Pain in the pelvic area

Pain in the pelvic muscles

may be due to various reasons, this is explained by the complex structure and variety of types of muscles of the pelvic region.

Some of them start right from the spine and attach directly to the pelvic bones, so muscle syndromes can be either vertebral or pelvic. There are muscles that are attached to the thigh, so the pain is localized in this area, especially when it comes to overstraining the piriformis or iliopsoas muscle.

Thus, a muscular reaction to a provoking factor can be expressed in a clinical sense by pain, both in the spine itself, in the sacrum, in the coccyx area, and in the lower abdomen, in the buttocks and legs.

Pain in the pelvic muscles is most often caused by hypertonicity, spasm of internal or external types of muscle tissue. The internal group of pelvic muscles includes:

• The iliopsoas muscle, which in turn consists of the iliacus and psoas major, both of these muscles are attached to the femur, takes part in the work of the posterior wall of the peritoneum.
• The obturator internus muscle starts from the pelvic cavity and passes through the ischium at an acute angle.
• The psoas minor muscle (lumbar muscle), located on the surface of the psoas major muscle, is practically fused with it.
• The piriformis muscle, which begins from the pelvic zone (in the zone II – IV of the sacral vertebrae) and passes through the ischium from the pelvic cavity.

The external group of pelvic muscles includes:

• The gluteus maximus, medius and minimus muscles. The large muscle is the most prominent and developed due to the fact that a person will be able to walk upright.
• Tensor fascia lata, the muscle is localized between the plates of the fascia lata at the level of the upper thigh.
• The quadratus femoris muscle originates from the edge of the ischial tuberosity and is attached to the upper zone of the intertrochanteric crest.
• The external obturator muscle begins in the area of ​​the pubic bone with the help of a tendon, passes behind the hip joint and is attached to the femur.

Such a variety of muscle tissue, their complex and branched arrangement determines the polyetiology of pain in the pelvic muscles.

Causes of pain in the pelvic muscles

Before finding out what provokes pain in the pelvic muscles, what are its causes, it is necessary to at least superficially understand how muscle tissue and the spine of this zone are interconnected in the sense of biomechanics.

The pelvis and spine are closely connected in an anatomical sense, and represent a kinematic functional chain. The pelvis itself is the base, the foundation for the spinal column; in addition, the lower limbs are attached to the pelvis, which in turn also affect the condition of the spine and pelvic bones due to their movements. Such a complex structure cannot function without strong, elastic joints, which are muscles, fascia, tendons, and ligaments. That is why it is believed that almost all pelvic pain is caused by a disorder, dysfunction of the muscular-ligamentous system, and less often by vascular factors. Conventionally, the causes of pain in the pelvic muscles can be divided into three categories:

• Vertebrogenic causes, dysfunction of the sacrococcygeal structure, dysfunction of the inguinal ligament and pubic symphysis.
• Pain caused by shortening, spasm of the oblique abdominal muscles or hypertonicity of the adductor femoral muscles, muscle-tonic syndromes, myofascial syndrome.
• Vascular disorders, dysfunction of the venous system, disturbance of venous and lymphatic outflow.

Also, the causes of myogenic pelvic pain can be divided by gender.

Factors that provoke pain in the pelvic muscles in women are associated with the specific anatomy and biomechanical function of muscle tissue and perineal fascia.

Causes of muscle pain in the pelvic area in women:

• Shortening of the oblique abdominal muscles, which are attached to the Pupart ligament. Muscle pain radiates to the groin area in the pubic area (symphysis) and intensifies when turning the body.
• Overstrain of the adductor muscles of the thigh, which occurs due to the specificity of the female gait (lateral swing, rotational movements of the pelvis). Spasmodic trigger points provoke pain reflected in the groin, pubis, and pain can also be felt in the vaginal and rectal areas. The pain intensifies with prolonged walking, especially in high heels, when the pelvis seems to twist, changing the tension of the pelvic diaphragm muscles. If a woman has a history of adhesions, conditional fixation of the pelvic muscles occurs and normal biomechanical processes are disrupted.
• Violation of venous outflow increases muscular pelvic pain in a sitting position. Alternate contraction and relaxation of the muscles (gluteal and obturator internus) can improve the outflow of the pudendal vein, reduce pain, thus the symptom is independently neutralized by movement, changing a static sitting posture.

Dysfunction of the sacrococcygeal joint provokes hypertonicity of the obturator internus muscle. The pain intensifies with movement and walking, as the muscles take part in the rotation of the hip joints.

Pelvic muscle pain in men is mistakenly mistaken for symptoms of prostatitis, which is subsequently not detected during examination.

What causes pain in the pelvic muscles in men?

• Vertebral muscular-tonic syndromes, among which the iliopsoas syndrome is the leader; this list also includes piriformis syndrome, which is also called muscular-compressive neuropathy of the sciatic nerve. In addition, pain in the muscles of the pelvic area can be caused by gluteus minimus or gluteus medius syndrome.
• Pelvic myofascial syndrome is a fairly common cause of such pain. MFPS is considered a complex chronic process that develops in the pelvic neuromuscular system in men prone to depression and hypochondria. In addition, myofascial syndrome can be triggered by hypothermia, inflammatory diseases of internal organs (MFPS will act as a secondary syndrome). Myofascial factor has not been studied enough, although its symptoms have clear diagnostic criteria.
• Pelvic genital pain in men is often accompanied by muscle spasms. Dysfunction of the pudendal nerve is called tunnel pudendopathy, when the nerve is pinched in the osteofibrous canal of the pubic bone. The consequence of such infringement is pain in the penis and in the surrounding pelvic muscles.

How does pain in the pelvic muscles manifest?

Signs and symptoms of pain in the pelvic muscles can be typical for muscle pain, but can also manifest as visceral, vertebrogenic pain. This is due to the close anatomical interaction of muscles, fascia, tendons, and nerve endings in the pelvic area. Therefore, it is so important to accurately identify all the characteristics of the symptom and determine its location. In clinical practice, there are three main types of pain in the pelvic area:

• Local pelvic pain, which is felt by the patient as muscular, but can be associated with any inflammation, pathology that concerns nerve endings, can irritate or impinge them. Such pain is most often constant, increases or decreases depending on posture, body position, and changes with movement. The pain symptom, as a rule, is aching in nature, feels diffuse, but when intensified, it can manifest itself as acute pain.
• Referred pelvic pain can be a consequence of the projection of a signal from the spine, and can also be a projection of the pathology of internal organs located in the pelvis and peritoneum. If the disease concerns internal organs, the pain does not change with movement and does not subside in a horizontal position. Rather, its intensity depends on the pathological process in the organ and changes in its structure and condition.
• Radiculopathies in the pelvic area can also be felt as muscle pain. The pain is felt as strong, intense, radiating along the nerve ending, within the root involved in the infringement. The pain depends on reflex movements – coughing, sneezing, as well as physical effort and tension. In addition, pain in the pelvic muscles may increase with movement that stretches the nerve.

Myofascial pain is distinguished by the fact that it is felt deep in the tissue. The characteristics of myogenic pain are as follows:

• The pain is localized in the thickness of the muscle fibers.
• The pain is dull.
• Pain can debut suddenly, without apparent objective reasons.
• Pain occurs both at rest and with movement.
• The pain can intensify to excruciating, severe and subside on its own to mild.
• Often the pain develops away from the trigger point itself, the tense muscle.
• A painful symptom can occur at the junction of tissues located in the area of ​​​​several trigger points or in antagonist muscles.
• Most often the pain is asymmetrical.
• Palpation of a painful trigger point causes a generalized reaction on the part of the patient (jumping symptom).
• Palpation of a spasmodic trigger point increases pain in the area of ​​the reflected symptom.

Considering that myofascial pelvic pain can occur in any striated muscle, and that they can be localized in any part of the pelvis, a detailed description of the symptoms and a thorough, comprehensive diagnosis play an important role.

Diagnosis of pain in the pelvic muscles

Diagnosing pelvic pain, in contrast to identifying the etiology of pain symptoms in other areas of the body, is extremely difficult. Despite the relative simplicity of the diagnostic algorithm, in which palpation plays the main role, it is myogenic factors that are often rejected as primary. This is due to insufficient knowledge of the pathogenetics and clinical picture of myogenic pelvic pain in principle; besides, depending on the location in the pelvic region, myalgia is often similar to the clinical manifestations of coccygodypia, proctalgia, and vulvodipia. Also, tunnel neuropathy of all types has a very similar picture – ilioinguinal, genital, femoral-genital. If the above factors, as well as somatic pathology, are excluded, the diagnosis of pain in the pelvic muscles is indeed carried out within the framework of the myogenic direction.

Thus, in order for the diagnosis of pain in the pelvic muscles to be carried out more accurately and quickly, it is necessary to exclude possible pathological factors associated with the internal organs located in the pelvic area:

Should be confirmed or excluded:

• Urological diseases:
  • Infectious diseases of the urinary tract.
  • Diseases of the musculoskeletal system.
  • Oncological process of organs located in the pelvic area (cancer of the bladder, uterus, and so on).
  • Urethral syndrome.
  • Diverticulum of the urethra or bladder.
  • Urolithiasis disease.
  • Prostatitis.
• Gynecological diseases – salpingoophoritis, salpingitis, endometritis, adhesions, fibroids, cysts, cervical canal stenosis, pelvic organ prolapse and so on.
• Varicose veins of the pelvis.
• Gastroenterological diseases – oncological process in the large intestine, colitis, diverticulitis, hernia. IBS (irritable bowel syndrome).
• Psychogenic factor.

Diagnosis can be difficult, since according to statistics, pelvic pain has more than 100 etiological causes known to medicine, and their symptoms are often similar to the manifestation of myalgia, or muscle pain is reflected from the main somatic source.

Unlike diagnostic measures for myalgia in other parts of the body, determining the root cause of pain in the pelvic area is longer and more complex. In addition to collecting anamnesis, the doctor must take into account the patient’s gender and age and collect the following information:

• The nature of the pain is aching, shooting, pressure, pulling, shooting.
• Localization of pain – in the sacrum, thigh, rectum, lower abdomen, and so on.
• Duration of pain – short-term pain, constant, chronic, periodic.
• What factors provoke pain – body position, diet, sexual relations, urination, defecation, menstrual cycle, stress.

In addition, diagnostic actions include:

• assessment of neurological status.
• palpation of muscles.
• identifying the degree of mobility of the spine in the lumbosacral area.
• tests, tests that identify pain-provoking movements.
• the presence or absence of TT – trigger points, diagnostically important for determining myofascial syndrome.
• if necessary, an X-ray of the spine is prescribed, as well as CT and (or) MRI.
• electromyography, which determines the level of neuromuscular conduction and tone.

Chronic pelvic pain (CPP), according to statistics, is caused by myofascial syndrome in 40-50%, especially in women (up to 65%).

To confirm MFPS (myofascial pain syndrome), in addition to the presence of trigger zones, the following criteria are required:

• Pain is most often cyclical; acyclic pain symptoms are typical for women.
• The pain is most often localized in the lower abdomen.
• The pain symptom persists for six months or more.
• The pain is not caused by the menstrual cycle in women, prostatitis in men, and is also not associated with sexual activity and frequency of sexual intercourse.

Treatment of pain in the pelvic muscles

The main goal of treating pain in the pelvic muscles caused by myogenic factors – fibromyalgia, myofascial syndrome – is to neutralize trigger, spasmodic areas and long-term relaxation of tense muscles.

• How to relax your pelvic muscles?
• Elimination of static tension, postural overexertion (posture, sitting, bending over, etc.).
• Providing long-term rest for tense muscles.
• Stretching the pelvic muscles using gentle muscle relaxant methods, such as massage, post-isometric relaxation.
• Prescribing myelorelaxants in tablet form, their combination with massage and muscle stretching is especially effective.
• Relief of acute pain with NSAIDs – non-steroidal anti-inflammatory drugs in any available form, depending on the nature of the symptom and the patient’s condition. A combination of NSAIDs, myelorelaxants, massage and physical therapy gives a good effect.
• It is possible to prescribe chondroprotectors as an auxiliary therapy.
• To maintain muscle tone in the lumbar region, it is often recommended to wear a corset, which relieves the load on the spine in this area.
• Destruction of trigger points is possible using an acupuncture method, which helps to minimize the use of synthetic drugs and speed up the healing process.
• For anxiety and depression, antidepressants and sedatives, often of herbal origin, are prescribed.

Treatment of pain in the pelvic muscles can be quite lengthy and persistent, especially if myalgia is combined with diseases of the internal organs and other complications.

Prevention of pain in the pelvic muscles

Preventive measures to help reduce the risk of developing pelvic pain are not specific and differ little from standard preventive measures.

Prevention of pain in the pelvic muscles is, first of all, careful attention to your own little-appreciated resource – health.

In our troubled age, when the speed of information, of life itself, is significantly faster than the speed of normal, physiologically acceptable perception and reaction, it is extremely important to keep not only the head, but also other parts of the body healthy. including the pelvis. In addition to the standard regular medical examinations necessary for every person, a reasonable distribution of both work and emotional stress provides an excellent preventive effect.

Obviously, the advice to avoid stressful situations is impossible to follow; stress as tension and mobilization is the same adaptive reaction to any stimulus that modern life is full of. Therefore, when tense, you need to be able to relax competently, of course, in normal healthy ways, without the use of alcohol and other destructive drugs. Physical and physical activity and sports not only strengthen muscle tissue, but also help relieve stress. According to many physiologists, active stimulation in the form of running, swimming, walking opens the body’s reserve “channels” and protects it from almost all complications, including muscle strain.

In addition, the prevention of pain in the pelvic muscles involves compliance with the following norms and rules:

• Before training or performing exercises, including exercise therapy, the muscles need to be “warmed up,” that is, warmed up.
• If professional activity is associated with constant static tension, every 40-60 minutes you need to change your position and perform unloading movements.
• You should correct your posture and straighten your back not only in front of the mirror, but also monitor its condition constantly.
• It is necessary to familiarize yourself with and perform breathing techniques that help saturate the muscles with oxygen and improve their blood supply. In addition, proper breathing is one of the main anti-stress methods.
• Following the rules of a balanced diet, consuming enough plant foods and vitamins strengthens the immune system, muscle tissue and the body as a whole.
• Muscle tissue, like the rest of the body, requires sufficient fluid. We should not forget that during the day you need to drink at least 1 liters of purified, good quality water. The fluid norm does not include strong tea and coffee, which are popular, but are unlikely to help prevent pain in the pelvic muscles.
• You should not get carried away with painkillers at the first symptoms of pain. Firstly, muscle pain is often not relieved by analgesics; it has a different pathogenetic and biological mechanism; secondly, such self-medication can distort the clinical picture and make diagnosis difficult when visiting a doctor.

Pain in the pelvic muscles is a rather complex multivariate symptom that has many causes. Among the factors that provoke pain, both objective, life circumstances are identified – overexertion after training, uncomfortable posture, as well as more serious diseases, including life-threatening ones. A timely visit to a therapist, who will conduct an initial examination and determine the specifics of the diagnostic direction, will help avoid complications and make it possible to quickly neutralize the pain.