Myofascial Pelvic Pain

Myofascial pelvic pain is a condition derived from shortening of the muscles of the pelvic floor, abdomen, or lower extremities. This makes the tissues prone to myofascial trigger points, which are taut bands, or knots that cause pain, weakness, or limited range of motion in the affected area. We think of them as electrical fuses that go awry and can cause referred pain or other symptoms related to the genitourinary system, such as urinary frequency or painful orgasm.

a thorough physical examination is required to confirm

A thoughtful interview may reveal risk factors for the development of myofascial pelvic pain. Evaluation consists of a methodical examination of the abdominal wall connective tissue, as well as muscles of the torso and thighs. Internal examination of the pelvic floor, either via the vagina and rectum in women or the rectum in men, is necessary to assess the tone and strength of the muscles. Texture of the muscles throughout are assessed for texture and presence of taut bands or knots, known as trigger points. Palpation of myofascial trigger points (MTPs) may reproduce symptoms, refer pain, or exhibit abnormal twitching. This confirms the diagnosis of a Myofascial Pelvic Pain. A thorough examination of these areas also aids in ruling out other causes for the symptoms, such as tumors, infections, or neurological disorders.

myofascial pain and ucpps

We identify myofascial pain in 60-70% of our patients presenting with UCPPS. However, there are usually other diagnoses coinciding with MTP and still others to explain the patients' symptoms. We frequently identify a phenomenon called central sensitization, previously termed Functional Somatic Syndrome. Central sensitization occurs in long-standing painful conditions, especially when associated with emotional trauma, depression, or other overlapping conditions outside of the pelvis.

Other causes of UCPPS should be explored, such as irritation of the pudendal nerve or the posterior femoral cutaneous nerve. These conditions, like myofascial pain, may worsen with prolonged sitting.

Small fiber peripheral neuropathy is becoming a more recognized cause of UCPPS and shares many of the symptoms we would associate with central sensitization.

how vista urology treats myofascial pelvic pain

We employ a tailored, multidisciplinary approach which may involve specialized manual physical therapy (connective tissue manipulation and MTP release), neuromodulating medications (such as certain antidepressant or anti-convulsant agents), dry needling (an adjunct to MTP release, which employs acupuncture needles), and injections (superficial temporary anesthetics).

At the core of our management strategy is education and daily self-care.

We also consult specialists to aid in cognitive behavioral therapies and mindfulness when indicated.