Gymnastic exercises in a comprehensive treatment of chronic pelvic pain syndrome

Aim. The paper aims to evaluate the effectiveness and, therefore, justify the use of gymnastic exercises in a comprehensive treatment of chronic pelvic pain syndrome. Materials and methods. The study involved 210 patients with chronic pelvic pain syndrome and 25 healthy volunteers as a control group. Skin sensitivity, sacral reflexes, quality of urination, and quality of life were examined using IPSS and QoL scores. The characteristics and intensity of pain were obtained with the LANSS pain scale and the Pain Detection questionnaire. Electrophysiological characteristics of the perineum muscles and lower extremities, along with cortico-spinal conductivity, were studied using needle electromyography (EMG). A developed program of 7 gymnastic exercises was used to strengthen the perineum muscles; rotational movements were applied to engage the lower extremities and stimulate the muscles of the inner thighs, i.e. the adductor muscles. Results. Electrophysiological studies confirmed the neuropathic nature of pain. Urinary disorders as comorbidities were considered the result of severe pain syndrome. Therapeutic and gymnastic exercises resulted in significant improvements in the quality of urination and pain relief. Control EMGs demonstrated increased activity of perineal muscles, decreased polyphasic MUPs, higher levels of central nervous control, and lower levels of depression. Conclusion. The study has confirmed the neurogenic and neuropathic nature of pain in patients with chronic pelvic pain syndrome and urinary disorders or emotional disorders as comorbidities. The exercise program for the pelvic floor muscles and muscles of the thigh can contribute to treatment for patients with chronic pelvic pain syndrome.