Pelvic Floor Pain

What is the pelvic floor?

The pelvic floor includes the muscles, ligaments and connective tissue that lie beneath and support the perineum and pelvis. It supports your organs, including the bowel, bladder, uterus, vagina, and rectum.

Pelvic Floor Pain:

Many different conditions may cause Pelvic Floor Pain. Identifying these conditions assists to find the proper treatment pathway. This includes a thorough evaluation and examination performed by a specialist in the Urogynecology field.

Causes:

Postpartum Pain
Vaginismus
Vulvodynia
Interstitial Cystitis/Bladder Pain Syndrome
Endometriosis
Post-Surgery
Mesh Complications
Trauma/Abuse
Urinary Tract Infections
Constipation
Pudendal Neuralgia

Hypertonic Pelvic Floor Disorder/ Pelvic Floor Dysfunction

One of the most commonly missed causes is called Hypertonic Pelvic Floor Disorder/Pelvic Floor Dysfunction. This is when muscles in the pelvic floor remain in a tense state and are unable to relax. Many people with non-relaxing pelvic floor muscles experience pelvic health conditions including painful intercourse, painful urination, urgency, pelvic pain and constipation.

Treatment Options

Pelvic Floor Physical Therapy

Pelvic floor physical therapy is a treatment for problems related to the pelvic floor. This specialized therapy includes exercises that can help relieve symptoms including pain and discomfort that are affecting your quality of life.

Medications

There are multiple vaginal suppositories and vaginal creams that may be used to assist in localized management of pelvic floor pain based on evaluation.

Pudendal Block/ Trigger Point Injections

Pudendal Block

Pudendal nerve blocks are a minimally invasive and non-surgical treatment for pelvic floor pain conditions. This may include pudendal neuralgia. The block is performed in the office setting. This is performed by a local anesthetic agent injected intravaginally into the pudendal nerves. These nerve blocks can help in the treatment and reduction of vaginal and perineal pain.

Trigger points

Trigger point injections are injections of a local anesthetic agent to the pelvic floor muscles through the vagina that are tightening and causing pain. This is also performed in the office setting and is a non-surgical treatment. This can be performed in adjunct to the pudendal block or as a separate procedure based on individualized patient’s pain.

Vaginal Botox Treatments

Botox is a neuromodulator that relaxes muscles when it is injected. This is used for multiple medical conditions as a therapeutic treatment as well as for cosmetic reasons. For this type of treatment, botox medication is injected into multiple pelvic floor muscles. This typically is performed in the operating room setting. And is a very successful modality of treatment.