Pelvic muscle pain

Pain in the pelvic muscles can be caused by various reasons, this is explained by the complex structure and variety of types of muscles in the pelvic region.

Some of them start directly from the spine and are attached directly to the pelvic bones, so muscle syndromes can be both vertebral and pelvic. There are muscles that are attached to the hip, so the pain is localized in this area, especially when it comes to overstraining the piriformis or iliopsoas muscle.

Thus, the muscular reaction to a provoking factor can be expressed in a clinical sense as pain, both in the spine itself, in the sacrum, in the coccyx area, and in the lower abdomen, buttocks and legs.

Pelvic muscle pain is most often caused by hypertonicity, spasm of internal or external types of muscle tissue. The internal group of pelvic muscles include:

• The iliopsoas muscle, which in turn consists of the iliac and lumbar major muscles, both of which are attached to the femur, participate in the work of the posterior wall of the peritoneum.
• The internal obturator muscle starts from the pelvic cavity and passes through the sciatica at an acute angle.
• The small lumbar muscle (lumbar minor muscle), located on the surface of the large lumbar muscle, practically fuses with it.
• The piriformis muscle, which begins in the pelvic area (in the area of the II – IV sacral vertebrae) and passes through the sciatica from the pelvic cavity.

The external group of pelvic muscles includes:

• Large, medium and small gluteal muscles. The large muscle is the most prominent and developed due to the fact that a person will be able to walk upright.
• The tensor fasciae lata is a muscle located between the plates of the fascia lata at the level of the upper thigh.
• The quadratus femoris muscle originates from the edge of the ischial tuberosity and is attached to the upper zone of the intertrochanteric crest.
• The external obturator muscle begins in the area of the pubic bone and passes behind the hip joint with the help of a tendon and is attached to the femur.

Such diversity of muscle tissue, their complex and branched arrangement determines the polyetiology of pain in the pelvic muscles.

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Causes of Pelvic Muscle Pain

Before finding out what provokes pain in the pelvic muscles, what are its causes, it is necessary to at least superficially understand how the muscle tissue, the spine of this area are interconnected in terms of biomechanics.

The pelvis and spine are closely connected in the anatomical sense, and represent a kinematic functional chain. The pelvis itself is the base, the foundation for the spinal column, in addition, the lower limbs are attached to the pelvis, which in turn also affect the condition of the spine and pelvic bones due to their movements. Such a complex structure cannot function without strong, elastic connections, which are muscles, fascia, tendons, ligaments. That is why it is believed that almost all pelvic pain is caused by a disorder, dysfunction of the muscular-ligamentous system, less often - vascular factors. Conventionally, the causes of pain in the pelvic muscles can be divided into three categories:

• Vertebrogenic causes, dysfunction of the sacrococcygeal structure, dysfunction of the inguinal ligament and pubic symphysis.
• Pain caused by shortening, spasm of the oblique abdominal muscles or hypertonicity of the adductor femoris muscles, muscle-tonic syndromes, myofascial syndrome.
• Vascular disorders, dysfunction of the venous system, impaired venous and lymphatic outflow.

Also, the causes of myogenic pelvic pain can be divided by gender.

Factors that provoke pain in the pelvic muscles in women are associated with the specific anatomy and biomechanical function of muscle tissue and perineal fascia.

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Causes of pelvic muscle pain in women:

• Shortening of the oblique abdominal muscles, which are attached to the inguinal ligament. Muscle pain radiates to the groin area in the pubic region (symphysis) and intensifies when turning the body.
• Overstrain of the adductor muscles of the thigh, which occurs due to the specificity of women's gait (lateral swing, rotational movements of the pelvis). Spasmodic trigger points provoke pain reflected in the groin, pubis, pain can also be felt in the vagina and rectum. The pain intensifies with prolonged walking, especially in high heels, when the pelvis seems to twist, changing the tension of the muscles of the pelvic diaphragm. If a woman has an adhesive process in her anamnesis, a conditional fixation of the pelvic muscles occurs, normal biomechanical processes are disrupted.
• Impaired venous outflow increases pelvic muscle pain in a sitting position. Alternate contraction and relaxation of the muscles (gluteal and internal obturator) can improve outflow through the genital vein, reduce pain, so the symptom is independently neutralized by movement, changing a static sitting position.

Dysfunction of the sacrococcygeal joint provokes hypertonicity of the internal obturator muscle. The pain increases with movement and walking, since the muscle is involved in the rotation of the hip joints.

Pelvic muscle pain in men is mistakenly taken for symptoms of prostatitis, which is subsequently not detected during examination.

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What causes pelvic muscle pain in men?

• Vertebral muscular-tonic syndromes, among which the iliopsoas muscle syndrome is the leader, also included in this list is the piriformis muscle syndrome, which is also called muscle-compression neuropathy of the sciatic nerve. In addition, pain in the muscles of the pelvic region can be caused by the syndrome of the small or middle gluteal muscles.
• Pelvic myofascial syndrome is a fairly common cause of such pain. MFBS is considered a complex chronic process that develops in the neuromuscular system of the pelvis in men prone to depressive states, hypochondria. In addition, myofascial syndrome can be provoked by hypothermia, inflammatory diseases of internal organs (MFBS will act as a secondary syndrome). Myofascial factor has not been studied enough, although its symptoms have clear diagnostic criteria.
• Pelvic genital pain in men is often accompanied by muscle spasms. Dysfunction of the pudendal nerve is called tunnel pudendopathy, when the nerve is pinched in the fibrous bone canal of the pubic bone. The consequence of such pinching is pain in the penis and in the surrounding pelvic muscles.

How does pelvic muscle pain manifest itself?

Signs and symptoms of pelvic muscle pain may be typical of muscle pain, but they may also manifest as visceral, vertebrogenic pain. This is due to the close anatomical interaction of muscles, fascia, tendons, nerve endings in the pelvic area. Therefore, it is so important to accurately identify all the characteristics of the symptom and determine its localization. In clinical practice, three main types of pelvic pain are distinguished:

• Local pelvic pain, which is felt by the patient as muscular, but can be associated with any inflammation, pathology that affects nerve endings, can irritate or pinch them. Such pain is most often constant, increases or decreases depending on the pose, body position, changes with movement. The pain symptom, as a rule, is aching in nature, is felt as diffuse, but when intensified, it can manifest itself as acute pain.
• Reflected pelvic pain may be a consequence of the projection of a signal from the spine, and may also be a projection of pathology of internal organs located in the pelvic and peritoneal area. If the disease affects internal organs, the pain does not change with movement, does not subside in a horizontal position. Rather, its intensity depends on the pathological process in the organ and changes in its structure, condition.
• Radiculopathies in the pelvic area can also be felt as muscle pain. The pain is felt as strong, intense, radiating along the nerve ending, within the root involved in the infringement. The pain depends on reflex movements - coughing, sneezing, as well as physical effort, tension. In addition, pain in the pelvic muscles can increase with movement that stretches the nerve.

Myofascial pain is characterized by being felt deep within the tissue. The characteristics of myogenic pain are as follows:

• The pain is localized in the thickness of muscle fibers.
• The pain is dull in nature.
• Pain can debut suddenly, without any apparent objective reasons.
• The pain occurs both at rest and during movement.
• The pain can increase to excruciating, severe and subside on its own to mild.
• Often the pain develops far from the trigger point itself, the tense muscle.
• Pain symptoms may occur at the junction of tissues located in the area of several trigger points or in antagonist muscles.
• Most often, the pain is asymmetrical.
• Palpation of a painful trigger point causes a generalized reaction from the patient (jump symptom).
• Palpation of a spasmodic trigger point increases the painful sensations in the area of the reflected symptom.

Given that myofascial pelvic pain can occur in any striated muscle and that it can be localized in any part of the pelvis, a detailed description of the symptoms and a thorough, comprehensive diagnosis play an important role.

Diagnosis of pelvic muscle pain

Diagnosis of pelvic pain, unlike identification of the etiology of pain symptoms in other areas of the body, is extremely difficult. Despite the relative simplicity of the diagnostic algorithm, in which palpation plays the main role, it is myogenic factors that are often rejected as primary. This is due to insufficient study of the pathogenetics, the clinic of myogenic pelvic pain in principle, in addition, myalgia, depending on the location in the pelvic area, is often similar to the clinical manifestations of coccygodypia, proctalgia, vulvodypia. Also, tunnel neuropathy of all types - ilioinguinal, genital, femoral-genital - have a very similar picture. If the above factors, as well as somatic pathology are excluded, the diagnosis of pain in the pelvic muscles is indeed carried out within the framework of the myogenic direction.

Thus, in order for the diagnosis of pelvic muscle pain to be carried out more accurately and quickly, it is necessary to exclude possible pathological factors associated with the internal organs located in the pelvic area:

The following must be confirmed or excluded:

• 1. Urological diseases:
  • Infectious diseases of the urinary tract.
  • Diseases of the musculoskeletal system.
  • Oncological process of organs located in the pelvic area (bladder cancer, uterus, etc.).
  • Urethral syndrome.
  • Diverticulum of the urethra or bladder.
  • Urolithiasis.
  • Prostatitis.
• Gynecological diseases – salpingo-oophoritis, salpingitis, endometritis, adhesions, fibroids, cysts, cervical canal stenosis, pelvic organ prolapse, etc.
• Varicose veins of the pelvis.
• Gastroenterological diseases – oncological process in the colon, colitis, diverticulitis, hernia. IBS (irritable bowel syndrome).
• Psychogenic factor.

Diagnosis can be difficult, since according to statistics, pelvic pain has more than 100 etiological causes known to medicine, and their symptoms are often similar to the manifestation of myalgia, or the muscle pain is reflected from the main somatic source.

Unlike diagnostic measures for myalgia in other parts of the body, determining the underlying cause of pelvic pain is longer and more complex. In addition to collecting anamnesis, the doctor must take into account the patient's gender and age and collect the following information:

• The nature of the pain is aching, shooting, pressing, pulling, shooting.
• Localization of pain – in the sacrum, thigh, rectum, lower abdomen, and so on.
• Duration of pain – short-term pain, constant, chronic, periodic.
• What factors provoke pain - body position, diet, sexual relations, urination, defecation, menstrual cycle, stress.

In addition, diagnostic actions include:

• assessment of neurological status.
• muscle palpation.
• identification of the degree of mobility of the spine in the lumbosacral region.
• tests, samples that reveal movements that provoke pain.
• the presence or absence of TT – trigger points, diagnostically important for determining myofascial syndrome.
• If necessary, an X-ray of the spine, as well as CT and/or MRI, is prescribed.
• electromyography, which determines the level of neuromuscular conduction and tone.

According to statistics, 40-50% of chronic pelvic pain (CPP) is caused by myofascial syndrome, especially in women (up to 65%).

To confirm MFPS (myofascial pain syndrome), in addition to the presence of trigger zones, the following criteria are required:

• The pain is most often cyclical in nature; acyclic pain symptoms are typical for women.
• The pain is most often localized in the lower abdomen.
• The pain symptom persists for six months or more.
• The pain is not caused by the menstrual cycle in women, prostatitis in men, and is not associated with sexual activity or frequency of sexual intercourse.

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Treatment of pelvic muscle pain

The main goal of the treatment of pelvic muscle pain caused by myogenic factors - fibromyalgia, myofascial syndrome - is the neutralization of trigger, spasmodic areas and long-term relaxation of the tense muscle.

• How to relax pelvic muscles?
• Elimination of static tension, postural overexertion (posture, sitting, bending, etc.).
• Providing long-term rest for tense muscles.
• Stretching the pelvic muscles using gentle muscle relaxation techniques such as massage and post-isometric relaxation.
• Prescribing muscle relaxants in tablet form is especially effective when combined with massage and muscle stretching.
• Relief of acute pain with NSAIDs – non-steroidal anti-inflammatory drugs in any available form depending on the nature of the symptom and the patient’s condition. A good effect is achieved by combining NSAIDs, muscle relaxants, massage and therapeutic exercise.
• It is possible to prescribe chondroprotectors as an adjuvant therapy.
• To maintain muscle tone in the lumbar region, it is often recommended to wear a corset that relieves the spine in this area.
• Destruction of trigger points is possible with the help of acupuncture method, which helps to minimize the use of synthetic drugs and speed up the healing process.
• For anxiety and depressive states, antidepressants and sedatives, often of plant origin, are prescribed.

Treatment of pelvic muscle pain can be quite long and persistent, especially if myalgia is combined with diseases of internal organs and other complications.

Prevention of pelvic muscle pain

Preventive measures that help reduce the risk of developing pelvic pain are not specific and differ little from standard preventive measures.

Prevention of pelvic muscle pain is, first of all, a careful attitude towards your own undervalued resource – your health.

In our hectic age, when the speed of information, of life itself, significantly outpaces the speed of normal, physiologically acceptable perception and reaction, it is extremely important to keep healthy not only the head, but also other parts of the body, including the pelvis. In addition to the standard, regular medical examinations necessary for every person, a reasonable distribution of both work and emotional load gives an excellent preventive effect.

Obviously, the advice - avoid stressful situations, is impossible to follow, stress as tension and mobilization is the very adaptive reaction to any irritant, which modern life is full of. Therefore, when straining, you need to be able to relax competently, of course, in normal healthy ways, without the use of alcohol and other destructive substances. Physical, motor activity, sports do not so much strengthen muscle tissue as help to get rid of stress. According to many physiologists, active excitation in the form of running, swimming, walking opens the body's reserve "channels" and protects it from almost all complications, including muscle strain.

In addition, prevention of pelvic muscle pain involves following these rules and regulations:

• Before training, performing exercises, including exercise therapy, the muscles need to be “warmed up”, that is, a warm-up should be performed.
• If your professional activity involves constant static tension, you need to change your position every 40-60 minutes and perform unloading movements.
• You should correct your posture and straighten your back not only in front of the mirror, but also monitor its condition constantly.
• It is necessary to become familiar with and perform breathing techniques that help saturate muscles with oxygen and improve their blood supply. In addition, proper breathing is one of the main anti-stress methods.
• Following the rules of rational nutrition, consuming sufficient amounts of plant foods and vitamins strengthens the immune system, muscle tissue and the body as a whole.
• Muscle tissue, as well as the whole body, requires a sufficient amount of liquid. Do not forget that during the day you need to drink at least 1.5 liters of water, purified, good quality. The liquid norm does not include strong tea and coffee, which are popular, but are unlikely to help prevent pain in the pelvic muscles.
• You should not get carried away with painkillers at the first symptoms of pain. Firstly, muscle pain is often not relieved by analgesics, it has a different pathogenetic and biological mechanism, and secondly, such self-medication can distort the clinical picture and complicate diagnosis when visiting a doctor.

Pelvic muscle pain is a rather complex multivariate symptom with many causes. Among the factors that provoke pain, both objective, life circumstances are identified - overexertion after training, uncomfortable posture, and more serious diseases, including life-threatening ones. Timely contact with a therapist who will conduct an initial examination and determine the specifics of the diagnostic direction will help to avoid complications and provide an opportunity to quickly neutralize the pain.