People presenting with pelvic floor disorders have been reported to have a high prevalence of overlapping pelvic conditions. This association has not been fully characterized.  We hypothesize that those presenting with chronic pelvic pain have co-existing bowel, urinary, sexual, and neuro-urological symptomatology necessitating a multidisciplinary approach.

259 patients completed the electronic intake for our subspecialized adult Urogynecology and Reconstructive Pelvic Surgery (URPS) clinic. 38 (14.7%) were male, 215 (83%) female, and 6 (2.3%) identified as transgender.  Of the 259 patients, 114 reported “yes” to pelvic pain, and 138 reported “no”, the remaining 7 patients did not answer the survey. Validated scoring systems: PHQ4 (anxiety and depression), AUASS (urinary symptoms), CRAD-8 (lower urinary tract symptoms, POPDI-6 (pelvic organ distress inventory), GUPI (genitourinary pain), PISQIR (sexual health and function), UDI-6 (urinary symptoms), and SHIM (sexual health inventory) were used. Binary data using cut-off values for presence of dysfunction was defined as UDI-6 score greater or equal to 25 (1) or AUA symptoms score greater than 8 (2), bowel dysfunction as CRAD-8 greater than 25 (3), PISQR score of less than 2.68 for sexual dysfunction (4), IIEF sexual function score of less than 5 (5), POPD-6 score greater than or equal to 25 (6), and autonomic symptom tally score of greater than 5.  Statistical analysis utilized Pearson correlation or Chi-square.

Results are attached below as Table 1, Figure 1 and Figure 2.

56 (51%) of patients with pelvic pain reported bowel symptoms (Chi-square = 19.5 p value = <0.001), 84 (82%) reported urinary symptoms (Chi-square = 33.1 p value = <0.001). 69 (73%)  reported prolapse symptoms (Chi-square = 41.3, p value = <0.001), 40 (54%)  reported autonomic symptoms (Chi-square = 8.0, p value = 0.005). 73 (50%) of patients with urinary symptoms reported bowel symptoms (Chi-square = 27.9, p value = <0.001), 52 (48%) reported autonomic symptoms (Chi-square = 7.8, p value = 0.005). 88 (67%) reported prolapse symptoms (Chi-square = 55.2, p value = <0.001). 52 (48%) reported autonomic symptoms (Chi-square = 27.9, p value = <0.001). 67 (84%) of patients with bowel symptoms reported prolapse symptoms (Chi-square = 67.7, p value = <0.001). 40 (62.5%) reported autonomic symptoms (Chi-square = 16.6, p value = <0.001), 44 (57%) reported prolapse symptoms (Chi-square =14.3, p value = <0.001) (Table 1).  

Using a histogram the mean number of symptoms per patient was 2.55 +- 1.55, n=150) (Figure 1). 

 Using binary logistic regression, the odds of pelvic pain significantly increased with urinary symptoms [odds 5.6 (CI 3.0 -10.3)], bowel symptoms [odds 3.3 (CI 1.9-5.7)], prolapse symptoms [odds 6.7 (CI 3.6-12.2)], and autonomic symptoms [odds 2.42 (CI 1.3 to 4.4) present relative to when they were absent]. The odds of urinary symptoms significantly in the setting of bowel symptoms [odds 5.3 (CI 2.7-10.3)], prolapse symptoms [odds 12.4 (CI 5.9-25.9)], and autonomic symptoms [odds 2.6 (CI 1.3-5.0) if present, relative to when they were absent]. The odds of bowel symptoms significantly increased when autonomic symptoms [odds 3.7 (CI 1.9-7.1)], and prolapse symptoms were present [odds 15.2 (CI 7.4-31.3), relative to when they were absent]. The odds of autonomic symptoms were significantly increased when prolapse symptoms were present [odds 3.44 (CI 1.7-6.6)]. (Table 2)

Our findings demonstrate a significant overlap among pelvic pain, urinary, bowel, sexual, prolapse, autonomic, and autonomic symptoms. A comprehensive multidisciplinary intake is recommended to screen for comorbid pelvic symptomatology when treating patients with pelvic floor disorders.

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