Clinical presentation and characteristics of pelvic floor myofascial pain in patients presenting with constipation

Andy Liu, Victor Chedid, Xiao J. Wang, Priya Vijayvargiya, Michael Camilleri

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Patients with pelvic floor myofascial pain (PFMP) have puborectalis tenderness on digital rectal examination (DRE). Little is known about its significance to anorectal function in patients presenting with constipation. Aim: To characterize demographics, clinical characteristics, findings on anorectal manometry (ARM), diagnosis of rectal evacuation disorder (RED), colonic transit [normal (NTC) or slow (STC)], and imaging in constipated patients with PFMP and compare these features to constipation without PFMP. Methods: We performed an electronic medical records review of patients with constipation evaluated by a single gastroenterologist between January 2008 and February 2019. Patients with PFMP were compared to controls with constipation but without PFMP (1:2 ratio). Key Results: A total of 98 PFMP cases and 196 controls were identified. Constipated patients with PFMP were more likely to have RED [OR 7.59 (3.82-15.09), P <.01]; controls were more likely to have either NTC [OR 4.25 (1.45-12.42), P <.01] or STC [OR 3.57 (1.45-8.78), P <.01]. RED in patients with PFMP is supported by comparison to controls: On DRE, they had increased resting tone [OR 2.25 (1.33-3.83), P <.01] and paradoxical contraction of the puborectalis upon simulated evacuation [OR 3.41 (1.94-6.00), P <.01]; on ARM, they had higher maximum resting pressure (102.9 mmHg vs 90.7 mmHg, P <.01) and lower rectoanal pressure gradient (−39.4 mmHg vs −24.7 mmHg, P <.01). Conclusions/Inferences: In constipated patients, PFMP is highly associated with RED. Its presence provides a valuable clue regarding the etiology of a patient's constipation; it should be assessed in all patients with constipation and should also be an additional target for management.

Original languageEnglish (US)
Article numbere13845
JournalNeurogastroenterology and Motility
Issue number7
StatePublished - Jul 1 2020


  • chronic constipation
  • digital rectal examination
  • dyssynergic defecation
  • pelvic floor dysfunction
  • pelvic floor tension myalgia
  • puborectalis tenderness

ASJC Scopus subject areas

  • Physiology
  • Endocrine and Autonomic Systems
  • Gastroenterology


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