The presence of abnormal palpatory findings in the sacrococcygeal area is correlated with chronic pelvic pain: a cross-sectional study

Objective This study examines the prevalence of abnormal palpatory findings (APFs) in the different pelvic areas among individuals with chronic pelvic pain syndrome (CPP-CPPS) and assesses correlations between APFs with clinical and psychosocial symptoms. Methods In this cross-sectional study, 326 participants (162 CPP-CPPS patients, 164 controls) underwent a standardized palpatory assessment of the sacroiliac, sacrococcygeal, and pelvic floor regions. The manual procedure was performed by two expert physiotherapists with a certification in osteopathic manipulation, following a consensus training. Symptom severity and psychosocial variables were assessed using the NIH Chronic Prostatitis Symptom Index (NIH-CPSI), the Hospital Anxiety and Depression Scale (HADS), and the Fear Avoidance Belief Questionnaire (FABQ). Correlation analyses explored relationships between APFs, the presence of pain, and psychosocial variables. Results In the sample we examined, CPP/CPPS symptoms were located in different abdominal and pelvic areas (41%), and both sexual and urinary functions were involved (60%). APFs were strongly associated with CPP-CPPS, particularly in the sacrococcygeal (r = 0.609, p < 0.01) and pelvic floor (r = 0.62, p < 0.01) areas. Multivariate analysis confirmed that sacrococcygeal dysfunction (OR: 3.02, CI: 1.96–4.65) and pelvic floor dysfunction (OR: 2.99, CI: 1.87–4.78) were independently associated with CPP-CPPS, whereas sacroiliac findings showed a weak correlation. Significant but weak correlations were also observed between APFs and psychosocial measures, including HADS and FABQ, indicating limited associations between anxiety, depression and fear-avoidance beliefs with APFs. Conclusions The results of this study highlight the relevance of sacrococcygeal and pelvic floor APFs as potential clinical markers in CPPS, supporting the rationale of targeted manual therapy interventions. This study suggests a role for multimodal management in CPP-CPPS, with future research needed to evaluate the predictive value of these dysfunctions.