*1.2.2.1. Urethral pain syndrome*

The conditions associated with the painful bladder include interstitial cystitis, bladder pain syndrome or BPS. The European Urological Association (EUA), the International Society for the study of BPS (ESSIC), the International Association for the Study of Pain (IASP) and several other groups now prefer the term bladder pain syndrome (BPS). Terms that end in "itis" in particular should be avoided unless infection and/or inflammation is proven and considered to be the cause of the pain (Abrams, Baranowski et al. 2006). Chronic pelvic pain may be subdivided into conditions with well-defined classical pathology, such as infection, and those

BPS is the occurrence of persistent or recurrent pain perceived in the urinary bladder region, accompanied by at least one other symptom, such as pain worsening with bladder filling and day-time and/or night-time urinary frequency. There is no proven infection or other obvious local pathology. BPS is believed to represent a heterogeneous spectrum of disorders. There may be specific types of inflammation as a feature in subsets of patients (Engeler, Baranowski

Pelvic floor muscle pain syndrome is the occurrence of persistent or recurrent episodic pelvic floor pain. It is often associated with symptoms suggestive of lower urinary tract dysfunction

BPS should be diagnosed on the basis of pain, pressure or discomfort associated with the urinary bladder, accompanied by at least one other symptom, such as daytime and/or nighttime increased urinary frequency, the exclusion of confounding diseases as the cause of symptoms, and if indicated, cystoscopy with hydrodistension and biopsy (van de Merwe, Nordling et al. 2008). Hunner's lesion and inflammation is referred to as BPS type 3. Current thought implicates an initial unidentified insult to the bladder, triggering inflammatory,

No infection aetiology has been implicated since BPS patients and controls have equal UTI frequency (Nickel, Shoskes et al. ; Warren, Brown et al. 2008). Of interest however is the fact that UTI and urgency are significantly more frequent during childhood and adolescence in

Cystoscopic and biopsy findings in both ulcer and non-ulcer BPS are consistent with defects in the urothelial glycosaminoglycan (GAG) layer. Urinary uronate, and sulphated GAG levels

The physiopathologic relationship between interstitial cystitis and rheumatic, autoim‐ mune, and chronic inflammatory diseases has been investigated. (Lorenzo Gomez and

Biological markers have been explored as an attractive idea to support or, even better, to

*Medical management:* Analgesics, corticosteroids, anti-allergic medications, Amitriptyline, Pentosan polysulphate sodium.Immunosuppressants such as Azathioprine, Cyclosporin A,

endocrine and neural phenomena (Warren, Wesselmann et al.).

patients who later develop BPS in adulthood (Peters, Killinger et al. 2009).

are increased in patients with severe BPS (Lokeshwar, Selzer et al. 2005).

confirm the clinical diagnosis and prognosis (Lokeshwar, Selzer et al. 2005).

The therapeutic modalities currently available for BPS include the following:

with no obvious pathology.

292 Electrodiagnosis in New Frontiers of Clinical Research

(Engeler, Baranowski et al. 2012).

Gomez Castro 2004).

et al. 2012).

Urethral pain syndrome is the occurrence of chronic or recurrent episodic pain perceived in the urethra, in the absence of proven infection or other obvious local pathology (Parsons 2011). There pathogenesis of urethral pain syndrome is unknown but it may part of the spectrum of BPS. Some have postulated that neuropathic hypersensitivity can develop following urinary a UTI (Kaur and Arunkalaivanan 2007). The same authors suggested that behavioural therapy including biofeedback and bladder training can be helpful (Kaur and Arunkalaivanan 2007).

## *1.2.2.2. Other causes of chronic pelvic pain*

Pelvic organ prolapse is often an asymptomatic condition, unless it is so marked that it causes back strain, vaginal pain and skin excoriation (Roovers, van der Vaart et al. 2004).

In the past few years, non-absorbable mesh has been used in the pelvic organ prolapse surgery. Although they may have a role in supporting the vagina, they are also associated with several complications including bladder, bowel and vaginal trauma (Niro, Philippe et al. 2010).A subset of these patients may develop chronic pain because mesh insertion causes nerve and muscle irritation (Daniels, Gray et al. 2009).

Most patients can be treated by surgical removal of the mesh (Margulies, Lewicky-Gaupp et al. 2008). If appropriate, multidisciplinary pain management strategies can be applied. Another cause of pain is previous surgery for incontinence with transoburator tapes. Chronic perineal pain at 12 months after surgery was reported by 21 trials and metaanalysis of these data showed strong evidence of a higher rate in women undergoing transobturator insertion (7%) compared to retropubic insertion (3%)(Barber, Kleeman et al. 2008; Lorenzo-Gómez, B et al. 2013).

*1.3.1. Physical therapies for the urinary incontinence*

augmented with biofeedback (Bidmead 2002).

if pelvic floor physiotherapy fails (Bidmead 2002).

Schanz et al. 2006; Delorme and Hermieu 2010).

*1.3.1.1. RTUI after surgical correction of UI or pelvic organs prolapses*

use, by both Urologists and Gynaecologists (Castiñeiras-Fernández 2005).

**2. Our experience with the treatment of bladder pain syndrome**

recurrence rate of UTI.

incontinence.

obtained at our academic unit.

The treatment of lower urinary tract's disorders with pelvic floor exercises with or without biofeedback represents a risk-free option which can be applied in a great number of women. The correct function of the female pelvic floor depends on the position and mobility of the urethra and the urethrovesical junction. Pelvic floor muscle training increases urethral closure pressure and stabilises the urethra, preventing downward movement during moments of increased physical activity. There is evidence that increasing pelvic floor strength may help to inhibit bladder contraction in patients with an overactive bladder. This training may be

Biofeedback with Pelvic Floor Electromyography as..

http://dx.doi.org/10.5772/56237

295

The evidence published in the guidelines regarding urinary incontinence suggests that UTI treatment does not correct the UI. It is unclear if improving the incontinence helps decrease

Valid methods to evaluate the morphologic and electromyographic abnormalities of the levator ani muscle are necessary in order to better select women or the treatment with

The most recently published systematic review in 2010 found that medication was less effective than behavioural therapy in a comparative effectiveness trial (81% vs. 69% reduction in UI episodes) (Goode, Burgio et al. 2010), therefore pelvic floor physiotherapy must always be the first line of treatment for stress incontinence and overactive bladder. Drugs must be prescribed

In 1995 the tension-free transvaginal tape (TVT) was introduced to treat UI (Ulmsten and Petros 1995). In 2001 another technique, the suburethral transobturator tape (TOT), was introduced (Delorme 2001). The main advantages were that the tape lays at a more anatomic position than in TVT, the needle does not cross the retropubic space, no abdominal incisions are made, there is a lower risk of vesical or intestinal injury and no cystoscopy is required (Sola Dalenz, Pardo

The simplicity of these techniques and their reproducibility has dramatically increased their

When surgical treatment is indicated, the TOT procedure is the procedure of choice, absent contraindications. This recommendation is supported by the establishment of TVT as a worldwide validated and proven procedure for the surgical correction of urinary stress

In the following sections we describe the experience with biofeedback and electromyography

pelvic floor training and biofeedback (Bo, Larsen et al. 1988; Espuña-Pons 2002).

Vulvovaginal pain can developed after bacterial vaginal infections or bacterial vaginosis. Infections change the vaginal ecosystem. Oestrogen deficiency in peri- and post-menopausal women can also lead to vulvar tissue atrophy and a subsequent irritation. Contact with irritanting agents such as soaps, detergents and topical preparations as well as vulvar trauma associated with accidents or surgery can lead to vulvar irritation and the development of vulvovaginal pain (White, Jantos et al. 1997 Mar).
