Pelvic Floor and Urinary Distress in Women With Fibromyalgia

Kim Dupree Jones, PhD, FNP, FAAN; Charlene Maxwell, DNP, FNP; Scott D. Mist, PhD; Virginia King, MD; Mary Anna Denman, MD; W. Thomas Gregory, MD


Pain Manag Nurs. 2015;16(6):834-840. 

In This Article

Abstract and Introduction


Fibromyalgia (FM) patients were recently found to have more symptom burden from bothersome pelvic pain syndromes that women seeking care for pelvic floor disease at a urogynecology clinic. We sought to further characterize pelvic floor symptoms in a larger sample of FM patients using of validated questionnaires. Female listserv members of the Fibromyalgia Information Foundation completed an online survey of three validated questionnaires: the Pelvic Floor Distress Inventory 20 (PFDI-20), the Pelvic Pain, Urgency and Frequency Questionnaire (PUF), and the Revised Fibromyalgia Impact Questionnaire (FIQR). Scores were characterized using descriptive statistics. Patients (n = 204 with complete data on 177) were on average 52.3 ± 11.4 years with a mean parity of 2.5 ± 1.9. FM severity based on FIQR score (57.2 ± 14.9) positively correlated with PFDI-20 total 159.08 ± 55.2 (r = .34, p < .001) and PUF total 16.54 ± 7 (r = .36, p < .001). Women with FM report significantly bothersome pelvic floor and urinary symptoms. Fibromyalgia management should include evaluation and treatment of pelvic floor disorders recognizing that pelvic distress and urinary symptoms are associated with more severe FM symptoms. Validated questionnaires, like the ones used in this study, are easily incorporated into clinical practice.


Fibromyalgia (FM) is a common, debilitating disorder of widespread pain affecting an estimated 5 million persons in the United States (Lawrence et al., 2008). Similarly, chronic pelvic pain is estimated to affect at least 9 million women (Mathias, Kuppermann, Liberman, Lipschutz, & Steege, 1996), and 4 to 7 million women report bladder pain/interstitial cystitis symptoms (Berry et al., 2011). Given that these three chronic pain syndromes are highly prevalent, it is not surprising that they often coexist. Indeed, people with FM often report numerous regional pain syndromes, including headaches, temporomandibular disorders, low back/neck pain, myofascial pain, irritable bowel, pelvic pain, and bladder pain (Adams & Denman, 2011; Arnold, Clauw, & McCarberg, 2011; Rodriguez, Afari, & Buchwald, 2009; Williams & Clauw, 2009).

Like FM, chronic pelvic pain and bladder pain have been characterized by some as functional or sensory hypersensitivity pain disorders for which there are conflicting etiologic theories and lack of standardized treatments (Clemens, Elliott, Suttorp, & Berry, 2012; Clemens et al., 2014; Adams & Denman, 2011). Pelvic floor disorders negatively influence a woman's activities of daily living, sexual function, bowel and bladder function, and overall quality of life. Despite their high prevalence and negative impact, little known about the relationship between pelvic/bladder symptoms and FM severity. The purpose of this study was to characterize pelvic floor and urinary symptoms in patients with FM. A secondary aim was to describe the strength of the relationship between pelvic floor and urinary symptoms with the total impact of FM.