E2905. An Interventional Radiologist’s Role in Treating High Tone Pelvic Floor Dysfunction
  1. Shivani Jain; LSUHSC-New Orleans SOM
  2. Alexandra Fairchild; LSUHSC-New Orleans SOM; University Medical Center New Orleans
Chronic pelvic pain (CPP) represents a group of complex disorders defined as nonmalignant pain in the pelvis perceived by either men or women. CPP has historically been refractory to conventional treatment modalities, and referral to pain management typically occurs at later stages of disease severity. The common neuropathic symptoms of CPP include paresthesias, numbness, burning, or lancinating pain. Emerging research has shown that botulinum toxin A injection of pelvic floor muscles may be a useful therapy for CPP that fails to respond to conservative management. This exhibit reviews the pathophysiological mechanisms underlying CPP and the techniques, effectiveness, and complications of pelvic floor injections utilized by interventional radiologists to manage refractory CPP.

Educational Goals / Teaching Points
We aim to provide a review of high tone pelvic floor dysfunction, addressing the workup and management of chronic pelvic pain with emerging IR techniques. Specific teaching points include pathophysiology of chronic pelvic pain secondary to high-tone muscle dysfunction, review of pelvic floor imaging techniques, with particular focus on dynamic MRI and ultrasound, and treatment techniques and adverse effects, encompassing both conservative management and interventional procedures. Interventions discussed will include a variety of physical therapy techniques, neuropathic pain modulation, biofeedback, electrical stimulation, muscle relaxants, and onabotulinum toxin A (BoNT-A) injections.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This educational exhibit will discuss the pathophysiology of chronic pelvic pain and provide a brief overview of the involved neuromuscular anatomy. Clinical examples of relevant diagnostic imaging will be included. Finally, we will discuss the growing role of interventional radiology in the management of this disease.

Chronic pelvic pain (CPP) is a poorly understood condition of the adult population that significantly impacts quality of life. Physical therapy (PT) remains the mainstay of conservative therapy; however, many cases of CPP remain refractory to physical therapy and other noninvasive modalities. Moreover, there is a lack of rigorous data on the effectiveness of traditional therapies. With minimally invasive techniques becoming increasingly available, more definitive treatment is appropriate for a broader patient population. The pathophysiology, diagnostic criteria, imaging, and management of chronic pelvic pain are relevant and informative topics for radiologists-in-training, as well as interested providers and students.