POSTPARTUM PERINEAL PAIN: PREVALENCE OF MYOFASCIAL PAIN SYNDROME: A CROSS-SECTIONAL STUDY

M. Torres-Lacomba¹, F. Vergara-Pérez¹, V. Prieto-Gónez², L. Lorenzo-Gallego², B. Navarro-Brazález¹

¹University of Alcalá, FPSM Research Group, Physiotherapy, Alcalá de Henares, Spain, ²Unviersity of Alcalá, FPSM Research Group, Alcalá de Henares, Spain

Background: Perineal pain is a recognized problem after vaginal delivery that negatively influences the physical and mental state of women, affecting their quality of life as well as their sexual activity. Perineal pain is present in many women after vaginal delivery. Lacerations that occur to the perineum, such as episiotomy or tearing, appear not to be the only sources of pain. In this sense, perineal pain has been identified that is not associated with the extension and location of the laceration, and that can even appear in women who do not present an episiotomy or tear after childbirth.

Purpose: The objective of this study was to estimate the prevalence of myofascial pain syndrome (MPS) in women with perineal pain in the puerperium.

Methods: Between January 2018 and April 2022, 162 primiparous women whose delivery was eutocic and took place at the Príncipe de Asturias Hospital in Madrid, were included. After 6-8 weeks of delivery, women were scheduled for a physical therapy assessment by a physiotherapist expert in the diagnosis and treatment of MPS. Perineal pain of myofascial origin was assessed. Active myofascial trigger points (MTrPs) were diagnosed by applying the diagnostic criteria described by Simons, Travell & Simons. Postpartum women's descriptions of pain and drawings of pain patterns on body maps guided the physical examination. Postpartum women did not receive any information about myofascial pain or other muscle pain syndromes.

Results: The mean age of the puerperal women was 26(4). Of the 162 women, 154 underwent episiotomy, and 6 suffered tears. In addition, 28 presented mechanical nociceptive pain related to the scar, and 79 (48.8%) presented dyspareunia, of which 58 (35.8%) presented nociceptive pain related to active MTrPs. The muscles affected by MPS were the levator ani muscle (47) and the obturator internus muscle (13). The symptomatology that was reproduced when palpating the MTrPs of the levator ani muscle and that the participants associated with their usual symptom was vaginal pain (n= 38), anal pain (n= 5), clitoral pain (n= 3), coccygeal pain (n= 2) and sensation of bladder fullness (n= 1). Palpation of the internal obturator muscle was intracavitary. In the case of the internal obturator muscle, 8 of the 13 women presented, in addition to the referred pattern described by Travell & Simon's, a pattern of referred pain in the area of the hypogastrium and in the ipsilateral iliac fossa that was described as "menstrual pain" , “ovarian pain” or “pain during sexual intercourse”. MTrPs were diagnosed in all cases on the contralateral side to the scar. In all cases, the episiotomy was performed on the right side and the MTrPs were found on the left side, except in 3 women in whom MTrPs were found bilaterally.

Conclusions: MPS is a potential cause of perineal pain during the puerperium. More prevalence and incidence studies are needed to corroborate these results.

Implications: Postpartum MPS needs to be identified and treated.

Funding acknowledgements: No funding.

Keywords:
Perineal pain
Myofascial pain syndrome
Puerperium

Topics:
Pain & pain management
Pelvic, sexual and reproductive health

Did this work require ethics approval? Yes

Institution: Hospital Príncipe de Asturias, Alcalá de Henares, Madrid

Committee: CEIC Hospital Príncipe de Aturias

Ethics number: OE_21_2013