Pain in the pelvic muscles

Pain in the pelvic muscles can be due to various reasons, this is due to the complex structure and variety of the muscles of the pelvic region.

Some of them begin directly from the spine and are attached directly to the pelvic bones, so the muscular syndromes can be both vertebral and pelvic. There are muscles that are attached to the hip, respectively, the pain is localized precisely in this zone, especially in the case of overexertion of the pear-shaped or iliac-lumbar muscle.

Thus, the muscular reaction to the provoking factor can be expressed clinically as pain, as in the vertebral column, in the sacrum, in the coccyx, and in the lower abdomen, in the buttocks and legs.

Pain in the pelvic muscles is most often caused by hypertension, spasm of internal or external muscle tissue. The internal group of pelvic muscles include: 

• The ilio-lumbar muscle, which in turn consists of ileum and large lumbar, both these muscles are attached to the femur, participate in the work of the back wall of the peritoneum.
• The internal blocking muscle begins from the cavity of the small pelvis, passes through the seat at an acute angle.
• Small lower back muscle (small lumbar muscle), located on the surface of the large lumbar muscle, practically fuses with it.
• Pear-shaped muscle that starts from the pelvic zone (in the zone II-IV of the vertebrae of the sacrum) and passes through the seat from the cavity of the small pelvis.

The external group of pelvic muscles include: 

• Large, medium and small gluteus muscles. The big muscle is the most embossed and developed due to the fact that a person will get the opportunity to walk upright.
• The broad fascia stretcher, the muscle is localized between the wide fascia plates at the top of the thigh.
• The square muscle of the thigh originates from the edge of the ischial hillock and is attached to the upper zone of the intervertebral crest.
• The external blocking muscle begins in the area of the pubic bone with the help of the tendon passes behind the hip joint and is attached to the femur.

Such a variety of muscle tissue, their complex with a branched arrangement, causes polyethiologic pain in the pelvic muscles.

[1], [2]

Causes of pain in the pelvic muscles

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

The pelvis and spine are closely related in the anatomical sense, and represent a kinematic functional chain. Actually, the pelvis is the base, the base for the vertebral column, in addition to the pelvis the lower extremities are attached, which in turn also affect the condition of the spine and pelvic bones due to their movements. Such a complex construction can not function without strong, elastic joints in which the muscles, fascia, tendons, ligaments protrude. That is why it is believed that almost all pelvic pains are caused by violation, dysfunction of the musculoskeletal system, less often - by vascular factors. Conditionally, 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, cramping of the oblique abdominal muscles or hypertension of the leading femoral muscles, muscle-tonic syndromes, myofascial syndrome.
• Vascular disorders, dysfunction of the venous system, violation of venous and lymphatic outflow.

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

The factors that cause pain in pelvic muscles in women are related to the specificity of anatomy and biomechanical function of muscle tissue, perineal fascia.

[3], [4]

Causes of muscle pain in the pelvic region in women: 

• Shortening of oblique abdominal muscles, which are attached to the papart ligament. Pain in the muscles irradiates into the inguinal zone into the pubic region (symphysis) and is strengthened when the body rotates.
• Overexertion of the adductor muscles of the hip, which occurs due to the specificity of the female gait (lateral swing, rotational movements of the pelvis). Spasmed trigger points provoke the reflected in the groin, in the pubic pain, and pain can be felt in the vagina, rectum. The pain is aggravated by prolonged walking, especially on high heels, when the pelvis is twisted, changing the tension of the muscles of the pelvic diaphragm. If a woman has a history of adhesions, conditional fixation of pelvic muscles occurs, normal biomechanical processes are disrupted.
• Disturbance of venous outflow strengthens muscular pelvic pain in a sitting posture. The alternate contraction and relaxation of the muscles (gluteal and internal locking) can improve the outflow on the genital, reduce pain, thus the symptom itself is neutralized in movement, changing the static sitting posture.

Violation of the function of the sacrococcygeal articulation provokes the hypertension of the inner occlusal muscle. The pain increases with movement, walking, as muscles participate in the rotation of the hip joints.

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

[5], [6]

What causes pain in the muscles of the pelvis in men? 

• Vertebral muscular-tonic syndromes, among which the ileal-lumbar muscle syndrome is leading, also includes the pear-shaped muscle syndrome, which is also called musculoskeletal neuropathy of the sciatic nerve. In addition, pain in the muscles of the pelvic region can be caused by a syndrome of small or medium gluteal muscles.
• Pelvic myofascial syndrome is a fairly common cause of these pains. MFBS is considered a complex chronic process that develops in the neuromuscular system of the pelvis in men prone to depressive conditions, hypochondria. In addition, myofascial syndrome can be triggered by hypothermia, inflammatory diseases of the internal organs (the MFBS will act as a secondary syndrome). The myofascial factor has not been studied enough, although its symptomatology has clear diagnostic criteria.
• Pelvic genital pain in men is often accompanied by muscle spasms. Dysfunction of the genital nerve is called tunnel pudendopathy, when the nerve is impaired in the bone-fibrous canal of the lateral bone. The consequence of this infringement is pain in the penis and in the surrounding pelvic muscles.

How does the pain in the pelvic muscles manifest?

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

• Local pelvic pain, which is felt by the patient as a muscle, but can be associated with any inflammation, a pathology that affect the nerve endings, can irritate or impair them. Such pain is most often constant, increases or decreases depending on the posture, body position, changes during movement. The pain symptom, as a rule, is aching, it is felt as diffuse, but with strengthening it can be manifested as acute pain.
• Reflected pelvic pain may be a consequence of the projection of the signal from the spine, and may also be a projection of the pathology of the internal organs located in the pelvic and peritoneal zones. If the disease affects the internal organs, the pain does not change during movement, does not subside in a horizontal position. Rather, its intensity depends on the pathological process in the organ and changes in its structure, state.
• Radiculopathies in the pelvic region can also be felt as muscle pains. The pain is felt as strong, intense, irradiating along the course of the nerve end, within the root, involved in infringement. Pain depends on reflex movements - coughing, sneezing, as well as physical effort, stress. In addition, the pain in the pelvic muscles can be enhanced by movement, stretching the nerve.

Myofascial pains differ in that they are felt in the depth of the tissue. Characteristics of myogenic pain are as follows: 

• The pain is localized in the thickness of the muscle fibers.
• The pain is dull.
• Pain can debut suddenly, without apparent objective reasons.
• Pain occurs both in a state of rest and in motion.
• Pain can intensify to painful, strong and self-subsiding to mild.
• Often the pain develops far from the trigger point itself, the tense muscle.
• Pain symptom may occur at the junction of tissues located in the zone of several trigger points or in antagonist muscles.
• Most often, the pain is asymmetric.
• Palpation of a painful trigger point causes a generalized reaction from the patient (a symptom of a jump).
• Palpation of the spasmodic trigger point intensifies the painful sensations in the area of the reflected symptom.

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

Diagnosis of pain in the pelvic muscles

Diagnosis of pelvic pain as opposed to detecting the etiology of pain symptoms in other areas of the body is extremely difficult. Despite the relative simplicity of the diagnostic algorithm, in which the main role is played by palpation, it is the myogenic factors that are often rejected as primary. This is due to the insufficient knowledge of pathogenetics, the clinic of myogenic pelvic pains in principle, besides, myalgia, depending on the localization site in the pelvic region, is often similar to the clinical manifestations of coccidgia, procalgia, vulvodipia. A tunnel neuropathy of all kinds - iliac-inguinal, genital, femoral-genital, is also very similar. If the above factors, as well as somatic pathology is excluded, the diagnosis of pain in the pelvic muscles is really carried out within the myogenic direction.

Thus, in order to diagnose pain in the pelvic muscles more accurately and quickly, it is necessary to exclude possible pathological factors associated with internal organs located in the pelvic region:

Should be confirmed or excluded:

• 1. Urological diseases: 
  • Infectious diseases of the urinary tract.
  • Diseases of the musculoskeletal system.
  • Oncoprocess of organs located in the pelvic area (cancer of the bladder, uterus and so on).
  • Urethral syndrome.
  • Diverticulum of the urethra or bladder.
  • Urolithiasis disease.
  • Prostatitis.
• Gynecological diseases - salpingoophoritis, salpingitis, endometritis, adhesions, fibroids, cysts, stenosis of the cervical canal, prolapse of pelvic organs and so on.
• Varicose veins of the pelvis.
• Gastroenterological diseases - oncology in the large intestine, colitis, diverticulitis, hernia. IBS (irritable bowel syndrome).
• Psychogenic factor.

Diagnosis can be difficult, because according to statistics, pelvic pains have more than 100 known etiologic causes, while their symptoms are often similar to the manifestation of myalgia, or pain in the muscles is reflected from the main somatic source.

In contrast to the diagnostic measures of myalgia in other parts of the body, the definition of the root cause of pain in the pelvic region is longer and more complex. In addition to collecting an anamnesis, the doctor necessarily takes into account the patient's sex and age and collects such information: 

• The nature of pain - aching, lumbago, pressure, pulling, shooting.
• Localization of pain - in the area of the sacrum, hip, rectum, lower abdomen and so on.
• The duration of the pain sensation is a 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: 

• evaluation of neurological status.
• palpation of muscles.
• revealing the degree of mobility of the spine in the lumbosacral zone.
• tests, tests that reveal pain-provoking movements.
• the presence or absence of TT-trigger points, which are diagnostic to determine myofascial syndrome.
• if necessary, X-ray of the spine, as well as CT and (or) MRI.
• electromyography, which determines the level of neuromuscular conduction and tone.

Chronic pelvic pain (CTB) is statistically 40-50% caused by myofascial syndrome, especially in women (up to 65%).

To confirm the MFBS (myofascial pain syndrome), in addition to the presence of trigger zones, the presence of such criteria is required: 

• Pain is often cyclical, acyclic pain symptoms are typical of women.
• The pain most often localizes me in the lower abdomen.
• The pain symptom persists for six months or more.
• Pain is not due to the menstrual cycle in women, prostatitis in men, nor is it related to sexual activity and frequency of sexual contacts.

[7]

Treatment of pelvic pain

The main goal, which is pursued by the treatment of pain in pelvic muscles, caused by myogenic factors - fibromyalgia, myofascial syndrome, is the neutralization of trigger, spasmodic areas and a long relaxation of the strained muscle.

• How to relax the pelvic muscles? 
• Elimination of static voltage, postural overvoltage (posture, sitting, incline and so on).
• Provide a lasting rest to the strained muscles.
• Stretching of the pelvic muscles with gentle muscle relaxant methods, such as massage, post-isometric relaxation.
• Purpose mielorelaksantov in the tablet form, especially effectively their combination with massage and stretching of muscles.
• Coping acute pain with NSAIDs - non-steroidal anti-inflammatory drugs in any accessible form, depending on the nature of the symptom and the condition of the patient. A good effect gives a combination of NSAIDs, mielorelaksantov, massage and therapeutic exercise.
• Chondroprotectors may be prescribed as an auxiliary therapy.
• To support muscle tone in the lumbar region, it is often recommended to wear a corset that unloads the spine in this area.
• Destruction of trigger points is possible with the help of an acupuncture method that helps minimize the use of synthetic drugs and accelerate the process of recovery.
• In anxious, depressed states, antidepressants, sedatives, often of plant origin, are prescribed.

Treatment of pain in the pelvic muscles can be quite long, stubborn, especially if myalgia combines with diseases of the internal organs and other complications.

Prevention of pain in the pelvic muscles

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

Prevention of pain in the pelvic muscles is, above all, a considerate attitude to your own little-valued resource - health.

In our troubled age, when the speed of information, life itself is much faster than the speed of normal, physiologically acceptable perception and response, it is extremely important to keep not only the head, but also other parts of the body healthy. Including the pelvis. In addition to the standard, regular checkups necessary for every person, an excellent preventive effect gives a reasonable distribution of both work and emotional load.

Obviously, advice - avoid stressful situations, it is impossible to fulfill, stress as tension and mobilization is the most adaptive response to any stimulus full of modern life. Consequently, straining, you need to be able and competently relax, of course, in normal healthy ways, without the use of alcohol and other destroying agents. Physical, motor activity, playing sports not so much strengthens muscle tissue, how much help to get rid of stress. According to many physiologists, active excitement in the form of running, swimming, walking opens the reserve "channels" of the body and protects it from almost all complications, including muscle strain.

In addition, the prevention of pain in the pelvic muscles involves compliance with such rules and regulations: 

• Before training, performing exercises, including exercise therapy, the muscles need to be "warmed up", that is, perform a warm-up.
• If professional activity is associated with a constant static stress, after every 40-60 minutes it is necessary to change the pose, perform unloading movements.
• It is necessary to correct your posture, and straighten your back not only in front of the mirror, but also to monitor its condition constantly.
• It is necessary to familiarize and perform breathing techniques that help oxygenation of muscles, improve their blood supply. In addition, proper breathing is one of the main anti-stress methods.
• Compliance with the rules of rational nutrition, the use of a sufficient amount of plant foods, vitamins strengthens the immune system, muscle tissue and the body as a whole.
• Muscle tissue, like the entire body, requires a sufficient amount of fluid. Do not forget that during the day you need to drink at least 1, 5 liters of water, purified, of good quality. The norm of the liquid does not include strong tea and coffee, which are popular, but are unlikely to help prevent pain in the pelvic muscles.
• Do not take a great interest in painkillers with the first pain symptoms. First, muscle pain is often not removed by analgesics, it has another pathogenetic and biological mechanism, secondly, such self-medication can distort the clinical picture and make it difficult to consult a doctor.

Pain in the pelvic muscles - this is a fairly complex multivariate symptom, which has many causes. Among the pain-provoking factors identified as objective, life circumstances - overstrain after training, uncomfortable posture, and more serious diseases, including life-threatening. Timely appeal to the therapist, who will conduct a primary examination and determine the specificity of the diagnostic direction, will help to avoid complications and will make it possible to quickly neutralize the pain.