Chronic pelvic pain (CPP) can be a problem for both men and women with fibromyalgia (FM). There are various causes of pelvic pain because our reproductive organs, bladder, part of our lower bowel, and our pelvic muscles and connective tissue reside there.
A CHRONIC PROBLEM
Chronic pelvic pain can vary from mild to severe, constant to intermittent, and symptoms can last from three to six months. Pain can involve the genitalia (vulva, prostate, testicles, penis), urethra (where urine comes out), bladder, rectum, vagina, peritoneum (such as seen from ruptured ovarian cysts), uterus, and painful trigger points (TrPs). Because it is complex, information here will focus on the relationship of pelvic pain and myofascial trigger points (TrPs).
MYOFASCIAL PAIN AND FIBROMYALGIA
Myofascial pain syndrome is considered a peripheral pain generator that co-occurs with many disorders and can contribute to centralization of pain, which includes fibromyalgia.
PELVIC PAIN AND TRIGGER POINTS
Pelvic muscles and the multi-layered muscles of the pelvic floor keep our organs where they should be. That’s a big job and any number of things can lead to development of TrPs that cause muscle dysfunction and pain. Myofascial trigger points are one of the greatest aggravators of chronic pelvic pain seen in both men and women, and pain is not the only symptom. Trigger points can develop close to blood and lymph vessels, as well as peripheral nerves, which can impede the flow of blood (causing circulation and temperature changes), lymph fluid (leading to swelling and congestion), and peripheral nerve impulses (causing numbness and tingling).
Trigger points can develop because of restrictive tissue after injury, infection, surgery, a disease process that affects the musculoskeletal system, or due to problems in other areas around the pelvis that radiate pain to it. For instance, TrPs in the pelvis can cause pelvic floor spasm and impede urine flow causing urinary retention and hesitancy. They can cause lower back and abdominal pain, pain in the tailbone, hip or groin pain, or pubic bone pain (the front on the pelvic bowl). TrPs can cause pain locally or radiate pain to other parts of the body specific to their location. They can also cause erectile dysfunction, sacral dysfunction, painful intercourse, rectal pain, menstrual pain, impotence, constipation, and more.
DIAGNOSIS TO TREATMENT
According to researchers, “myofascial pain syndrome in the pelvic floor is a very common condition in urology, and it is often overlooked or misdiagnosed.” Most likely this is because physicians get little training, and this great imitator can lead to confusing symptoms. That’s why urologists (gynecological urologists for women), physical therapists, and body workers who are well versed in myofascial management specifically for chronic pelvic pain are imperative for our team.
Treatment might include:
- Pelvic floor physical therapy
- Electro-stimulation – Intravaginal, pelvic floor, and peritoneum (lining of the abdominal cavity and organs)
- Guided self-treatment at home
- Myofascial release
- Vaginal manual trigger point therapy
- Rectal manual trigger point therapy
- Intravaginal trigger point injections
- Pelvic floor trigger point injections
- Sacral neuromodulation
- Management of sacral joint dysfunction
- Ultrasound therapy
- Internal muscle relaxants and analgesics
- Topical analgesics
Muscle fibers with trigger points can cause a cascade of events that few physicians know to investigate. For instance, trigger points that restrict urine flow can lead to chronic urinary tract infections, and TrPs can cause pain that mimics prostatitis or cause impotence. Unless our care provider understands this, we could miss valuable treatment.
Chronic pelvic pain can be caused by many things, and myofascial involvement can be primary or secondary to our problem. So, if TrPs are suspected, it’s time to see a specialist. Misdiagnosis or no diagnosis at all is not acceptable.