Which Department to Consult for Pelvic Floor Myofascial Pain? What Are the Symptoms? Don’t Ignore Chronic Lower Abdominal Pain!

Pelvic floor myofascial pain, as the name suggests, is an inflammation of the muscles and fascia in the pelvic floor. Common symptoms include chronic pelvic pain, discomfort around the perineum or anus, pain during sexual activity, difficulty urinating or defecating, and it may even affect the lower back and inner thighs. These issues often lead to a decreased quality of life for patients.

Due to the wide range of symptoms, early-stage patients often mistake the condition for urinary, gynecological, or gastrointestinal problems, and therefore commonly first seek medical attention in urology, obstetrics and gynecology, or gastroenterology departments.

What Are the Causes and Location of Pelvic Floor Myofascial Pain?

Myofascial Pelvic Pain Syndrome (MFPP) is a common but frequently overlooked or misdiagnosed condition. It is a chronic pain syndrome caused by persistent tension, overuse, or irritation of the muscles and fascia of the pelvic floor.

The pelvic floor muscles are located at the base of the pelvis. This muscle group is responsible for supporting organs like the bladder, uterus, and rectum. When myofascial inflammation occurs or when "trigger points" form in these muscles, it can cause pelvic pain that is difficult to pinpoint.

Causes of Pelvic Floor Myofascial Pain

• Poor Posture: Habits like prolonged sitting, standing, or crossing your legs can contribute to the condition.
• Childbirth Trauma: Tearing or adhesions in the pelvic floor muscles during delivery.
• Overuse of Pelvic Floor Muscles: Excessive or improper use of these muscles during activities like heavy weightlifting or squats.
• Increased Muscle Strain: Chronic constipation or being overweight can place extra stress on the muscles.
• Direct Injury: Direct trauma or muscle dysfunction that leads to stiffness and oxygen deprivation in the muscles.

High-Risk Groups for Pelvic Floor Myofascial Pain

• Women, especially those who have given birth.
• Individuals who regularly perform high-intensity exercises like heavy weightlifting or squats.
• People with chronic constipation.
• Individuals with poor postural habits, such as prolonged sitting, standing, or crossing their legs.
• Overweight individuals.

Which Medical Departments Treat Pelvic Floor Myofascial Pain?

Myofascial Pelvic Pain Syndrome (MFPP) is often difficult to diagnose clinically because its symptoms mimic those of urinary, gynecological, gastrointestinal, or lower back conditions. It's frequently mistaken for issues like urinary tract infections, ovarian cysts, hemorrhoids, or sciatica. The pain can also shift location, and imaging tests often appear normal, so a diagnosis heavily relies on clinical experience, a detailed patient history, and physical muscle palpation.

If you suspect you have pelvic floor myofascial pain, you can seek professional help from the following departments for diagnosis and treatment:

Medical Specialties That Can Diagnose and Treat MFPP

• Obstetrics & Gynecology: Female patients experiencing chronic pelvic pain or pain during sexual activity can consult a gynecologist. The physician will assess the condition of the pelvic floor muscles and may provide treatment or referrals as needed.
• Colorectal Surgery: Patients whose primary symptoms involve difficulty with bowel movements, anal pain, or discomfort can consult a colorectal surgeon. After ruling out gastrointestinal issues, the physician may evaluate whether the symptoms are related to pelvic floor muscle dysfunction.
• Urology: For symptoms such as difficulty urinating, frequent urination, urinary incontinence, or pelvic pain, a urologist can assess and treat pelvic floor dysfunction.
• Cardiovascular Surgery: If pain is located near the groin or upper thigh, it is important to rule out vascular conditions such as venous thrombosis or arterial stenosis. Once vascular causes are excluded, a cardiovascular surgeon may provide treatment related to pelvic floor myofascial pain.

Are There Costs for Pelvic Floor Myofascial Pain Examination?

The initial examination for pelvic floor myofascial pain primarily relies on clinical palpation. During this exam, your doctor will feel the muscles and fascia around the pelvic floor, including the perineum and anal area, and may perform an internal vaginal or rectal exam. They are looking for painful spots, muscle tension, or hardened areas.

The cost of this preliminary examination is generally included in the registration fee you pay when you visit the clinic. You will only incur additional costs if more in-depth tests are required.

What Are the Treatment Options for Pelvic Floor Myofascial Pain?

Once you are diagnosed with pelvic floor myofascial pain, the goal of treatment is to relieve chronic pain, relax tense muscles, and restore pelvic function. Treatments can be divided into three main categories: medication, physical therapy, and surgical intervention. These methods are most effective when combined with daily self-care.

1. Medication

During the acute phase of pelvic floor myofascial pain, anti-inflammatory drugs, muscle relaxants, and pain relievers can be applied locally via the vagina to help relax pelvic floor muscles and reduce pain. Vitamin and nutrient supplementation may also promote muscle and fascial repair. In stubborn cases, invasive drug injections may be recommended.

• Frequency and Duration: Adjusted according to symptom severity; short-term use during the acute phase; injections as advised by the physician for persistent cases.
• Effectiveness: Can effectively relieve acute pain and reduce muscle tension, but long-term improvement usually requires combination with other therapies.

2. Physical Therapy

The aim of physical therapy is to relax the fascia, release trigger points, and improve pelvic mobility. Common methods include heat therapy, pelvic floor muscle massage, and shockwave therapy.

• Frequency and Duration: Shockwave therapy typically involves 6–8 sessions, 1–2 times per week, with about 80% of patients experiencing improvement. Heat therapy or warm baths can be done daily.
• Effectiveness: Most patients report significant reduction in pain and discomfort, enhancing overall quality of life.

3. Surgical Treatment

Surgery is not the primary treatment for pelvic floor myofascial pain and is usually reserved for cases with clear structural abnormalities or lesions that do not respond to conservative therapy.

• Frequency and Duration: Usually completed in a single procedure.
• Effectiveness: Surgery addresses specific structural problems but has limited effect on isolated myofascial inflammation. Postoperative rehabilitation, including physical therapy, may still be necessary.

How to Soothe Pelvic Floor Myofascial Pain in Your Daily Life

In addition to formal treatment, patients can take several daily measures to ease pelvic floor discomfort:

• Avoid prolonged sitting: Use a soft cushion or U-shaped seat cushion to reduce pressure.
• Apply heat to the pelvic area: Warm compresses for 15–20 minutes daily can help relax the muscles.
• Practice proper breathing: Techniques such as diaphragmatic breathing help the body enter a relaxed state.
• Perform stretching exercises: Poses like Child’s Pose, Cat-Cow, and Butterfly Pose can help relax the pelvis and hip joints.
• Avoid overdoing Kegel exercises: Tense muscles need relaxation rather than further contraction.

Common Q&A on Pelvic Floor Myofascial Pain from PTT and Dcard

Q1: Can strength training cause pelvic floor myofascial pain?

Yes, especially exercises like squats that engage the pelvic floor muscles. Without proper warm-up and post-workout relaxation, the pelvic floor can be overused, leading to muscle stiffness, fascia hypoxia, chronic inflammation, and eventually pelvic floor myofascial pain.

However, appropriate and properly performed strength training can benefit pelvic floor function. The key is to avoid overexertion and incorrect posture.

Q2: Does massage and heat therapy help with pelvic floor myofascial pain?

Yes. Heat therapy and warm baths promote blood circulation, relax the pelvic floor muscles, and relieve pain. Additionally, using massage balls on related muscle groups can ease tension. Combining these methods with physician-guided physical therapy is even more effective.

Q3: Is pelvic floor myofascial pain common in men?

The incidence of pelvic floor myofascial pain is lower in men. This is because men generally have stronger pelvic floor muscles, while women are more susceptible due to factors like childbirth, hormones, and lifestyle habits.

Q4: Can I see a traditional Chinese medicine (TCM) practitioner for pelvic floor myofascial pain?

Yes, you can. TCM treatments like acupuncture, needle-knife therapy, and floating needle therapy can help release pelvic floor muscle adhesions and promote the flow of qi and blood, which can help improve your symptoms.

Q5: Can pelvic floor myofascial pain be cured?

If diagnosed promptly and treated with a combination of medication, physical therapy, and lifestyle changes, most patients will see significant improvement or even a full recovery. Continued use of heat therapy, massage, and avoiding poor posture can also help provide long-term relief from discomfort.

Don't Overlook Chronic Lower Abdominal Pain: How to Prevent Pelvic Floor Myofascial Pain

Pelvic floor myofascial pain may sound serious, but you can effectively lower your risk by adjusting your daily habits and adopting some preventative measures. Here are a few ways to prevent the condition:

• Avoid Poor Posture: Refrain from habits like crossing your legs or prolonged sitting or standing. Maintain proper sitting posture and get up to move around every 30 to 60 minutes to reduce pressure on the pelvic floor muscles.
• Regular, Moderate Exercise: Develop a habit of regular exercise to avoid long periods of inactivity. Core muscle training, in particular, helps stabilize the pelvis and distribute pressure.
• Learn Proper Lifting Techniques: When lifting heavy objects, bend your knees and keep your back straight. Use your leg muscles to lift to prevent excessive stress on your lower back and pelvic floor.
• Ensure Regular Bowel Movements: Avoid constipation by establishing a regular bowel routine. This reduces straining during defecation and relieves pressure on the pelvic floor.
• Actively Relax Pelvic Floor Muscles: Try gentle pelvic floor stretches or practice deep breathing exercises during stressful moments to promote relaxation.
• Maintain a Healthy Weight: Being overweight or obese increases the burden on the pelvic floor. Maintaining a healthy weight helps prevent this condition.

Dr. Huang reminds everyone that you should not ignore persistent symptoms such as pain in the lower abdomen, perineum, or around the anus, difficulty with urination or defecation, or pain during sexual intercourse. These could be warning signs of pelvic floor myofascial pain or other serious pelvic issues.

It is crucial to seek professional medical diagnosis and treatment early to identify the cause and receive proper care. This will help prevent the condition from worsening and affecting your quality of life.