女性骨盆肌肉骨骼功能異常與間質性膀胱炎/膀胱疼痛症候群相關性之探討
劉明岳1，李明輝1.2，吳惠卿1.2，陳怡靜3，莊雅淨3
1衛生福利部 苗栗醫院；2中台科技大學；3中山醫學大學
The Evaluation of Correlation between Pelvic Musculoskeletal Dysfunction and Interstitial Cystitis/ Bladder Pain Syndrome in Female Patients
Ming Yueh Liu1, Ming-Huei Lee1,2, Huei-Ching Wu1,2, Yi-C hing Chen3
1 Department of Urology, Miao-Li Hospital, Ministry of Health&Welfare, Taiwan；2Central Taiwan University of Science and Technology；3Department of Physical Therapy, Chung-Shan Medical University
Purpose: Interstitial Cystitis / Bladder Pain Syndrome (IC/BPS) is a chronic disease characterized by urinary urgency, frequency, and pain. Many IC/BPS patients also suffer from pelvic pain, dyspareunia, and urinary hesitancy which induced by pelvic floor spasm or pelvic musculoskeletal dysfunction. The purpose of this study is to analyze the correlation of the female pelvic musculoskeletal disorders with different severity and symptom scale in women with IC/PBS.
Materials and methods: Thirty four women aged from 20 y/o to 65 y/o with IC/PBS were included in this study. The pelvic musculoskeletal dysfunction assessments (including muscle strength, muscle flexibility, muscle pressure pain test, skeletal structures, etc.) and the Interstitial Cystitis Symptom Index and Problem Index (ICSI and ICPI) were conducted during the study. The subjects were divided into two groups according to their severity which was defined by their total scores of ICSI and ICPI. Chi Square test and Independent-sample T test were used to compare the differences between two groups. The correlation between symptom questionnaire scores and pelvic musculoskeletal dysfunction assessments were analyzed for all subjects by Spearman's rho. Significance was set at p < 0.05.
Results: The results shown significant differences in ICSI, VAS scale of Pain and Urgency, abdominal muscle strength, as well as the myofascial pain of tensor fascia lata and puborectalis between two groups. The significant positive correlations were found between related scale and waist circumference, body mass index, rectus femoris flexibility test, sacroiliac joint screening examination, and myofascial tender point pain level (piriformis, puborectalis, and pubococcygeus). Whereas significant negative correlations were found between related scale and abdominal muscle strength, abdominal muscle endurance, reflex contraction ability of pelvic floor muscle during coughing, and piriformis flexibility test.
Conclusion: More common abnormal findings on pelvic musculoskeletal exam were found in women with more severe IC/PBS. In women with IC/PBS, the understanding of the pelvic musculoskeletal dysfunction would be beneficial to provide a complete advice in treatment prescription.
Key Words: interstitial cystitis, bladder pain syndrome, pelvic musculoskeletal dysfunction