the O'Leary-Sant Symptom and Problem Questionnaire, a test that measures urinary frequency urgency pain, and nocturia.
Scores on the 36-item questionnaire went from a mean of 15.75 before treatment to a mean of 8.5 afterward.
Fifteen of the 16 patients reported at least some improvement in symptoms.
In those cases, pelvic pain was attributable to pelvic misalignment caused by sacroiliac dysfunction, Dr. Lukban said.
He and his colleagues made the diagnosis through structural assessment of pelvic alignment and range-of-motion evaluations of the patients' hips and lumbar spine.
"The evidence continues to mount supporting the importance of including the musculoskeletal system as a component of the management paradigm for chronic pelvic pain," Rhonda K. …