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Publications

Journal Article Ppublish

PubMed: 38551348 DOI: 10.1097/JCMA.0000000000001093

Pain in the enthesis of levator ani muscle: A novel source of chronic pelvic pain.

J Chin Med Assoc 87(5):505-510

Authors: Nurida Khasanah, Chih-Wei Peng, Jessica Jay Fang, Muhammad Nurhadi Rahman, Dedik Sulistiawan, Hung-Yen Chin

Affiliations

  • Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan, ROC.
  • Faculty of Medicine Public Health and Nursing, Department of Obstetrics and Gynecology, Universitas Gadjah Mada-Dr Sardjito General Hospital, Yogyakarta, Indonesia.
  • School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan, ROC.
  • School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan, ROC.
  • Research Center of Biomedical Device, Taipei Medical University, Taipei, Taiwan, ROC.
  • Department of Obstetrics and Gynecology, Taipei Medical University Hospital and School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC.
  • School of Public Health, Taipei Medical University, Taipei, Taiwan, ROC.
  • Departement of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia.

Abstract

BACKGROUND

Managing chronic pelvic pain (CPP) remains a challenge due to its diverse range of causes. A newly identified anatomical entity known as the enthesis of the levator ani muscle (LAM) and its associated disorders might play a role. This paper describes a novel insight into CPP's origin, aiming to improve accurate diagnosis and treatment.

METHODS

Data were collected from medical records (paper or electronic) retrospectively. The study included 112 patients meeting the criteria, divided into CPP and non-CPP groups. Clinical symptoms, including location of LAM enthesis, referred pain from pain in LAM enthesis, and related lower urinary tract symptoms (LUTSs) were discussed. To identify differences in symptoms between the groups, a Chi-squared test and descriptive analyses were conducted.

RESULTS

Bimanual examination revealed tender sites in the attachment of the LAM to the pubic bone. LAM enthesis pain presumably caused referred pain in at least 10 areas, primarily in the lower abdominal quadrate (40.2%-47.3%) followed by the inguinal area (8.9%-15.1%). Multiple LUTSs were observed, including urinary frequency (72.3%), urgency (42.9%), nocturia (53.6%), residual urine sensation (64.3%), urinary incontinence (30.3%), painful bladder (34.8%), and weak urine stream (47.9%). Patients in the CPP groups experienced significant residual urine sensation (53.6%) and bearing-down sensation (42%) compared to the non-CPP group.

CONCLUSION

Pain in LAM enthesis is a novel cause of pelvic pain and LUTSs that warrants attention for the evaluation and management of CPP.

MeSH

Signs And Symptoms, Sensation, Pelvic Pain, Muscles, Pain, Referred