Friday, April 30, 2010

Pelvic Floor Muscles and Pain-Not gender specific

Causes
Pelvic pain can be from many causes such as, vulvodynia, irritable bladder, infection, interstitial cystitis, vaginal atrophy, prostate problems/pain, and last but certainly not least, myofascial trigger points. fibromyalgia (FM) and chronic myofascial pain (CMP) from myofascial trigger points, AKA myofascial pain syndrome (MPS) often co-exist.


Fibromyalgia (FM) and Chronic Myofascial Pain (CMP)

FM and CMP often co-exist. CMP from myofascial trigger points is a peripheral nerve to muscle problem and FM is a central nervous system problem. When they co-exist, the peripheral message of painful trigger points to the brain of an FM patient keeps the brain in a hypersensitive state," causing a “wind up” phenomenon at the HPA-axis (dysfunctional in FM). If you have both, it bloodies the diagnostic waters and most importantly delays appropriate treatments.

The function and discription of pelvic floor muscles
The muscles in the pelvic floor are what keep your organs from falling to the floor. There is the perineum, the urogenital triangle, the anal triangle. These muscle systems support the rectum, the vagina/penis, and the urethra.

Symptoms and therapy
Pelvic floor trigger points symptoms can include, pain in the genitals, perineum, bladder, vulva, urethra, prostate, tailbone, vagina, rectum and even the low back and groin. Trigger points can cause sexual dysfunction, painful intercourse, menstrual pain, and impotence. A pelvic floor therapist is specialized physical therapists will treat these with electo-stimulation, and teach you how to do pressure therapy with tennis balls and such at home. I am a firm believer that women should see a gynecological urologist, just like children should see a pediatrician. But make no mistake, if you are a man reading this, trigger points can be present in your pelvic floor too, with its own host of complications as previously mentioned, including erectile dysfunction.

If you have trigger points in this area, you most likely have them elsewhere. Myofascial trigger points can mimic many things and cause pain, dysfunction, and shortening of the muscle affected by this knotted up muscle fiber in a taut band of muscle. Such things as paresthesia (numbness and tingling), if located next to a nerve, circulation/temp changes (if located next to a blood vessel) and swelling (if located next to a blood or lymph vessel) may also be present. It is possible that TrPs in the pelvic floor could be satellites of a primary TrP located in muscles that refer pain to the area. A good trigger point manual will help you determine referral patterns of TrPs. You can search Amazon or Barnes and Nobel for books by Clair Davies and Hal Blatman.

Seldom are doctors well informed about myofascial pain and trigger points, no surprise I am sure. All they have to do is go to pubmed and search trigger points (TrPs) to see the research. Newer research suggests that it may be present in all FM patients, though CMP is not always accompanied by FM, making the two distinct disorders.

Of course rule out other problems as suggested. You will be able to feel the pea sized knotted up TrP in a taut band of muscle unless the muscle is too hard, beneath another muscle or bone or even in the vaginal vault (in which case you may have to have your mate help you locate them. If the trigger point (TrP) is active you will have pain in the pelvic floor muscle affected and in the referral pattern. If the TrP is latent (meaning present but only hurts when you sit on it), it is just as important to treat it. Sit on a tennis ball and find the area of discomfort. Apply pressure with your weight to maximum discomfort, then back off to about 70% (so blood can still get to the TrP) and keep pressure for about 30-60 seconds. Follow up with a gentle stretch of the muscle using your fingers.

Prevention
An ounce of prevention is worth a pound of cure. Once you are able to get the TrPs under control, pay attention to aggravating conditions. Those that come to mind are poor posture, pants that are too tight, and a chair that does not provide adequate support.

Always rule out other cause of pelvic pain and discuss your symptoms with your doctor. If your pain and dysfunction is not found to be from another source, please look for those myofascial trigger points, they are treatable.

Lamb hugs, Celeste, author

"Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection”

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