Pelvic pain is often caused by tight muscles in the abdomen, thighs, groin, and buttock’s, as well as muscles of the pelvic floor. Myofascial trigger points are tender areas in these muscles that can refer pain to all structures in the pelvic region, leading to chronic pain syndromes. Trigger Points in specific muscles of the posterior half of the pelvic floor can be the source of poorly defined pain in the perineal region and discomfort in the anus, rectum, coccyx and sacrum and is commonly labelled as coccygodynia or levator ani syndrome. Trigger Points in muscles in the anterior half of the pelvic floor refer pain to genital structures (vagina, vulva, penis and scrotum). Active Trigger Points in these muscles can interfere with intercourse by causing an aching pain in the vaginal or in the perineal region. Myofascial Trigger Points in the deeper pelvic muscles can effect bowel and bladder function, and can be linked to symptoms of interstitial cystitis, urinary urgency and frequency, pelvic pain and painful intercourse.
Pelvic pain due to muscular involvement can come about from tissues being overstretched, torn or cut in childbirth or from abdominal surgery. The muscles can also weaken or tighten from disuse and injury; and habitual postures and movements can slowly stretch or compress structures in the pelvis, leading to pain and dysfunction. The pelvic muscles, joints and nerves may be the sole cause of pain or just part of the problem.
Trigger Points are linked with hypertonicity, spasmed or shortened muscles and an inability to relax pelvic musculature voluntarily. By reducing pelvic floor hypertonicity and manually releasing myofascial trigger points, many painful pelvic conditions can be relieved.
Pain of organic or infectious nature must be ruled out before the diagnosis of pelvic pain of muscular origin can be made and manual therapy started.
The ilustrations below show the locations of many trigger points that cause pelvic pain.
Marek Jantos School of Psychology, University of Adelaide