Myofascial dysfunction associated with chronic pelvic floor pain: Management strategies

Abstract

Myofascial pain as a cause of chronic pelvic pain with or without pelvic organ pathology is well-documented in the literature. Causes of this pain are multifactorial, including specific pelvic organ pathologies, neuromuscular disorders, and psychologic causes. Management of this myofascial component of chronic pelvic pain involves a multidisciplinary approach including physicians, physical therapists, neurologists, and psychiatrists. Treatment strategies, including behavioral management, medications, physical therapy, trigger point injections, neuromodulation, botulinum toxin injection, and other lesser known treatment modalities, are discussed in detail in this article.

Multidisciplinary Approach to Chronic Pelvic Pain

“…Myofascial pain syndrome (MFPS) describes a disorder in which pain is attributed to tender pelvic floor muscles that are exacerbated by hypersensitive trigger points in the skeletal muscle [21]. Symptoms include a sense of aching, heaviness, or burning in the pelvis, vagina, vulva, rectum, or bladder, and referred pain to the thighs, buttocks, or lower abdomen.…”

Physical Therapy for Female Pelvic Pain

“…One system for classifying the etiology of pelvic pain described in the literature is that of a primary versus secondary dysfunction [ 17,[19][20][21][22] . Consideration of pelvic pain that is "primary" compared to that which is "secondary" is a helpful model to employ when investigating individual etiology and determining course of care.…”

“…Physical therapists are trained in the evaluation and treatment of dysfunction of the musculoskeletal system, such as disorders of posture, movement, and function. The high prevalence of musculoskeletal fi ndings observed in women with chronic pelvic pain has led some authors to suggest that the women's health physical therapist play an early role in their evaluation [ 20,22 ] . This allows the physical therapist to contribute by determining the degree of musculoskeletal involvement, providing recommendations on appropriateness of physical therapy as an intervention, and if necessary, commencing physical therapy to address dysfunction even while other medical consultations, evaluations, and interventions are being explored [ 20,22 ] .…”

Rééducation pelvi-périnéologique, techniques manuelles et douleurs pelvi-périnéales

“…Les objectifs kinésithérapiques sont de restaurer la fonction musculaire et de limiter l'aggravation d'un symptôme et les conséquences sur la fonction sexuelle en réduisant les composantes algiques et les tensions musculaires [26].…”