Semin Reprod Med 2018; 36(02): 136-142
DOI: 10.1055/s-0038-1676090
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Fibromyalgia and Irritable Bowel Syndrome in Female Pelvic Pain

Christina M. Johnson
1   Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware
,
Gretchen E. H. Makai
1   Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware
› Author Affiliations
Funding The authors have no relevant financial disclosures. No external support was received for this review.
Further Information

Publication History

Publication Date:
19 December 2018 (online)

Abstract

Fibromyalgia and irritable bowel syndrome are common disorders which often coexist in women with chronic pelvic pain. Like pelvic pain, these disorders describe symptoms without pathologic findings. Women with chronic pelvic pain have a higher prevalence of fibromyalgia (4–31%) and irritable bowel syndrome (8–41%) than the general population. Aberrant pain processing and psychosocial stressors are implicated in the co-occurrence of these pain syndromes (chronic overlapping pain conditions), but active epidemiologic, psychosocial, and neurobiologic research is ongoing. Given the higher prevalence of fibromyalgia and irritable bowel syndrome in women with chronic pelvic pain, gynecologists should have more education in diagnosis and treatment of these and other chronic overlapping pain conditions to improve care for women.

 
  • References

  • 1 Steege JF, Siedhoff MT. Chronic pelvic pain. Obstet Gynecol 2014; 124 (03) 616-629
  • 2 Clauw DJ. Fibromyalgia: a clinical review. JAMA 2014; 311 (15) 1547-1555
  • 3 Kindler LL, Bennett RM, Jones KD. Central sensitivity syndromes: mounting pathophysiologic evidence to link fibromyalgia with other common chronic pain disorders. Pain Manag Nurs 2011; 12 (01) 15-24
  • 4 Smith RP. Lower gastrointestinal disease in women. Obstet Gynecol Clin North Am 2001; 28 (02) 351-361 , viii
  • 5 Mearin F, Lacy BE, Chang L. , et al. Bowel disorders. Gastroenterology 2016; 150: 1393-1407
  • 6 Mayer EA. Clinical practice. Irritable bowel syndrome. N Engl J Med 2008; 358 (16) 1692-1699
  • 7 Prior A, Whorwell PJ. Gynaecological consultation in patients with the irritable bowel syndrome. Gut 1989; 30 (07) 996-998
  • 8 Maixner W, Fillingim RB, Williams DA, Smith SB, Slade GD. Overlapping chronic pain conditions: Implications for diagnosis and classification. J Pain 2016; 17 (9, Suppl): T93-T107
  • 9 Vehof J, Zavos HM, Lachance G, Hammond CJ, Williams FM. Shared genetic factors underlie chronic pain syndromes. Pain 2014; 155 (08) 1562-1568
  • 10 Hughes L. Physical and psychological variables that influence pain in patients with fibromyalgia. Orthop Nurs 2006; 25 (02) 112-119 , quiz 120–121
  • 11 Jones KD, Maxwell C, Mist SD, King V, Denman MA, Gregory WT. Pelvic floor and urinary distress in women with fibromyalgia. Pain Manag Nurs 2015; 16 (06) 834-840
  • 12 Waylonis GW, Heck W. Fibromyalgia syndrome. New associations. Am J Phys Med Rehabil 1992; 71 (06) 343-348
  • 13 Ghizzani A, Di Sabatino V, Suman AL, Biasi G, Santarcangelo EL, Carli G. Pain symptoms in fibromyalgia patients with and without provoked vulvodynia. Pain Res Treat 2014; 2014: 457618
  • 14 Adams K, Osmundsen B, Gregory WT. Does fibromyalgia influence symptom bother from pelvic organ prolapse?. Int Urogynecol J Pelvic Floor Dysfunct 2014; 25 (05) 677-682
  • 15 Nimnuan C, Rabe-Hesketh S, Wessely S, Hotopf M. How many functional somatic syndromes?. J Psychosom Res 2001; 51 (04) 549-557
  • 16 Warren JW, Howard FM, Cross RK. , et al. Antecedent nonbladder syndromes in case-control study of interstitial cystitis/painful bladder syndrome. Urology 2009; 73 (01) 52-57
  • 17 Clemens JQ, Meenan RT, O'Keeffe Rosetti MC, Kimes TA, Calhoun EA. Case-control study of medical comorbidities in women with interstitial cystitis. J Urol 2008; 179 (06) 2222-2225
  • 18 Krieger JN, Stephens AJ, Landis JR. , et al; MAPP Research Network. Relationship between chronic non-urological associated somatic syndromes and symptom severity in urological chronic pelvic pain syndromes: baseline evaluation of the MAPP study. J Urol 2015; 193: 1254-1262
  • 19 Nickel JC, Tripp DA, Pontari M. , et al. Interstitial cystitis/painful bladder syndrome and associated medical conditions with an emphasis on irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome. J Urol 2010; 184 (04) 1358-1363
  • 20 Nickel JC, Tripp DA. ; International Interstitial Cystitis Study Group. Clinical and psychological parameters associated with pain pattern phenotypes in women with interstitial cystitis/bladder pain syndrome. J Urol 2015; 193 (01) 138-144
  • 21 Clauw DJ, Schmidt M, Radulovic D, Singer A, Katz P, Bresette J. The relationship between fibromyalgia and interstitial cystitis. J Psychiatr Res 1997; 31 (01) 125-131
  • 22 Warren JW, Langenberg P, Clauw DJ. The number of existing functional somatic syndromes (FSSs) is an important risk factor for new, different FSSs. J Psychosom Res 2013; 74 (01) 12-17
  • 23 Lai HH, North CS, Andriole GL, Sayuk GS, Hong BA. Polysymptomatic, polysyndromic presentation of patients with urological chronic pelvic pain syndrome. J Urol 2012; 187 (06) 2106-2112
  • 24 Sanses TV, Chelimsky G, McCabe NP. , et al. The pelvis and beyond: musculoskeletal tender points in women with chronic pelvic pain. Clin J Pain 2016; 32 (08) 659-665
  • 25 Arnold LD, Bachmann GA, Rosen R, Rhoads GG. Assessment of vulvodynia symptoms in a sample of US women: a prevalence survey with a nested case control study. Am J Obstet Gynecol 2007; 196 (02) 128.e1-128.e6
  • 26 Arnold LD, Bachmann GA, Rosen R, Kelly S, Rhoads GG. Vulvodynia: characteristics and associations with comorbidities and quality of life. Obstet Gynecol 2006; 107 (03) 617-624
  • 27 Gordon AS, Panahian-Jand M, Mccomb F, Melegari C, Sharp S. Characteristics of women with vulvar pain disorders: responses to a Web-based survey. J Sex Marital Ther 2003; 29 (Suppl 01) 45-58
  • 28 Sinaii N, Cleary SD, Ballweg ML, Nieman LK, Stratton P. High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis. Hum Reprod 2002; 17 (10) 2715-2724
  • 29 Choung RS, Herrick LM, Locke III GR, Zinsmeister AR, Talley NJ. Irritable bowel syndrome and chronic pelvic pain: a population-based study. J Clin Gastroenterol 2010; 44 (10) 696-701
  • 30 Fenton BW, Brobeck L, Witten E, Von Gruenigen V. Chronic pelvic pain syndrome-related diagnoses in an outpatient office setting. Gynecol Obstet Invest 2012; 74 (01) 64-67
  • 31 Jamieson DJ, Steege JF. The prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in primary care practices. Obstet Gynecol 1996; 87 (01) 55-58
  • 32 Lamvu G, Nguyen RH, Burrows LJ. , et al. The Evidence-based Vulvodynia Assessment Project. a national registry for the study of vulvodynia. J Reprod Med 2015; 60 (5-6) 223-235
  • 33 Romans S, Belaise C, Martin J, Morris E, Raffi A. Childhood abuse and later medical disorders in women. An epidemiological study. Psychother Psychosom 2002; 71 (03) 141-150
  • 34 Warren JW, Clauw DJ. Functional somatic syndromes: sensitivities and specificities of self-reports of physician diagnosis. Psychosom Med 2012; 74 (09) 891-895
  • 35 Williams RE, Hartmann KE, Sandler RS, Miller WC, Steege JF. Prevalence and characteristics of irritable bowel syndrome among women with chronic pelvic pain. Obstet Gynecol 2004; 104 (03) 452-458
  • 36 Zondervan KT, Yudkin PL, Vessey MP. , et al. Chronic pelvic pain in the community--symptoms, investigations, and diagnoses. Am J Obstet Gynecol 2001; 184 (06) 1149-1155
  • 37 Farquhar CM, Hoghton GB, Beard RW. Pelvic pain--pelvic congestion or the irritable bowel syndrome?. Eur J Obstet Gynecol Reprod Biol 1990; 37 (01) 71-75
  • 38 Matheis A, Martens U, Kruse J, Enck P. Irritable bowel syndrome and chronic pelvic pain: a singular or two different clinical syndrome?. World J Gastroenterol 2007; 13 (25) 3446-3455
  • 39 Ek M, Roth B, Ekström P, Valentin L, Bengtsson M, Ohlsson B. Gastrointestinal symptoms among endometriosis patients--a case-cohort study. BMC Womens Health 2015; 15: 59
  • 40 Moore JS, Gibson PR, Perry RE, Burgell RE. Endometriosis in patients with irritable bowel syndrome: specific symptomatic and demographic profile, and response to the low FODMAP diet. Aust N Z J Obstet Gynaecol 2017; 57 (02) 201-205
  • 41 Brooks L, Hadi J, Amber KT, Weiner M, La Riche CL, Ference T. Assessing the prevalence of autoimmune, endocrine, gynecologic, and psychiatric comorbidities in an ethnically diverse cohort of female fibromyalgia patients: does the time from hysterectomy provide a clue?. J Pain Res 2015; 8: 561-569
  • 42 Yunker AC, Ritch JMB, Robinson EF, Golish CT. Incidence and risk factors for chronic pelvic pain after hysteroscopic sterilization. J Minim Invasive Gynecol 2015; 22 (03) 390-394
  • 43 Geller EJ, Babb E, Nackley AG, Zolnoun D. Incidence and risk factors for pelvic pain after mesh implant surgery for the treatment of pelvic floor disorders. J Minim Invasive Gynecol 2017; 24 (01) 67-73
  • 44 Longstreth 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) 1285-1290
  • 45 Warren JW, Clauw DJ, Wesselmann U, Howard FM, Gallicchio L, Morozov V. Functional somatic syndromes as risk factors for hysterectomy in early bladder pain syndrome/interstitial cystitis. J Psychosom Res 2014; 77 (05) 363-367
  • 46 Sperber AD, Morris CB, Greemberg L. , et al. Development of abdominal pain and IBS following gynecological surgery: a prospective, controlled study. Gastroenterology 2008; 134 (01) 75-84
  • 47 Gardella C, Johnson KM, Dobie DJ, Bradley KA. Prevalence of hysterectomy and associated factors in women Veterans Affairs patients. J Reprod Med 2005; 50 (03) 166-172
  • 48 Adams LM, Turk DC. Psychosocial factors and central sensitivity syndromes. Curr Rheumatol Rev 2015; 11 (02) 96-108
  • 49 Paras ML, Murad MH, Chen LP. , et al. Sexual abuse and lifetime diagnosis of somatic disorders: a systematic review and meta-analysis. JAMA 2009; 302 (05) 550-561
  • 50 Dobie DJ, Kivlahan DR, Maynard C, Bush KR, Davis TM, Bradley KA. Posttraumatic stress disorder in female veterans: association with self-reported health problems and functional impairment. Arch Intern Med 2004; 164 (04) 394-400
  • 51 Ciszek BP, Khan AA, Dang H. , et al. MicroRNA expression profiles differentiate chronic pain condition subtypes. Transl Res 2015; 166 (06) 706-720.e11
  • 52 Pazmany E, Ly HG, Aerts L. , et al. Brain responses to vestibular pain and its anticipation in women with genito-pelvic pain/penetration disorder. Neuroimage Clin 2017; 16: 477-490
  • 53 Wiech K, Ploner M, Tracey I. Neurocognitive aspects of pain perception. Trends Cogn Sci 2008; 12 (08) 306-313
  • 54 Julien N, Goffaux P, Arsenault P, Marchand S. Widespread pain in fibromyalgia is related to a deficit of endogenous pain inhibition. Pain 2005; 114 (1-2) 295-302
  • 55 Henningsen P, Zipfel S, Herzog W. Management of functional somatic syndromes. Lancet 2007; 369 (9565) 946-955
  • 56 Fenton BW. Limbic associated pelvic pain: a hypothesis to explain the diagnostic relationships and features of patients with chronic pelvic pain. Med Hypotheses 2007; 69 (02) 282-286
  • 57 Chaban V. Estrogen and visceral nociception at the level of primary sensory neurons. Pain Res Treat 2012; 2012 (2012) 1-6
  • 58 Woodworth D, Mayer E, Leu K. , et al; MAPP Research Network. Unique microstructural changes in the brain associated with urological chronic pelvic pain syndrome (UCPPS) revealed by diffusion tensor MRI, super-resolution track density imaging, and statistical parameter mapping: a MAPP network neuroimaging study. PLoS ONE 2015; 10 (10) e0140250
  • 59 Huang L, Kutch JJ, Ellingson BM. , et al. Brain white matter changes associated with urological chronic pelvic pain syndrome: multisite neuroimaging from a MAPP case-control study. Pain 2016; 157 (12) 2782-2791
  • 60 Kutch JJ, Ichesco E, Hampson JP. , et al; MAPP Research Network. Brain signature and functional impact of centralized pain: a multidisciplinary approach to the study of chronic pelvic pain (MAPP) network study. Pain 2017; 158 (10) 1979-1991
  • 61 As-Sanie S, Harris RE, Napadow V. , et al. Changes in regional gray matter volume in women with chronic pelvic pain: a voxel-based morphometry study. Pain 2012; 153 (05) 1006-1014
  • 62 Berman SM, Naliboff BD, Suyenobu B. , et al. Reduced brainstem inhibition during anticipated pelvic visceral pain correlates with enhanced brain response to the visceral stimulus in women with irritable bowel syndrome. J Neurosci 2008; 28 (02) 349-359
  • 63 Wingenfeld K, Heim C, Schmidt I, Wagner D, Meinlschmidt G, Hellhammer DH. HPA axis reactivity and lymphocyte glucocorticoid sensitivity in fibromyalgia syndrome and chronic pelvic pain. Psychosom Med 2008; 70 (01) 65-72
  • 64 Ploteau S, Labat JJ, Riant T, Levesque A, Robert R, Nizard J. New concepts on functional chronic pelvic and perineal pain: pathophysiology and multidisciplinary management. Discov Med 2015; 19 (104) 185-192
  • 65 Williams RE, Hartmann KE, Sandler RS, Miller WC, Savitz LA, Steege JF. Recognition and treatment of irritable bowel syndrome among women with chronic pelvic pain. Am J Obstet Gynecol 2005; 192 (03) 761-767
  • 66 Allaire C, Williams C, Bodmer-Roy S. , et al. Chronic pelvic pain in an interdisciplinary setting: 1-year prospective cohort. Am J Obstet Gynecol 2018; 218 (01) 114.e1-114.e12
  • 67 Ouyang A, Wrzos HF. Contribution of gender to pathophysiology and clinical presentation of IBS: should management be different in women?. Am J Gastroenterol 2006; 101 (12, Suppl): S602-S609
  • 68 Fischer S, Nater UM. Functional somatic syndromes: asking about exclusionary medical conditions results in decreased prevalence and overlap rates. BMC Public Health 2014; 14: 1034
  • 69 Gewandter JS, Chaudari J, Iwan KB. , et al. Research design characteristics of published pharmacologic randomized clinical trials for irritable bowel syndrome and chronic pelvic pain conditions: an ACTTION systematic review. J Pain 2018; 19 (07) 717-726
  • 70 Aaron LA, Herrell R, Ashton S. , et al. Comorbid conditions in chronic fatigue:a co-twin control study. J Gen Intern Med 2001; 16 (01) 24-31