From the Guidelines
High tone pelvic floor dysfunction should be managed with a multidisciplinary approach, including pelvic floor physical therapy, biofeedback training, and lifestyle modifications, to improve quality of life and reduce symptoms. High tone pelvic floor dysfunction occurs when the pelvic floor muscles are too tight and unable to relax properly, leading to symptoms such as pelvic pain or pressure, pain during sexual intercourse (dyspareunia), difficulty emptying the bladder completely, urinary urgency or frequency, constipation or straining with bowel movements, and lower back pain that doesn't respond to usual treatments 1. According to the ACR Appropriateness Criteria for pelvic floor dysfunction in females, the goal of treatment is to improve the patient's quality of life, as the condition primarily causes morbidity but is not life-threatening 1.
Symptoms and Diagnosis
Common symptoms of high tone pelvic floor dysfunction include:
- Pelvic pain or pressure
- Pain during sexual intercourse (dyspareunia)
- Difficulty emptying the bladder completely
- Urinary urgency or frequency
- Constipation or straining with bowel movements
- Lower back pain that doesn't respond to usual treatments
- Sensation of something "falling out" of the vagina or rectum
- Pain when sitting, or referred pain in the hips, groin, or abdomen
Diagnosis is typically made through a combination of clinical evaluation, physical examination, and diagnostic tests such as urodynamic studies, anal manometry, and radiologic tests like fluoroscopy, MRI, and ultrasound 1.
Treatment and Management
Treatment for high tone pelvic floor dysfunction typically involves:
- Pelvic floor physical therapy with techniques to help muscles relax
- Biofeedback training
- Manual therapy
- Stretching exercises
- Lifestyle modifications, such as:
- Avoiding prolonged sitting
- Using proper posture
- Practicing stress reduction techniques
It is essential to consult with a healthcare provider who specializes in pelvic health for proper diagnosis and treatment, as symptoms can overlap with other disorders like interstitial cystitis, prostatitis, or endometriosis 1.
From the Research
High-Tone Pelvic Floor Dysfunction Symptoms
- High-tone pelvic floor dysfunction (HTPFD) is a neuromuscular disorder of the pelvic floor characterized by non-relaxing pelvic floor muscles, resulting in lower urinary tract and defecatory symptoms, sexual dysfunction, and pelvic pain 2
- Symptoms of HTPFD can include chronic pelvic pain, urinary symptoms, defecatory symptoms, and sexual dysfunction 2, 3
- HTPFD can affect up to 80% of women with chronic pelvic pain, making it a significant health concern 2
Treatment Options
- Pelvic floor physical therapy (PFPT) is recommended as the first-line treatment for HTPFD, with universal agreement among experts 2
- If satisfactory symptom improvement is not reached with PFPT, second-line options include trigger or tender point injections, vaginal muscle relaxants, and cognitive behavioral therapy 2
- Onabotulinumtoxin A injections can be used as a third-line treatment, with symptom assessment after 2-4 weeks 2
- Sacral neuromodulation is recommended as a fourth-line intervention 2
- Biofeedback therapy can also be used to treat pelvic floor disorders, including HTPFD, and has demonstrated efficacy in the treatment of chronic constipation and fecal incontinence 4
Barriers to Treatment
- Financial constraints, perceived lack of utility, time constraints, and travel issues are common barriers to accessing PFPT for HTPFD 5
- Anxiety and fear of treatment can also be barriers to care, although these are less common 5
- Insurance noncoverage and unclear explanations of treatment are also significant barriers to care 5
Compliance with Treatment
- Compliance with PFPT is a significant issue, with only 1 in 5 patients referred to PFPT for HTPFD being fully compliant with recommended therapy 6
- Noncompliant patients are more likely to smoke and have mental health disease, and are less likely to return to their prescribing provider 6
- Patients who are noncompliant with PFPT are less likely to receive second-line treatment, highlighting the importance of compliance with initial treatment 6