If you have chronic pelvic pain (CPP), you know the symptoms. What you may not know is that myofascial trigger points, shortened pieces of muscle fiber that form a knot and shorten the muscle involved, play a role of their own in this painful disorder.
What Myofascial Trigger Points Can Do
In "Essential Elements of Pelvic Pain in Men and Women," we discovered the many possible causes of chronic pelvic pain. But, what you may not know is that myofascial trigger points (MTrPs) have been identified as one of the greatest aggravators of chronic pelvic pain, and pain is not the only symptom. Besides pelvic muscle dysfunction,"trigger points can also develop because of restrictive tissue after injury, infection, or surgery or because of problems in other areas around the pelvis that radiate pain. Trigger points can cause a decrease in urine flow in men and women, erectile dysfunction, urinary retention (setting the stage for infection), urgency (always feeling like you have to urinate) because the knot in the muscle obstructs flow or presses on nerves. They can also contribute to functional bowel problems. Though MTrPs can be anywhere there is muscle or muscle attachments, we are going to focus on the role of myofascial trigger points that affect the pelvic area.
Offensive Trigger Points
It is not just the complex structure of muscles in the pelvis that can develop trigger points. Myofascial trigger points in adductor magnus (thigh), or internal oblique (abdomen) are capable of causing bladder pain and frequency. Trigger points in the adductor magnus can cause a host of referred pain to groin and inner thigh, pelvic and pubic bones, rectum and vagina and can cause menstrual cramping (as can TrPs in the rectus abdominus, muscle in the abdomen). Trigger points (TrPs) in the internal oblique can also cause bladder difficulties in both men and women. The muscles of the pelvis and the multi-layered muscles of the pelvic floor can become tight, unforgiving, and short due to MTrPs and can refer pain to the urethra, rectum, coccyx, or the crease of the buttocks.
For proper treatment, it’s important to understand that the source of our pain can be localized (such as in the muscles in the diagram) or well away from pelvis. Treating MTrPs, whether active (painful without touching) or latent (only painful with touched) that refer pain to a specific region is extremely important for sustained relief. Often times, those who claim to know myofascial trigger points do not understand the complexity, referral patterns, or the work of the pioneers in the field, Dr. Janet Travell and Dr. David Simons.
Therapies to Help You
It is important to identify perpetuating factors and bring them under control. Among other things, these include, co-existing hip problems, piriformis syndrome, pudendal neuralgia, low back or sacroiliac joint dysfunction, and other overlapping conditions. Pay close attention to aggravating factors such as, sitting too long or on hard surfaces and chairs that can’t be adjusted to your body type, over activity, infection, poor posture, or wearing tight pants. Use proper lifting techniques. Yoga ball therapy can help stretch muscles of the pelvic floor, and after treatment will respond to strengthening (to avoid further problems.). Remember, if you are strengthening and the pain is worse, there are MTrPs left untreated. Therapies that help include:
- Intravaginal and pelvic floor trigger point injections
- External and internal massage of the perineum and in women the vagina
- Bladder retraining
- Transcutaneous electrical nerve stimulation (TENS)
- Tennis ball and therapeutic ball
- Dietary changes Include IC diet here. Find link
- Probiotics for the bladder
- Stretching movements
- Topical analgesics (such as oragel)
- Oral pain medicine
- Specific myofascial therapy by a trained specialist
- Sometimes, all are necessary.
Once other possible causes of CPP have been ruled out, consideration of the myofascial trigger points must be made by a physician trained to do so. The same applies to physical therapists or therapeutic massage therapists/body workers. Those who do not understand the role of trigger points in chronic pelvic pain may suggest traditional therapies, such as, Kegel exercise, which can worsen symptoms unless trigger points are brought under control. When co-existing conditions, such as piriformis syndrome, spinal disease, IBS, etc. are involved; a host of pain referral patterns and other symptoms can occur. This is why identifying ALL your pain patterns (whether you feel a trigger point there or not) is important information for your specially trained healthcare provider.
Myofascia trigger points only play one possible role in CPP. Watch for the final post in this series, "Why Knowing the Cause of Pelvic Pain is Essential to Treatment."
Here’s to a healthy pelvic floor. Hope ahead.
Essential Elements of Pelvic Pain in Men and Women
Recognizing Myofascial Pelvic Pain in the Female Patient with Chronic Pelvic Pain
Myofascial trigger points of the pelvic floor: associations with urological pain syndromes and treatment strategies including injection therapy