A therapist-gynecologist alliance: a complex biologically active supplement with probiotic action for correcting intestinal biocenosis disorders

Background: The era of widespread use of antibacterial drugs in clinical practice has led to an increase in the incidence of intestinal microbiome disturbances. However, this problem extends beyond the gastrointestinal tract (GIT). Chronic pelvic pain syndrome (CPPS) remains a common condition in outpatient obstetrician-gynecologist practice and is associated with a microbial imbalance in the intestinal biocenosis, necessitating interdisciplinary management of this group of patients. It has been established that the incidence of CPPS directly correlates with the incidence of intestinal microbiome disturbances due to an exponential decline in the proportion of butyrate-producing bacteria in the gastrointestinal tract.

Objective: Evaluation of the effectiveness of incorporating a complex probiotic biologically active supplement into the treatment regimen for intestinal microbiome disturbances in patients with CPPS as part of an interdisciplinary approach to outpatient management of patients with CPPS. Materials and methods: An observational case-control study was conducted at the Voronezh State Clinical Polyclinic No. 1, a clinical base of the Department of Obstetrics and Gynecology No. 2 of the Voronezh State Medical University named after N.N. Burdenko, from 2024 to 2025. The study involved 80 women with a clinically confirmed diagnosis of CPPS. All study participants underwent a study of the composition of the intestinal microbiome using the Colonoflor-16 polymerase chain reaction (PCR). Two study groups were formed: Group 1 (n = 40) – control – patients with a clinically confirmed diagnosis of CPPS, who underwent complex treatment, including non-steroidal anti-inflammatory drugs, therapeutic exercises, physiotherapy, biofeedback therapy; Group 2 (n = 40) included patients with a clinically confirmed diagnosis of CPPS. They received an extended treatment regimen, including nonsteroidal anti-inflammatory drugs, physiotherapy, exercise therapy and gymnastics, biofeedback therapy, and a combination probiotic. The effectiveness of the treatment was assessed on days 14 and 30 from the start of therapy. A sample of women (n = 10) taking probiotic underwent a repeat analysis of their intestinal microbiome. All participants underwent a full range of laboratory and instrumental studies in accordance with the criteria of the European Urological Association (EUA). The list of interventions performed on patients is regulated by Order of the Ministry of Health of the Russian Federation No. 1130n «On approval of the Procedure for the provision of medical care in the profile of «Obstetrics and Gynecology». Statistical analysis was performed using Statistica 10.0 (StatSoft); differences were considered statistically significant at p < 0.05.

Results: In the group of patients with CPPS receiving the probiotic, a significant reduction in pain severity, improvement in the emotional component of pain (VAS scale), and an improvement in overall well-being were observed. Furthermore, a repeat assessment of the intestinal microbiome revealed a significant increase in the absolute and relative numbers of butyrate-producing bacteria, resulting in a decrease in the rate of proinflammatory reactions and improved synaptic transmission and muscle contraction due to the catalysis of the butyrate-mediated prostaglandin synthesis pathway.

Conclusion: Expanding the CPPS treatment regimen by correcting the composition of the intestinal microbiome through the administration of a complex probiotic improves clinical (psychological and diagnostic) indicators due to the relatively high rate of growth of butyrate-producing bacteria and a decrease in systemic prostaglandin levels.