{"paper_id":"6f2c70eb-3157-40f0-9d3d-dfb9b4d2b6bd","body_text":"Abstract\nEndometriosis causes pain in many different mechanisms. In addition to direct pain caused by implants, patients often develop additional pain generators. One of them is the spasm of the pelvic floor muscles. Those muscles become spastic in the mechanism known as viscerosomatic convergence. In this mechanism, painful impulses travel from the pelvis to the spinal cord through the afferent fibers. They reconnect in the dorsal horn of the spinal cord, and efferent signals travel back to the muscles of the pelvis triggering them to spasm. Spasming pelvic floor muscles are a source of pain by themselves similarly to muscle spasm elsewhere in the body. They also lead to obstructive voiding, constipation, pain with and after urination, pain with and after bowel movement, and pain with and after intercourse. Constipation from spasming rectal sphincter likely leads to bowel becoming hyperactive to aid with evacuation of the stool. Those are the symptoms of irritable bowel syndrome. Mechanism called viscero-visceral convergence may explain direct involvement of the bladder. Afferent impulse travels from the peritoneal surface and then reconnects in the spinal cord to visceral efferent fiber traveling to the bladder. This explains bladder pain in those patients. It is crucial in patients with endometriosis to identify all the sources of pain since they must be addressed to alleviate. Pelvic floor muscles need to generally be addressed first. Patients should be referred to pelvic floor physical therapy. They may also benefit from muscle relaxants, especially vaginal suppositories. Patients with severe muscle spasm will benefit from injection botulinum toxin A into those muscles. Those injections may need to be repeated but ultimately physical therapy will allow muscles to stay relaxed. Bladder pain also needs to be addressed. Bladder hydrodistentions and installations in addition to pelvic muscle treatment may be effective in patients with bladder pain.\nAccess this chapter\nTax calculation will be finalised at checkout\nPurchases are for personal use only\nSimilar content being viewed by others\nReferences\nChung MK, Chung RP, Gordon D. Interstitial cystitis and endometriosis in patients with chronic pelvic pain: the “Evil Twins” syndrome. JSLS. 2005;9(1):25–9. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3015562&tool=pmcentrez&rendertype=abstract.\nMorotti M, Vincent K, Becker CM. Mechanisms of pain in endometriosis. Eur J Obstet Gynecol Reprod Biol. 2017; https://doi.org/10.1016/j.ejogrb.2016.07.497.\nLongstreth GF, Preskill DB, Youkeles L. Irritable bowel syndrome in women having diagnostic laparoscopy or hysterectomy. Relation to gynecologic features and outcome. Dig Dis Sci. 1990;35(10):1285–90. https://doi.org/10.1007/BF01536421. PMID: 2145139\nHoward FM. Surgical treatment of endometriosis. Obstet Gynecol Clin North Am. 2011;38(4):677–86. https://doi.org/10.1016/j.ogc.2011.09.004. PMID: 22134016\nKoziol JA. Epidemiology of interstitial cystitis. Urol Clin North Am. 1994;21(1):7–20. PMID: 8284848\nButrick CW. Patients with chronic pelvic pain: endometriosis or interstitial cystitis/painful bladder syndrome? J Soc Laparoendosc Surg. 2007;11(2):182–9. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3015726&tool=pmcentrez&rendertype=abstract.\nGiamberardino MA, Costantini R, Affaitati G, et al. Viscero-visceral hyperalgesia: characterization in different clinical models. Pain. 2010;151(2):307–22. https://doi.org/10.1016/j.pain.2010.06.023.\nIssa B, Onon TS, Agrawal A, et al. Visceral hypersensitivity in endometriosis: a new target for treatment? Gut. 2012;61(3):367–72. https://doi.org/10.1136/gutjnl-2011-300306.\nKuo TLC, Ng LG, Chapple CR. Pelvic floor spasm as a cause of voiding dysfunction. Curr Opin Urol. 2015; https://doi.org/10.1097/MOU.0000000000000174.\nVisser E, Schug SA. The role of ketamine in pain management. Biomed Pharmacother. 2006; https://doi.org/10.1016/j.biopha.2006.06.021.\nHanno P, Dmochowski R. Status of international consensus on interstitial cystitis/bladder pain syndrome/painful bladder syndrome: 2008 snapshot. Neurourol Urodyn. 2009; https://doi.org/10.1002/nau.20687.\nButrick CW. Interstitial cystitis/bladder pain syndrome. Management of the pain disorder: a urogynecology perspective. Urol Clin North Am. 2012; https://doi.org/10.1016/j.ucl.2012.06.007.\nWarren JW, Jackson TL, Langenberg P, Meyers DJ, Xu J. Prevalence of interstitial cystitis in first-degree relatives of patients with interstitial cystitis. Urology. 2004; https://doi.org/10.1016/j.urology.2003.08.027.\nBerry SH, Elliott MN, Suttorp M, et al. Prevalence of symptoms of bladder pain syndrome/interstitial cystitis among adult females in the United States. J Urol. 2011; https://doi.org/10.1016/j.juro.2011.03.132.\nHanno PM, Burks DA, Clemens JQ, et al. AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2011; https://doi.org/10.1016/j.juro.2011.03.064.\nFriedlander JI, Shorter B, Moldwin RM. Diet and its role in interstitial cystitis/bladder pain syndrome (IC/BPS) and comorbid conditions. BJU Int. 2012; https://doi.org/10.1111/j.1464-410X.2011.10860.x.\nParsons CL, Dell J, Stanford EJ, et al. Increased prevalence of interstitial cystitis: previously unrecognized urologic and gynecologic cases identified using a new symptom questionnaire and intravesical potassium sensitivity. Urology. 2002; https://doi.org/10.1016/S0090-4295(02)01829-0.\nHanno P. Is the potassium sensitivity test a valid and useful test for the diagnosis of interstitial cystitis? Int Urogynecol J. 2005;16(6):428–9. https://doi.org/10.1007/s00192-005-1306-5.\nFitzGerald MP, Payne CK, Lukacz ES, et al. Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. J Urol. 2012;187(6):2113–8. https://doi.org/10.1016/j.juro.2012.01.123.\nLaviana A, Jellison F, Kim J-H. Sacral neuromodulation for refractory overactive bladder, interstitial cystitis, and painful bladder syndrome. Neurosurg Clin. 2014;25(1):33–46. https://doi.org/10.1016/j.nec.2013.08.001.\nAredo JV, Heyrana KJ, Karp BI, Shah JP, Stratton P. Relating chronic pelvic pain and endometriosis to signs of sensitization and myofascial pain and dysfunction. Semin Reprod Med. 2017;35(1):88–97. https://doi.org/10.1055/s-0036-1597123.\nHartmann D, Sarton J. Chronic pelvic floor dysfunction. Best Pract Res Clin Obstet Gynaecol. 2014; https://doi.org/10.1016/j.bpobgyn.2014.07.008.\nNesbitt-Hawes EM, Won H, Jarvis SK, Lyons SD, Vancaillie TG, Abbott JA. Improvement in pelvic pain with botulinum toxin type A – single vs. repeat injections. Toxicon. 2013;63:83–7. https://doi.org/10.1016/j.toxicon.2012.11.018.\nChey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. JAMA. 2015;313(9):949–58. https://doi.org/10.1001/jama.2015.0954.\nSaha L. Irritable bowel syndrome: pathogenesis, diagnosis, treatment, and evidence-based medicine. World J Gastroenterol. 2014;20(22):6759–73. https://doi.org/10.3748/wjg.v20.i22.6759.\nVork L, Weerts ZZRM, Mujagic Z, et al. Rome III vs Rome IV criteria for irritable bowel syndrome: a comparison of clinical characteristics in a large cohort study. Neurogastroenterol Motil. 2018;30(2):e13189. https://doi.org/10.1111/nmo.13189.\nYang J, Deng Y, Chu H, et al. Prevalence and presentation of lactose intolerance and effects on dairy product intake in healthy subjects and patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2013;11(3):262–268.e1. https://doi.org/10.1016/j.cgh.2012.11.034.\nZhang Y, Li L, Guo C, et al. Effects of probiotic type, dose and treatment duration on irritable bowel syndrome diagnosed by Rome III criteria: a meta-analysis. BMC Gastroenterol. 2016;16(1):62. https://doi.org/10.1186/s12876-016-0470-z.\nVazquez–Roque MI, Camilleri M, Smyrk T, et al. A controlled trial of gluten-free diet in patients with irritable bowel syndrome-diarrhea: effects on bowel frequency and intestinal function. Gastroenterology. 2013;144(5):903–911.e3. https://doi.org/10.1053/j.gastro.2013.01.049.\nCamilleri M. Peripheral mechanisms in irritable bowel syndrome. N Engl J Med. 2012;367(17):1626–35. https://doi.org/10.1056/NEJMra1207068.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEditor information\nEditors and Affiliations\nRights and permissions\nCopyright information\n© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG\nAbout this chapter\nCite this chapter\nHibner, M. (2022). The Evil Quadruplets: Painful Conditions Coexisting with Endometriosis. In: Oral, E. (eds) Endometriosis and Adenomyosis. Springer, Cham. https://doi.org/10.1007/978-3-030-97236-3_10\nDownload citation\nDOI: https://doi.org/10.1007/978-3-030-97236-3_10\nPublished:\nPublisher Name: Springer, Cham\nPrint ISBN: 978-3-030-97235-6\nOnline ISBN: 978-3-030-97236-3\neBook Packages: MedicineMedicine (R0)","source_license":"CC0","license_restricted":false}