Pelvic pain is common in females and occurs for several reasons ranging from temporary menstrual cramps to chronic pelvic pain linked to an underlying condition or pelvic floor dysfunction.
Understanding the cause of female pelvic pain is key to relieving it and treatment often includes addressing painful pelvic trigger points and myofascial pain to restore pelvic floor function and improve muscle flexibility.
Let's dive into the difference between pelvic trigger points pain vs myofascial pain, and effective therapies for treating both.
Pelvic Pain Explained
The pelvis is described as the part of the body from the lower abdomen to the groin. Therefore, pelvic pain constitutes pain anywhere in the pelvis, including the lower abdomen, lower back, hips, perineum, rectum, tailbone, thighs, or vagina. It can also occur in the pubic symphysis, which is the joint between the left and right pelvic bone. And in the sacroiliac joints, which connect the pelvis to the lower spine.
Acute pelvic pain is diagnosed when the pain is sudden and intense, while chronic pelvic pain is constant, or comes and goes, for longer than six months. Chronic pelvic pain is often due to a constant state of tightness or dysfunction in the pelvic floor muscles. What causes tight pelvic floor muscles in women can vary, each of which we’ll outline below.
What Causes Tight Pelvic Floor Muscles?
Tight pelvic floor muscles and the painful trigger points and myofascial pelvic pain that ensue can be caused by several medical conditions, life experiences, or pelvic injuries.
These include:
- Pregnancy
- Childbirth
- Perineal tears during childbirth
- Pudendal Neuralgia
- Pelvic prolapse
- Poor posture
- Pelvic surgery
- Pelvic injuries
- Dyspareunia
- Untreated sexually transmitted infections (STIs)
- Untreated urinary tract infections (UTIs)
- Holding the urge to urinate for too long and too often
- Chronic constipation
- Irritable bowel syndrome (IBS)
- Endometriosis
- Previous sexual abuse
- Interstitial cystitis
- Vulvodynia
What is Pelvic Trigger Point Pain and Myofascial Pain
Pelvic trigger point pain and myofascial pain are common causes of chronic pelvic pain. The two ailments are somewhat interrelated and usually instigated by tight pelvic floor muscles.
Pelvic Trigger Point Pain
Described as a painful muscle knot, or an area of a muscle that has tightened and not relaxed, trigger points are small, dime-sized nodules of irritation. Also known as myofascial trigger points, it is believed that they develop due to a lack of blood flow after a muscle injury, or due to overly tight muscles that remain in a constant state of contraction.
When touched, pressed, or irritated, trigger point pain can temporarily intesify.
Pelvic trigger points are known to occur in any part of the muscle tissue in the pelvic area, including the abdominals, hips, lower back, and groin. Additional symptoms can vary according to where pelvic trigger points are located, however, these painful knots and their subsequent symptoms can be released with the help of a physical therapist and a specialized pelvic tool that can be used at home.
Myofascial Pelvic Pain
Fascia is the tissue that supports the musculoskeletal system of the body, essentially connecting the bones, muscles, skin, and other organs and protecting them from injury. When the fascia is soft and fluid it functions correctly, however, if it becomes tight or stiff in a particular part of the body it can cause pain.
When myofascial pain occurs in the pelvis, for instance, it is because the fascia in this part of the body has tightened around the pelvic organs, bones, and pelvic floor muscles. Painful trigger points within the pelvic floor muscles that are left untreated often result in myofascial pelvic pain. Similar to trigger points, myofascial pain can be relieved with the correct type of massage from a pelvic physical therapist.
Symptoms of Tight Pelvic Floor Muscles
The pelvic floor muscles are designed to naturally tighten and release to support body stabilization and the correct functioning of the pelvic organs. When damaged, injured, or affected by an underlying condition like endometriosis, however, the pelvic floor muscles tend to spasm and remain tense. This type of muscle spasming can feel like knotting pain or a sense of heaviness in the pelvic area.
In addition to contributing to body posture and mobility, the pelvic floor muscles also support the bladder, bowel, reproductive organs, and rectum, and enable bodily functions like urination, bowel movements, pain-free sex, and orgasms. So when the pelvic floor muscles are tight, and sufficient support of these organs is lacking, additional symptoms can include:
- Feeling a sudden urge to urinate
- The need to urinate frequently
- Pain during or after bowel movements
- Pain during sex (dyspareunia)
- Pain or discomfort after sitting for too long
- Pain when riding a bicycle
- Pain with bowel movements
- Tight hips with limited mobility
- Pain inserting tampons
How to Treat Pelvic Trigger Point & Myofascial Pain
If you’re suffering from ongoing pelvic pain, it's a good idea to book an evaluation with a pelvic physical therapist to better understand the cause and side effects of your condition. When experiencing long-term pelvic pain, women often consult with an OB/GYN or urologist depending on their additional symptoms. However, treating the underlying condition that might be affecting the pelvic organs will not treat tight pelvic floor muscles.
An evaluation from a physical therapist will include a discussion about your symptoms and an examination of the muscles and fascia in the pelvic floor, abdomen, lower back, hips, groin, and thighs to check for muscle contractions and trigger points.
Below are the most effective treatments for pelvic trigger points and myofascial pain.
Stretching & Dilator Therapy
Your pelvic physical therapist might discover that your pelvic pain can be treated with pelvic stretching yoga exercises and the use of vaginal dilators in the comfort of your own home. Designed to slowly relax and stretch the vaginal and pelvic floor muscles over time, vaginal dilators are typically used as a set, with sizes ranging from that of a pinkie finger to an erect penis.
Progressing gently and slowly through a set of vaginal dilators can improve pelvic floor muscle flexibility and restore proper function, as well as relieve pain during sex. Here at Intimate Rose, our sets of vaginal dilators are made with body-safe, medical-grade silicone to provide additional comfort and safety as well as effective dilation.
In conjunction with dilation therapy, gentle yoga stretches for the hips and pelvis can help release any tightness in the surrounding pelvic muscles too.
Trigger Point Therapy
When painful trigger points are identified within the pelvic floor muscles, physical therapists will typically suggest and perform trigger point therapy to release the muscle contraction. By applying the right amount of pressure directly against the painful nodule, blood flow slowly returns to the area and allows the muscle to relax.
Pelvic Massage Wand
Ergonomically designed pelvic massage wands are particularly helpful for releasing painful trigger points in places that are difficult to reach, such as the pelvic floor muscles. They are also highly recommended for at-home use to continue trigger point release therapy started by a physical therapist.
Several studies have shown that regular massage with a pelvic wand significantly improves blood flow to the trigger point, releases the contraction, and allows the muscle to relax. 95% of the women who participated in these studies found pelvic wand massage to be either very effective or moderately effective. None of the study participants reported their pelvic pain worsening.
Our pelvic wand design here at Intimate Rose was developed by our president and chief clinical officer, Dr. Amanda Olson, who is also an experienced pelvic physical therapist.
As the only pelvic wands on the market that are fully covered in medical-grade, BPA-free silicone, Intimate Rose Pelvic Massage Wand is comfortable and safe for your body.
They also include gentle vibration settings for more effective massage on deep pelvic trigger points and the core of the wand can be cooled or heated for added comfort.
Myofascial Release Therapy
If your physical therapist identifies myofascial pelvic pain they usually suggest myofascial release therapy. This is a manual massage therapy focused on a particular area of the body rather than just one trigger point. Myofascial release therapy involves moving, massaging, and stretching the muscles and tendons within the afflicted part of the body.
Although relaxing, myofascial massage release therapy also provides the sensation of a deep tissue stretch. It can be performed with the hands as well as other pelvic tools when needed, such as vaginal dilators if that part of the body is affected.
Conclusion
The best way to determine and treat the cause of chronic pelvic pain is to schedule an evaluation with a pelvic physical therapist. Pregnancy, childbirth, injuries, surgeries, urological and reproductive conditions can all cause pelvic pain. However, treating the underlying condition will not necessarily release the tight pelvic floor muscles, painful trigger points, or myofascial pelvic pain that ensues.
To release chronic pelvic pain, it is often necessary to relax the muscles, tendons, and fascia within the pelvic area as well as treat whatever caused the tightness to begin with.
References
National Library of Medicine - Recognizing Myofascial Pelvic Pain in the Female Patient with Chronic Pelvic Pain - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492521/
Physiopedia – Trigger Point Pain - https://www.physio-pedia.com/Trigger_Points
National Library of Medicine - Safety and effectiveness of an internal pelvic myofascial trigger point wand for urologic chronic pelvic pain syndrome - https://pubmed.ncbi.nlm.nih.gov/21613956/
Phyisiopedia – Myofascial Pain - https://www.physio-pedia.com/Myofascial_Pain
National Library of Medicine - Low Dose, High-Frequency Movement Based Dilator Therapy for Dyspareunia: Retrospective Analysis of 26 Cases - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8240346/