Painful pelvic floor (pelvic muscle dysfunction)
What is painful pelvic floor?
This condition goes by several different names – hypertonic pelvic floor, levator myalgia, pelvic muscle spasm. It is a condition that is frequently overlooked as a cause for pelvic pain.
The symptoms seem quite varied – sudden (sometimes incapacitating) pain in the low abdomen or shooting into the vagina or rectum; nausea and feeling faint; difficulty emptying the bladder or bowel; frequent urination; painful sex; pain after long periods of sitting or exercise; pain at night. In some cases these will be worse right before your period, but often they can seem to occur out of the blue, and with no relationship to your cycle. An app (such as 'Clue') can be really helpful to track these symptoms.
Pain may last a few minutes to a few hours, is often felt low in the pelvis where a woman may have been told her ovaries or endometriosis are. Some women say it feels achey, twisty, and others note they feel sick or sweaty with it. Typically pain relievers like ibuprofen (Neurofen) or paracetamol (Panadol) don't make much difference, but a heat pack might.
The cause is overly-tight pelvic floor muscles. This can arise due to pain in other areas of the pelvis (eg with endometriosis, or frequent thrush or urinary infections), after unwanted or painful sex, or when the pelvic floor is suddenly asked to do a lot more (eg – BootCamp!). Many women will have had an issue for years but not really had a good answer for their pain. It is easy to figure out if this is an issue for you with an examination, and then you can get on with treatment.
This is usually with a specialist pelvic floor physiotherapist to identify the muscles, and then massage out trigger points and relax them. Many women don't need anything more than a few sessions and care and attention to this often-neglected area.
If this is unsuccessful there are other therapies we can discuss including targeted Botox, although this is not necessarily a long-term fix.