The Prevalence of Severe Concomitant Pelvic Floor Disorders in Women With Endometriosis: A Cross-Sectional Analysis

INTRODUCTION: Endometriosis is a common gynecologic condition characterized by chronic pelvic inflammation and pain. Due to anatomic proximity and shared innervation, “crosstalk” between pelvic organs and endometriosis often occurs, resulting in coexisting dysfunction. These often manifest themselves as pelvic floor disorders (PFDs), specifically interstitial cystitis/bladder pain syndrome (IC/BPS) and pain with bowel movements; hypersensitivity disorders like overactive bladder, which includes urinary frequency and urgency urinary incontinence (UUI); and functional disorders such as voiding or defecatory dysfunction. Despite overlapping pathophysiology and symptom presentations of these conditions, limited research has examined factors associated with concurrent PFDs in women with endometriosis. Endometriosis is a common gynecologic condition characterized by chronic pelvic inflammation and pain. Due to anatomic proximity and shared innervation, “crosstalk” between pelvic organs and endometriosis often occurs, resulting in coexisting dysfunction. These often manifest themselves as pelvic floor disorders (PFDs), specifically interstitial cystitis/bladder pain syndrome (IC/BPS) and painful bowel movements; hypersensitivity disorders like overactive bladder, which includes urinary frequency and urgency. OBJECTIVE: This study sought to characterize the prevalence of severe pelvic floor disorders among women seeking treatment for endometriosis. METHODS: This ongoing cross-sectional study includes women seeking care for endometriosis who participated in a prospective registry and answered “yes” to “Has a doctor or other health care provider ever diagnosed you with endometriosis?” on the EPHect patient questionnaire. Participants were classified as having bothersome PFDs if they reported severe symptoms of urinary frequency, UUI, voiding dysfunction, defecatory dysfunction (straining, incomplete defecation), or pain with bowel movements on the Interstitial Cystitis Symptoms and Problem Index (ICSI-ICPI, cut point >12) or the Pelvic Floor Disability Index (PFDI-20, “quite a bit” of bother, which is the highest level of severity on the PFDI). RESULTS: Out of 44 participants included in the analysis, 75% (33/44) had endometriosis with at least one concomitant severe PFD symptom (Table 1). The most commonly reported PFD was IC/BPS (65.9%), followed by urinary frequency (27.3%) and incomplete defecation (27.3%, Table 2). Urgency urinary incontinence was the least reported PFD (15.9%). Among the 33 participants categorized as having concomitant severe PFDs, almost 2 out of 3 women reported having >1 concomitant severe PFD, with a median of 3 (interquartile range 1 to 4). When categorized by bladder pain symptoms (IC/BPS), lower urinary tract symptoms (UUI, urinary frequency, voiding dysfunction), or defecatory symptoms (straining, incomplete, or pain with defecation), most participants had a combination of all three symptoms (52.4%), followed by IC/BPS with lower urinary tract symptoms only (6/21, 28.6%). Only 1/21 (4.8%) reported no bladder pain in combination with lower urinary tract and defecatory symptoms. CONCLUSIONS: A significant proportion of women seeking care for endometriosis report concomitant severe PFDs, with IC/BPS being the most prevalent in our cohort. The majority of participants with concomitant PFDs had >1 severe PFD, which most typically involved a combination of bladder pain, urinary tract, and defecatory symptoms. We plan to explore associations between endometriosis/PFD symptom phenotypes and patient characteristics in future studies as enrollment in this ongoing cross-sectional study continues.Table 1Table 2