Central Sensitisation Syndrome: A Frequent Finding in Women with Pelvic Floor Symptoms Without Evident Urogenital Prolapse

• Published in: International Urogynecology Journal Vol. 35; no. 1; pp. 227 - 236
• Main Authors: Vermeulen, Carolien K. M., Tunnissen, Willemijn, Coolen, Anne-Lotte W. M., Veen, Joggem, Dietz, Viviane, van Leijsen, Sanne A. L., Bongers, Marlies Y.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 2024; Springer Nature B.V
• Subjects: Central Nervous System Sensitization; Female; Gynecology; Humans; Hypotheses; Hysterectomy, Vaginal; Medicine; Medicine & Public Health; Original Article; Pelvic Floor - surgery; Pelvic Organ Prolapse - complications; Pelvic Organ Prolapse - diagnosis; Pelvic Organ Prolapse - surgery; Pelvis; Quality of Life; Surveys and Questionnaires; Urology; Pelvic organ prolapse; Pelvic floor symptoms; Central sensitisation syndrome; Nociplastic pain
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-023-05697-w

Introduction and hypothesis Women with central sensitisation syndrome (CSS) experience poorer subjective post-operative outcomes even after successful pelvic floor reconstruction. This study tests the hypothesis that women with pelvic floor symptoms (PFS) without relevant pelvic organ prolapse (POP), are more likely to have CSS. Methods A questionnaire was sent to women who participated in the POP-UP study in 2017. The POP-UP study evaluated POP in 247 women 16 years after laparoscopic or vaginal hysterectomy. POP-Q data and Pelvic Floor Distress Inventory (PFDI-20) results were used and supplemented with CSS-specific questionnaires. A Central Sensitisation Inventory (CSI) score above 40 implicates CSS. Women were divided into groups based on POP beyond the hymen in relation to the PFDI-20 score. Outcomes of women with PFS and without POP (called ‘group 1’) were compared with the rest of the cohort (groups 2–4; women without PFS and/or with POP). Results A total of 136 women were included in the analysis. A CSI score above 40 was present in 16 out of 42 women of group 1 (37%) versus 11 out of 93 women of groups 2–4 (12%), p  < 0.0001. Passive coping was more prevalent in group 1 ( p  = 0.039), and more deviations in somatisation, depression, anxiety and distress were found in group 1 ( p values of < 0.0001, 0.018, 0.003 and 0.002 respectively). Conclusions This study suggests that CSS might be more prevalent in women with PFS without relevant POP. More awareness of CSS and valid individual counselling may overcome unnecessary surgery for POP and help in setting realistic expectations.