Why Tight Pelvic Floor Muscles Create Pain and How Pelvic Floor Physical Therapy Provides Relief

Genitopelvic pain can significantly impact a person's quality of life, affecting their ability to engage in activities such as urination, bowel movements, and sexual intercourse. At Sky Women's Health, we highly recommend pelvic floor physical therapy for nearly every condition contributing to genital and pelvic pain.

In this blog post, we will explore the reasons behind this recommendation, highlighting the importance of pelvic floor muscles, the complexities of pelvic floor dysfunction, the role of muscle tension in causing pain, and the application of osteopathic principles. We will also discuss how botulinum neurotoxin injections can be an effective treatment option and the importance of active engagement in pelvic floor exercises.

Understanding the Pelvic Floor Muscles: The pelvic floor muscles play a crucial role in supporting the pelvic organs. Acting as a hammock, these muscles extend from the pubic bone in the front to the sacrum and tailbone in the back. They cradle important structures such as the bladder, uterus, urethra, perineum, and rectum. The pelvic floor muscles exhibit a delicate balance of contracting to maintain continence and relaxing when necessary for urination, bowel movements, tampon insertion, and sexual intercourse.

Complexities of Pelvic Floor Dysfunction: Various musculoskeletal conditions, including reduced spinal mobility, sacroiliac joint dysfunction, misalignment of pubic bones, and pelvic obliquities (ie. tilted pelvis), are associated with vulvodynia and pelvic floor dysfunction. Conditions such as levator ani syndrome, pelvic floor tension myalgia, vaginismus, animus, coccydynia, sphincter dyssynergia, pelvic floor spasm, and a shortened pelvic floor (muscles that are too tight, clenched, or spasming) are examples of overactive pelvic floor dysfunction. Stressful lifestyles can lead individuals to subconsciously squeeze their pelvic floor muscles, causing overactivity. Individuals with a tight pelvic floor often hold tension in the jaw, neck, and shoulders contributing to headaches and neck pain. Patients are usually suprised when asked if they clench their jaw when presenting for pelvic pain.

Why it hurts: Muscle Tightening and Sexual Pain: Muscle tightening in the pelvic floor can result in compression of blood vessels, reducing blood flow and oxygen supply to the area. This can lead to lactic acid buildup and compression of nerves, such as the pudendal nerve, causing pain. The decrease in oxygen can also trigger a hypoxic inflammatory response, resulting in tenderness and a burning sensation seen in provoked vestibulodynia. Therefore, it becomes clear that tight pelvic floor muscles can contribute to sexual pain and discomfort.

Osteopathic Principles at Work: Applying osteopathic principles, we understand that structure follows function and vice versa. Pelvic floor physical therapists utilize a range of tools and techniques to address pelvic floor dysfunction. These include education, myofascial release, trigger point release, visceral manipulation, pelvic floor training, biofeedback, dilators, wands, vibrators, electrical stimulation, and more. By adopting a comprehensive approach, therapists aim to restore proper muscle function, alleviate pain, and improve overall well-being.

Botulinum Neurotoxin Injections: In some cases, botulinum neurotoxin injections can be an effective treatment option in combination with pelvic floor PT. Neurotoxin works by 1) preventing the release of acetylcholine, responsible for contraction and 2) calming nerve endings by preventing the release of substance P, responsible for nerve-related pain. At Sky Women's Health, Dr. Moyers has had great success in helping patients with persistent dysfunction through Botox injections. We encourage patients to be in active pelvic floor physical therapy during injections. This combination approach allows for muscle retraining, ensuring that the muscles remain released and functional even after the effects of the medication wear off. 

Importance of Comprehensive Care: To achieve optimal results in managing genitopelvic pain, a holistic approach is crucial. Combining quality medical care, behavioral therapy, and pelvic floor physical therapy can significantly improve both pain levels and sexual function. It is important to remember that healing takes time, and patients need to actively participate in their treatment by diligently following their prescribed exercises and therapies.

Conclusion: Pelvic floor physical therapy is a highly recommended treatment for various conditions contributing to genitopelvic pain. Understanding the complexities of pelvic floor dysfunction, the impact of muscle tension on pain, and the application of osteopathic principles can help individuals on their healing journey. Botulinum neurotoxin injections can complement treatment when persistent pelvic floor dysfunction is present. A comprehensive approach that includes active patient participation and engagement is key to achieving long-term pain relief and improved quality of life. At Sky Women's Health, we provide the necessary support and tools to help our patients find healing and regain control of their lives.

Source: when sex hurts, UNDERSTANDING AND HEALING PELVIC PAIN, Andrew Goldestin, MD, Caroline Pukall, PhD, Irwin Goldstein, MD and Jill Krapf, MD 2023