The events listed below, be they acute or repetitive, can injure muscles and nerves, thereby causing chronic pelvic pain:
• Bicycling on hard uncomfortable seats
• Sitting for long periods on poorly designed chairs
• Chronic muscle tightening
• External trauma/falls
• Pelvic surgical procedures
• Recurrent vaginal/urinary infections
• Repeated or vigorous squatting
• Straining with bowel movements
• Stress/emotional trauma
The three underlying causes of chronic pelvic pain and dysfunction that practitioners generally fail to recognize are myofascial (muscle) trigger points, pudendal neuralgia, and pudendal nerve entrapment (PNE). Because they are the ultimate culprits that must be addressed to resolve the patient’s pain, we will focus on them here.
Myofascial Trigger Points
Many chronic pelvic pain conditions, as well as the need to urinate urgently and frequently, are commonly caused by pelvic floor muscle spasm. Because the spasm that is causing the pain or dysfunction may not be felt by the patient or apparent to the practitioner, only its effect on the body organs captures our attention.
The major pelvic organs (urethra, vagina and rectum) are surrounded by the muscles of the pelvic floor. When these muscles become tight and stressed they compress the organs, creating dysfunction and/or pain. Further, the surrounding skin, or possibly the bladder lining, may become sensitive or inflamed when the compressed, painful muscles stimulate pelvic nerve reflexes.
Pelvic floor muscle spasm can usually be attributed to the development of hypersensitive myofascial trigger points. These are tight, tender knots in the muscle fibers that are quite painful when compressed and typically refer pain to other areas of the body. Referred pain often sidetracks practitioners by drawing their attention away from the trigger point’s actual location. This makes it difficult to correctly diagnose and effectively treat the patient’s problem.