P1432 - Pelvic Floor Dysfunction in Fibromyalgia Patients as Determined by Anorectal Manometry: Results of a Retrospective Study

Sean M. Sileno, MD, David J. Cangemi, MD
Mayo Clinic Health System, Jacksonville, FL

Introduction: Fibromyalgia (FM) is a common cause of diffuse chronic pain, especially among women. There is data suggesting that symptoms of pelvic floor dysfunction (PFD) may be more common in patients with FM. However, the prevalence of PFD in FM patients, as measured by anorectal manometry (ARM), has not been described to date.

Methods: We identified a retrospective cohort population consisting of FM patients who underwent ARM between January 2019 and March 2020. Demographic data, medical history, and ARM data were recorded. PFD was assessed by manometric evidence of dyssynergia, abnormal rectal sensory thresholds, and/or delayed balloon expulsion. This data was compared to a control group made up of the 100 most recent ARMs completed in symptomatic patients without FM. Data analysis was performed using univariate and multivariate testing.

Results: 149 patients (71 with FM and 78 controls) underwent ARM testing; constipation was the most common indication for testing for FM patients and controls (73.2% vs. 82.1% respectively, p=0.238). Patients with FM were more often female (94.4% vs. 70.5%; p=0.0002), and were more often taking opioids or neuropathic pain agents [(29.6% vs 11.5%; p=0.008), (59.2% vs 26.9%; p=0.0001)] compared to controls. Controls had higher rates of non-hysterectomy gynecologic surgery (29.5% vs. 5.6%; p=0.0002) and colorectal surgery (14.1% vs. 4.2%; p=0.0497). Patients with FM had lower mean anal resting pressures on ARM (79.5 mmHg vs. 100.6 mmHg; p=0.0125) and had lower rectoanal pressure differential measurements (1 mmHg vs. 67.2 mmHg; p< 0.0001). Pelvic dyssynergia (PD) was identified in 60.9% of FM patients, similar to controls (61%); other ARM parameters are shown in Table 1. There was no statistically significant difference between the two groups with regard to anal squeeze pressures, rectal sensory thresholds, or balloon expulsion times.

Discussion: PD was identified in over half of FM patients undergoing ARM, but the rate was similar to controls. FM patients were found to have significantly lower resting anal pressures and rectoanal pressure differential measurements, the clinical significance of which is unclear. Notably, in our limited retrospective study, there were no significant differences between FM patients and controls with regard to other markers for PFD, including rectal sensory thresholds and balloon expulsion times. Larger cohort studies are needed to further investigate the prevalence of pelvic floor dysfunction in patients with FM.



Disclosures:


Sean M. Sileno, MD, David J. Cangemi, MD. P1432 - Pelvic Floor Dysfunction in Fibromyalgia Patients as Determined by Anorectal Manometry: Results of a Retrospective Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.