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Pelvic floor trigger points are an often ignored part of chronic pelvic pain. A pelvic floor myofascial release is one way to turn off these triggers and get pain relief from what can be a distressing and constant pain. This article will cover:
Once the common causes of pelvic pain have been excluded, too often people are told to “learn to live with the pain.” I think being put in the ‘too hard’ basket for pelvic pain is really unfortunate. In my experience, careful examination will often reveal very sensitive and active pelvic trigger points.
Once these are treated, chronic pelvic pain can be either reduced or abolished. This can truly change people’s lives, and it’s also something people can learn to do for themselves.
Chronic pelvic pain is slightly more common in women than men, as women pelvic organs men don’t: the uterus, ovaries, fallopian tubes.
One problem with chronic pelvic pain is that the majority of doctors only examine problems with the organs as the primary source of that pain.
In women, they’ll examine the uterus, and other organs, while in men they’ll look for problems in the prostate. In both, they’ll investigate bladder and bowel problems, as these can give chronic pelvic pain.
Organ dysfunction or disease are serious issues and need to be ruled out if you have pelvic pain. However, when this has been ruled out, and you have ongoing chronic pelvic pain, many people hit a dead end.
After the internal organs have been checked out, this is when it’s worth looking at the pelvic floor muscles as a cause of pain. This step still stays strangely hidden from the view of many gynecologists, urologists, gastroenterologists, and other people who deal with chronic pelvic pain.
They miss the fact a good proportion of chronic pelvic pain does not arise from the organs they treat and instead comes from two sources. The first is myofascial pain, arising from the muscles in the pelvic floor.
The second, (which goes together with all kinds of chronic pain,) is pain amplification coming from a malfunction of your pain system. These two things dance together to create chronic pelvic pain.
Finally, it is not uncommon to have prostatitis or inflammation of the pelvic organs with secondary trigger points adding to the pain. This means you can resolve the original pain, but then have untreated trigger points continuing to cause discomfort.
Inside your pelvis, the pelvic floor muscles are a complex group that run along the inside of the pelvic rim. They form a basket shape to keep the pelvis stable and contain the organs of this area.
These muscles are where myofascial and trigger point pain comes from. There are two layers of muscles in this group. The outer layer of muscle is called the urogenital diaphragm, which is a sheet of muscle running across the base of the pelvis.
The next layer above that is a whole complex of muscles all joined together. These are big strong muscles to hold the innards of your pelvis inside and are called the Levator Ani. They arise from the sacrum at the back of the pelvis and they run around the inside of the pelvis in a cup-shaped structure. When these muscles get trigger points in them, they can cause severe and long lasting pelvic pain.
Trigger points in the pelvic floor muscles can be turned on by:
Once pelvic floor muscles get active trigger points, you need to have access to them to put gentle pressure on the points and turn them off. In women, you have access to two pathways: vaginal and rectal, and in men the only access is rectal. You need to do this kind of internal treatment because the pelvic floor muscles are on the inside of the pelvic bones.
Treating these trigger points can be done by a qualified physiotherapist. It’s also possible to treat yourself. However, if you’re treating yourself, it’s easier to reach the trigger points using a specialized tool, rather than your hands.
There’s a number of tools on the market you can insert and use to treat pelvic floor muscles. It’s important to be very gentle when treating these trigger points. This is because the muscles are in an area that doesn’t usually get any physical contact and are likely to be highly sensitive.
Use ischemic pressure to slowly do a pelvic floor myofascial release. The technique works in the same way as it does to release triggers anywhere else.
After the treatment, the next thing to do is to is apply heat for 5 minutes. Long term, getting relief means using all the techniques you’d use with chronic pain: learning how to relax the muscles; good posture; natural movement; diaphragmatic breathing.
There is a group of physiotherapists who specialize in treating chronic pelvic floor pain, and consulting one of these is often a good idea to get started on treating these trigger points.
In extreme cases, anal or vaginal dilators need to be used. This is because very active pelvic floor triggers can cause the muscles to go into spasm, making both these orifices extremely tight. This condition of vaginismus can make intercourse impossible. Spasm of the muscles around the rectum can cause problems with evacuating, which can lead on to other health issues. Pelvic floor trigger points can seriously impede other pelvic functions.
Successfully treating them is not just a physical thing. What’s also very helpful is techniques to manage your stress, anxiety, breathing, and your pain system.
A lot of people have pelvic pain that has a burning quality.
Unlike other areas of the body, burning pain in the pelvis doesn’t always mean a nerve is affected. Burning pain be coming from organs, or pelvic floor muscles, or a nerve, it doesn’t always have a diagnostic significance.
The one notable exception to this is when you have burning pain in a small thin band associated with numbness and tingling. This is a sign you may be dealing with one very unusual nerve: the pudendal nerve.
The pudendal nerve arises from the sacral plexus. It starts inside the pelvis, then goes outside the pelvis, hooks around the ischial spine, and then comes back inside the pelvis.
This is unusual nerve anatomy. As it hooks around the ischial spine, the pudendal goes through a tiny little canal and comes down to supply the perineum, which is the area between the anus and genitalia.
If the pudendal nerve gets pinched or irritated, it will give a classic neuropathic pain. This is a stabbing, burning, shooting, pain running in the distribution of the pudendal nerve, with numbness and tingling.
Treatments of this particular pain can be difficult. You can inject cortisone in the pudendal canal or surgical releases can be done.
The surgery to release pudendal nerve problems is problematic because often the pudendal pain is part of a broader pelvic pain problem. And in the mix is the pelvic floor muscles themselves, with potentially active triggers which will benefit from being treated.
While pelvic floor trigger points are covered in our trigger point course, we also recommend Isa Herrerra’s course on pelvic pain release, as this is what she specializes in. Here’s where to join her free masterclass >>>