Quantitative Assessment of Pelvic Floor Muscle Fitness in Myofascial Pelvic Pain

PROJECT SUMMARY
Myofascial Pelvic Pain (MPP) is a frequently overlooked musculoskeletal cause of chronic pelvic pain
affecting 10-20% of all adult women. Pelvic floor muscle tightening in MPP results in acidosis and
accumulation of neuroinflammatory mediators, leading to self-reinforcing pelvic pain and bowel, bladder,
and sexual dysfunction. A challenge in the management of MPP has been a lack of quantitative measures
of pelvic floor physiology capable of quantifying functional alterations in the pelvic floor musculature in 3-
dimensional space. This deficiency has in turn hampered both a greater understanding of the mechanisms
of MPP and the development of novel therapeutics. Our research group has developed an innovative
approach to identify pelvic floor muscle dysfunction using a near infra-red spectroscopy (NIRS) optical,
vaginal interface designed to image and quantify in real-time oxygenation and hemodynamics regionally
throughout the pelvic floor in response to contraction and relaxation of the muscle. During the R61 phase,
we plan to validate this technology as an effective, non-invasive, and scalable method to assess pelvic floor
muscle fitness. We will seek to establish parameters to describe the severity and spatial patterns of
myofascial dysfunction and how these parameters correlate with individual muscular assessment, the
spectrum of pelvic pain manifestations, and bowel, bladder, and sexual complaints. We will also correlate
these findings with current subjective methods of pelvic floor assessment in control subjects and MPP
subjects, specifically focusing on the ability of NIRS to provide repeatable measurements independent of
user expertise and training. In the R33 phase, we will utilize this technology to examine prospective changes
in pelvic floor fitness in MPP patients following a range of myofascially-directed therapies, including
pharmacologic muscle relaxation, onabotulinumA toxin pelvic floor injection, and myofascial release
physical therapy. We will correlate NIRS outcomes and symptomatic measures with systemic inflammatory
markers pre- and post-treatment to understand better the role of neuroinflammation in the clinical syndrome
of MPP. We will also employ machine learning models to examine if this technology can be utilized to predict
responses to individual treatments. Demonstration that objective measures of muscle fitness recover as
symptoms improve following myofascially-directed therapies will provide the first direct evidence of the
underlying nature of MPP, evidence needed to evolve current therapeutic approaches. Through
interdisciplinary collaboration of specialists in urology, gynecology, integrative medicine, and computational
medicine, this novel imaging technique providing both spatial and functional evaluation of the pelvic floor
will assist in the diagnosis and management of chronic pelvic pain and promote additional research into
novel approaches to address the poorly recognized epidemic of myofascial pelvic pain in women.

Grant Number: 1R61AT013008-01
NIH Institute/Center: NIH
Principal Investigator: A. Lenore Ackerman