Guide to Pelvic Pain: What to Know About Pelvic Floor Trigger Points
Pelvic pain is a disruptive pain typically experienced in the lower abdomen, pelvis, or perineum. Pelvic pain is likely more common than you think, with one in seven suffering from some kind of pelvic floor pain, and approximately between 4% and 16% suffering from chronic pelvic pain symptoms.
Fortunately, pelvic floor pain can be treated, but appropriate treatment requires an understanding the various causes, risk factors, and treatment exercises to help restore better function, flexibility, and strength to the muscles and joints in the pelvic region.
In this guide, we’ll do just that. Read on to learn more about pelvic floor tension and myalgia (also known as pain), pelvic floor trigger points, and physical therapy exercises and movement that you can do to reduce your pain.
What is Pelvic Pain
Pelvic floor pain, also known as pelvic floor myalgia, can mean pain anywhere in the pelvis and can occur for the variety of reasons. Pelvic pain can include pain in the hips, low back, pubic symphysis or sacroiliac joints or in the vagina, rectum, perineum or tailbone. Pelvic floor myalgia can occur because the muscles in the pelvic floor stay in a continuously contracted state, like there is the sensation of a knot. It can also occur due to a variety of other reasons that we’ll detail below.
Myofascial Trigger Points
Myofascial trigger points are a common cause of pelvic pain. With constant pain or tension in the pelvic floor muscles, it’s common to develop what’s known as trigger points like these — or muscle knots. These trigger points are spots within the tissue or muscle fascia that experience hyper-irritability. Myofascial trigger points can cause pain or even worsen it, especially when touched or irritated. Trigger points can also be the culprit of decreased pelvic floor strength and a lack of flexibility in the surrounding muscles.
Trigger points can be located in any of the surrounding muscle tissues in the pelvic floor issue or in surrounding areas like the abdominals, hips, low back, and even the upper thigh area, so it’s common to experience a wide variety of symptoms depending on where the trigger points are located within the body.
Tight Pelvic Floor Symptoms
Pelvic floor pain is often described as an uncomfortable feeling of heaviness in the pelvic areas. Symptoms lasting over 3 months are considered chronic pelvic pain. However, there are a number of other symptoms commonly associated with pelvic pain, include:
Pain with sitting or inability to sit for long periods of time
Pain during penetrative sex
Pain with sitting or riding a bike
Pain while lying on your back or side
Pain with getting in and out of chairs or when sitting down
Pain with bowel movements
Urinary urgency
Urinary frequency
Limited mobility in hips and lower back
Problems with inserting tampons or menstrual cups
One of the best ways to identify if the pain you’re suffering from is caused by your pelvic floor and/or myofascial trigger points is to schedule an evaluation with a pelvic floor physical therapist. Physical therapists can walk through your health history with you to better understand if the symptoms you’re experiencing are indeed pelvic floor pain. They can also string together symptom patterns and examine the various fascia layers and muscles in your hips, abdomen, pelvic floor, back, and thighs.
Pelvic floor physical therapists can help identify where overactive or tight muscle bands are located in your body, and where hard or tender knots — myofascial trigger points — are located. These can be located through a combination of physical therapist palpation and patient report when the muscle is being examined.
What Causes Tight Pelvic Floor Muscles?
Pelvic floor muscles do a lot of things for you like supporting your bladder, urethra, rectum, and reproductive organs, but they are also important for bowel movements, urination, sexual function, and orgasms. Pelvic floor muscles should naturally tense and release, but for some people, the muscles can remain in a state of tension, much like a muscle spasm.
The causes of pelvic floor pain and tight pelvic floor muscles can vary significantly from person to person and in some cases a cause may not even be identified. However, many common causes of tight pelvic floor muscles include:
Pregnancy and childbirth
Damage to the pelvic floor during childbirth
Repeatedly pushing too hard when passing a bowel movement
Changes in the muscles that control bladder and bowel movements
History of holding one’s bladder
Irritable bowel syndrome (IBS)
Nerve damage or pressure on the nerves near the pelvis
Weak pelvic floor muscles
Endometriosis
A history of sexual abuse
Interstitial cystitis
A prolapse (a shift in the pelvic organs)
Poor posture
Prevention
While certain risk factors can make people susceptible to pelvic floor pain, in many cases pelvic floor pain can be prevented through exercise and a healthy lifestyle. Exercises that are known to help with preventing pelvic floor pain include:
Deep abdominal wall and core stabilization exercises
Strength training and stretching
Meditation and body-awareness exercises
Eating a fiber-rich, whole-foods-based diet
Staying well hydrated
Relieving yourself of urine and stool when needed, rather than holding it
Maintaining a healthy weight
Practicing proper posture
Practicing good feminine hygiene
Exercises for Pelvic Floor Pain
If you’re experiencing pelvic floor pain, it’s best to check with your healthcare provider or consult a pelvic floor physical therapist for proper diagnosis and treatment. Some common therapy exercises for pelvic floor pain often include the following:
Pelvic Floor Wand For Trigger Points
A pelvic wand can be especially helpful for relieving pain with trigger points in hard-to-reach places. Pelvic wands are designed to reach both surface level and deep pelvic floor muscles and can help ease pain by giving a pelvic massage that improves circulation and relaxation to the muscles in the pelvic floor.
Myofascial Trigger Point Release
Trigger points can experience release and relief by applying consistent, gentle pressure to the surrounding muscles and fascia to help enhance function and blood flow. In fact, research shows that those who regularly did pelvic massage exercises to help with myofascial trigger point release saw a decline in pelvic pain and an improvement in their overall pelvic floor function.
Muscle and Fascia Stretching
Yoga and deep stretching do more than just make your body feel good. These restorative and gentle forms of exercise are also commonly used physical therapy strategies to help reduce pelvic floor pain. With the goal to help stretch your muscles and fascia, stretching that focuses on areas around the abdomen and pelvic floor can help relieve the pressure and discomfort caused by trigger points.
Additionally, foam rolling and proprioceptive neuromuscular facilitation (PNF), a form of assisted stretching used to improve range of motion and physical performance are common methods used to help treat pelvic floor pain. PNF focuses on stretching a muscle group to its full limit and holding the stretch for a few seconds, which helps the muscles and surrounding fascia relax.
Dry Needling
Dry needling is a process where a very thin needle, similar to those used in acupuncture, is inserted through the skin into a trigger point to help it relax by increasing blood flow to the trigger point, the surrounding muscle, and the fascia. Dry needling can be used anywhere on the body for trigger points, but for purposes of treating pelvic floor pain, it’s generally used to treat pain from trigger points that are located in the low back, abdomen, pelvic floor and thighs.
What Kind of Physical Therapist Do I Need?
When seeking treatment for ailments in the body, it’s always best to look for a medical professional that focuses on a specific area. The same goes for searching for a physical therapist to help with pelvic floor pain. While all physical therapists should have the education and knowledge to treat pelvic floor pain, it’s often worth seeking treatment from a physical therapist who has a specific focus on treating pelvic floor pain. Some things to look for when searching for the right pelvic floor physical therapist include the following:
Someone who has a focus area on women’s health and specifically states they work with pelvic floor problems.
A board-certified specialist in women’s physical health.
A pelvic floor physical therapist who has taken continuing education courses in pelvic health and related areas.
Pelvic floor pain can be debilitating. However, suffering doesn’t have to be permanent. In many cases, pelvic floor pain can be treated through physical therapy exercises and a change in lifestyle and overall health.
If you’re ready to start working with a pelvic floor physical therapist to get your pain under control, contact us for an appointment here.
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.