Levator ani muscle enthesis‐related pain in patients with bladder pain syndrome: A retrospective cross‐sectional study

Abstract Objective Interstitial cystitis/bladder pain syndrome is a chronic pelvic pain condition with heterogenous mechanisms. Levator ani muscle (LAM) enthesis‐related pain has been proposed as a musculoskeletal contributor to bladder pain symptoms. This study investigated whether LAM enthesis‐related pain is independent of cystoscopic glomerulation in patients presenting with bladder pain symptoms. Methods This single‐center retrospective study included 231 patients with painful bladder symptoms who underwent cystoscopy between January 2019 and September 2024. Patients were stratified according to the presence or absence of cystoscopic glomerulations. Demographic characteristics, lower urinary tract symptoms, and pelvic pain phenotypes were compared between groups. Logistic regression was used to assess associations between cystoscopic glomerulation and LAM pain subtypes. Results Age, height, body weight, body mass index, and lower urinary tract symptoms did not differ significantly between groups. Glomerulations were not significantly associated with LAM pain ( P = 0.168) or enthesis‐related pain ( P = 0.372). In logistic regression analysis, glomerulations were not associated with overall LAM pain (odds ratio 0.71; 95% confidence interval 0.37–1.35; P = 0.292) or LAM enthesis‐related pain (odds ratio 0.98; 95% confidence interval 0.51–1.87; P = 0.940). Conclusions LAM enthesis‐related pain was not significantly associated with cystoscopic glomerulation in this cohort. These findings suggest that LAM enthesis‐related pain may represent a possible musculoskeletal phenotype among patients with bladder pain syndrome; however, this hypothesis requires prospective validation.