Many people with pelvic pain have pelvic floor dysfunction, but specifically hypertonic muscles, or muscles that are too tight. The pelvic floor muscles are a group of muscles that attach to the front, back and sides of the bottom of the pelvis and sacrum. They are like a hammock or a sling, and they support the bladder, uterus, prostate and rectum. They also wrap around your urethra, rectum, and vagina (in women).
These muscles must be able to contract to maintain continence, and to relax allowing for urination and bowel movements, and in women, sexual intercourse.
When these muscles have too much tension (hypertonic) they will often cause pelvic pain, or urgency and frequency of the bladder and bowels. When they are low-tone (hypotonic) they will contribute to stress incontinence and pelvic organ prolapse. You can also have a combination of muscles that are too tense and too relaxed.
Hypertonic muscles can cause the following symptoms:
- Urinary frequency, urgency, hesitancy, stopping and starting of the urine stream, painful urination, or incomplete emptying
- Constipation, straining, pain during or after bowel movements
- Unexplained pain in your low back, pelvic region, hips, genital area, or rectum
- Pain during or after intercourse, orgasm, or sexual stimulation
- Uncoordinated muscle contractions causing the pelvic floor muscles to spasm
Pelvic floor muscle problems are diagnosed by specially trained doctors and physiotherapists using internal and external “hands-on” or manual techniques to evaluate the function of these muscles. They will assess your ability to contract and relax these muscles, and feel for tight bands or Trigger Points in the muscles. The bones and muscles of your lower back, hips and sacro-iliac joints will need to be assessed as well since these joints can stress your pelvic floor muscles. When your pelvic floor muscles are tight or weak they can also stress the joints of your back and hips, leading to persistent low back and hip pain. It is important for people who have unresolved low back and hip problems who also have pelvic floor problems (Incontinence, Prolapse, urinary or bowel urgency and frequency, Constipation or Painful Intercourse), to seek out a pelvic floor assessment since their pelvic floor problems may well be the reason that their low back and hip pain is not getting better.
If an internal examination of the muscles is too painful, the connective tissue of your abdomen, thighs, groins and low back are often very tight. The connective tissue forms the container of the muscles, and these often need to be relaxed before any internal work can be done. The connective tissue dysfunction becomes the priority before the trigger points, or tight muscles can be effectively treated.
When your pelvic floor muscles are tight and weak, the tension is treated before the weakness. Once the muscles have reached a normal resting tone, and are able to relax fully, their strength is reassessed and pelvic floor strengthening exercises are prescribed if appropriate.
Self-care is an important part of treatment. Avoid pushing or straining when urinating and ask your health care provider about how to treat constipation. Relaxing the muscles in the pelvic floor area is important, and doing reverse kegels may be one way to help lengthen and relax these muscles. Regular deep breathing is an important part of learning to relax tension in all of your muslces, but particularly the pelvic floor. Using methods such as warm baths twice daily can also be helpful.
Medication such as compounded vaginal or rectal diazepam can be quite helpful and may be prescribed by your doctor. These medications can be used as local muscles relaxants in the vagina or rectum. Good posture to keep pressure off your bladder and pelvic organs, and other stretching techniques such as yoga, can be helpful to avoid tightening and spasms in the pelvic floor muscles as well.
Persistent pain education is an important part of treating pelvic floor muscle problems since the pelvic area is an area that we often hold our stress. Anxiety, stress and our thoughts, attitudes and beliefs can perpetuate the pain in our pelvis; understanding how our pain system works has shown to be an effective way of reducing the threat of ongoing pelvic floor problems.