DOES PELVIC SURGERY IMPACT THE EFFICACY OF PELVIC FLOOR PHYSICAL THERAPY FOR PELVIC PAIN?
Pelvic floor physical therapy (PFPT) is effective for myofascial pelvic pain. We look at whether a history of prior pelvic surgery affects patient outcomes.
We performed a retrospective review of patients referred for pelvic floor physical therapy (PFPT) due to pelvic pain between March 2015 through February 2016. Variables including the Numerical Rating Scale (NRS) for pain (both average (AVG) and worst day (WST) scores), the Pelvic Floor Distress Inventory questionnaire (PFDI) and the Pelvic Floor Impact Questionnaire (PFIQ) were collected at the first encounter (ENC) and at the last ENC. Patients with a history of pelvic surgery (SGY) were compared to those who did not (N-SGY) using descriptive statistics and Wilcoxon rank sum tests.
A total of 91 patients were included. 55% (50/91) of patients had prior pelvic surgery, most commly hysterectomy (36/50). Other surgeries included salpingectomy, endometrial ablation, myomectomy, bladder suspension, ovarian cyst removal, anal fissure, oophorectomy, sacralcolpopexy and midurethral sling. The SGY group was older (mean 53 vs. 41, p=0.0002) and had undergone more deliveries (median 2 vs. 0, p=0.004). Median NRS scores for AVG and WST at first ENC were significantly higher for SGY than N-SGY; at last ENC, however, these scores were not significantly higher than N-SGY. Both groups had significant intragroup AVG and WST NRS score improvements from first to last ENC. (see Table) PFDI was significantly higher for SGY at first ENC (p=0.007) and last ENC (p=0.003) and within group analysis showed only N-SGY significantly improved (SGY: n=23, -19, p=0.24; N-SGY: n=22, -31, p < 0.0001). Baseline PFIQ scores were not different for SGY vs. N-SGY groups yet improvement within both groups was significant (FE to LE SGY: n=24, -28, p=0.004; N-SGY: n=17, -28, p=0.004).
For patients who underwent PFPT for pelvic pain, significant improvement in NRS and PFIQ scores were seen regardless of whether or not they had a history of pelvic organ surgery. PFDI scores were significantly improved for the N-SGY group only after PFPT.