# Assessing multifactorial etiology of overactive bladder using a novel PFM-Hip-Trunk muscle network analysis

> **NIH NIH R21** · UNIVERSITY OF MIAMI SCHOOL OF MEDICINE · 2023 · $440,651

## Abstract

Abstract
Interstitial cystitis/ bladder pain syndrome (IC/BPS) is one of the most debilitating chronic pelvic pain
(CPP) conditions that negatively impacts the quality of life and sexual activities in 2.7% to 6.5% of
women in the US. Pelvic floor muscle (PFM) overactivity, characterized by an increase in the
tonic muscle activity, is a condition related to myofascial pain that presents in the majority of CPP
conditions, including up to 85% of women with IC/BPS. However, pelvic floor pain is intrinsically a
multifactorial dysfunction that is attributed to postural issues, myofascial trigger points, and abnormal
muscle tone. Myofascial therapy, including specific pelvic floor muscle soft tissue mobilization and
muscle stretching, is standard treatment for patients with IC/BPS and concomitant PFM
tenderness. Unfortunately, even among IC/BPS patients with PFM tenderness on exam, only
59% of patients report symptom improvement after myofascial therapy. Pelvic floor myofascial
therapy, however, does not address movement impairments of the trunk and hips, which are also
associated with pelvic pain. A pelvic floor muscle phenotyping framework would allow IC/BPS
patients to be categorized to facilitate individualized treatment. Unfortunately, no technology is
currently available for quantitatively and objectively assessing PFM etiologic factors associated with
IC/BPS, which, otherwise, would advance the understanding of the underlying mechanisms and
allow for phenotyping patients for appropriate intervention.
Our team has successfully 1) developed a novel intra-vaginal high-density surface
electromyography (HD-sEMG) technique to reliably and quantitatively assess PFM overactivity in
women with IC/BPS and 2) developed a novel muscle network analysis technique to reveal, for
the first time, the inter-muscular connectivity pattern alterations among patients with
neuromuscular conditions, and 3) demonstrated the feasibility to cluster patients with IC/BPS
into phenotypic subgroups, depending on the underlying mechanism. This study aims to
comprehensively assess the PFM overactivity, hip/trunk muscle activity alteration, PFM-to-Hip/
Trunk inter-muscular connectivity, and distinct PFM phenotypic subtypes in IC/BPS. This research
represents the first effort to comprehensively assess the PFM overactivity, hip/trunk muscle activity
alteration, PFM-to-Hip/Trunk inter-muscular connectivity, and distinct PFM phenotypic subtypes in
IC/BPS. The integration of these multifactorial assessments will advance our understanding
of the multifactorial pathology of IC/BPS. The quantification of relative importance of these
pathological contributors will allow for IC/BPS patient phenotyping. Identification of PFM
phenotypic subtypes may facilitate personalized physical therapy treatments.

## Key facts

- **NIH application ID:** 11146223
- **Project number:** 7R21HD112985-02
- **Recipient organization:** UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
- **Principal Investigator:** Yingchun Zhang
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $440,651
- **Award type:** 7
- **Project period:** 2023-09-01 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11146223

## Citation

> US National Institutes of Health, RePORTER application 11146223, Assessing multifactorial etiology of overactive bladder using a novel PFM-Hip-Trunk muscle network analysis (7R21HD112985-02). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/11146223. Licensed CC0.

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