Diazepam and Pelvic Floor Dysfunction
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The mystery behind what it is and is there a place for vaginal Valium® (diazepam) in the treatment of it?
Odds are that many individuals probably have never even heard of pelvic floor dysfunction, more so many of those suffering from this condition may be unaware/have never been properly diagnosed. In this article, we break down the mystery behind this condition and what you need to know about it.
What Exactly is Pelvic Floor Dysfunction (PFD)?
As defined by the American Society of Colon and Rectal Surgeons (ASCRS), pelvic floor dysfunction consists of a multitude of conditions, which can result in pelvic pain and ultimately affect the ability of your bowel to properly store and empty itself.
While there are several conditions, which can cause pelvic floor dysfunction, often times the cause is not known.
What Can Cause Pelvic Floor Dysfunction?
- History of trauma, prior surgical procedures, vaginal childbirth
People suffering from this dysfunction have difficulty controlling the muscles in the pelvic floor meaning they cannot properly contracting or relax them. The pelvic floor is composed of several different muscles in the pelvic area, which are responsible for supporting organs including the rectum, the bladder, prostate (men), and uterus (women).
Symptoms can present in the urinary tract, rectum, prostate or vagina.
- Frequent/painful urination
- Constipation/straining during a bowel movement
- Unexplainable lower back pain/abdominal pain
- Pain related to sexual function
- Leakage of bowels
- Trouble starting/stopping urination
- A feeling of incomplete emptying of bowels
- Pain in the pelvic area
How Do You Diagnose It?
As mentioned before since it is often unknown what causes PFD and since symptoms of this condition are so nonspecific, it may be difficult to properly diagnose such patients. Clinicians can use the following tools to assist them in diagnosing patients: ultrasound of anus/rectum, stimulation test to evaluate nerves of the pelvic region, and defecating proctogram (uses X-ray to record muscles of the pelvic floor).
What Treatment Options Are Out There?
- Physical therapy:The most common treatment is to work with a physical therapist to help with relaxation and coordinating of muscles by performing different exercises.
- Relaxation techniques: yoga and warm baths
- Strengthening exercises: Kegel exercises (squeeze and relax pelvic floor muscles)
- Biofeedback training: Physical therapist uses sensors/videos with tailored pelvic floor muscle exercises
- Surgery: Recommended in certain situations, i.e.: rectal prolapse
- Low dose muscle relaxants (tizanidine)
So What About Diazepam? What Data Is Available For Using It In Pelvic Floor Dysfunction?
What we know about diazepam:
Diazepam is prescription medication, which is categorized as a Benzodiazepine. Benzodiazepines are a class of medications, which exert their effect by augmenting the action of inhibitory neurotransmitter GABA in the central nervous system. Most notably benzodiazepines are known for their sedative, anxiolytic (calming) effects, and muscle relaxant effects.
Typically diazepam is utilized in practice for the short-term treatment of anxiety disorders and in some case, it may also be used to treat muscle spasms and seizures. However, data has shown that intravaginal diazepam may be a useful treatment option for treating pain secondary to spasms in PFD patients.
Diazepam and PFD?
A study evaluating charts of 26 patients who were given diazepam suppositories as adjuvant therapy for PFD and sexual pain, found that 25 out of 26 patients reported clinically significant improvement with the suppositories. Use of the diazepam suppositories also improved sexual pain and tone of the pelvic floor muscle. The findings of this study suggest that vaginal diazepam may improve outcomes in patients suffering from PFD compared with the typical treatment plans.
While vaginal diazepam is not FDA approved for the treatment of PFD, data suggests it may be a potential treatment option for patients suffering from PFD who have not found relief otherwise. Vaginal diazepam for PFD may also be beneficial for patients who find frequent visits to the physical therapist cumbersome.
Since this medication is not available commercially a specialty pharmacy is in the unique position to help patients meet their needs by compounding a medication like this.
- American Society of Colon and Rectal Surgeons. Pelvic Floor Dysfunction Expanded Version | ASCRS. [online] Available at https://www.fascrs.org/patients/disease-condition/pelvic-floor-dysfunction-expanded-version
- Pelvic Floor Dysfunction. Cleveland Clinic, 2014. Available at https://my.clevelandclinic.org/health/diseases/14459-pelvic-floor-dysfunction/management-and-treatment
- For Medical Professionals- Treating patients with pelvic floor dysfunction. Mayo Clinic. Available at https://www.mayoclinic.org/medical-professionals/clinical-updates/general-medical/treating-patients-with-pelvic-floor-dysfunction
- Valium®. (diazepam). [package insert]. Roche Products Inc. NJ; 2008.
- Carrico DJ, Peters KM. Vaginal diazepam use with urogenital pain/pelvic floor dysfunction: serum diazepam levels and efficacy data. Urol Nurs. 2011;31(5):279-84, 299.
- Image source suppositories: https://drjengunter.files.wordpress.com/2018/02/screen-shot-2018-02-20-at-5-45-35-pm.png?w=750
- Pelvic image source: https://cdn.images.express.co.uk/img/dynamic/11/590x/secondary/Do-YOU-suffer-with-pelvic-pain-854876.jpg