Chronic pelvic pain: Pelvic floor problems, sacro-iliac dysfunction and the trigger point connection

AbstractMyofascial pelvic pain (MFPP) of pelvic floor muscles is a common cause of chronic pelvic pain (CPP). The pathological mechanisms and treatments of MFPP are complex and still unclear until now. The levator ani muscle (LAM) is the major pelvic floor muscle. The purpose of this study was to examine the fascia and attachment of LAM through the electromyogram (EMG) and cadaver dissection. Electrophysiological stimulation of the obturator fascia above the arcus tendinous levator ani (ATLA) could trigger contraction and electrophysiological changes in LAM insertion. The LAM of embalmed adult cadavers was examined especially in the area above the ATLA. Some skeletal muscle fibers were found above the ATLA within the obturator fascia and were confirmed by Masson’s trichrome section staining. Our electromyography (EMG) and anatomical data implied that the attachment of LAM aponeurosis extended beyond ATLA to the inferior border of the superior ramus of the pubic bone. The new discovered attachment of LAM could provide a reference position for clinical diagnosis and treatment of MFPP or CPP.

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A randomized comparison of training programs using a pelvic model designed to enhance pelvic floor examination in patients presenting with chronic pelvic pain

International Urogynecology Journal ◽

10.1007/s00192-020-04487-y ◽

2020 ◽

Author(s):

Maria Giroux ◽

Suzanne Funk ◽

Erwin Karreman ◽

Huse Kamencic ◽

Rashmi Bhargava

Keyword(s):

Pelvic Floor ◽

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Training Programs

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Multimodal treatment of myophasal chronic pelvic pain in women: institutional experience

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20191922 ◽

2019 ◽

Vol 8 (5) ◽

pp. 1708

Author(s):

Guadalupe Guerrero Reyes ◽

Cristobal Barragan Ochoa ◽

Claudia M. Moysen Marin ◽

Vianey B. Ayala Quispe ◽

Laura Escobar Del barco ◽

...

Keyword(s):

Pelvic Pain ◽

Multimodal Treatment ◽

Chronic Pelvic Pain ◽

Trigger Point ◽

Pain Scale ◽

Treatment Modalities ◽

Average Score ◽

Significant Difference ◽

Institutional Experience ◽

Multimodal Management

Background: Chronic pelvic pain of myofascial origin is an underdiagnosed condition and with partial responses to the different treatment modalities. The objective of this study was to report the results of the multimodal management of Myofascial Chronic Pelvic Pain.Methods: Retrospective cohort of 33 patients with myofascial chronic pelvic pain, during the period 01 January 2016 to August 31, 2018, who were treated based on trigger point infiltration and analgesic vaginal electrostimulation. The analogous visual pain scale (VAS) was used at the beginning, sixth, twelfth and six months after the last electrostimulation session, in order to measure the effect of the treatment.Results: During the study period, 32 patients with chronic myofascial pelvic pain were found who received the multimodal scheme that is offered in our clinic. The average score of the EVA before starting the treatment was 8.5 points, at the sixth session of the treatment the average EVA was 3.6 points, at the twelfth session of 1.3 points and the average score of the EVA at six months after the last session of the multimodal treatment was 2.9 points. A significant difference was demonstrated in the average EVA score in the first with respect to the sixth, twelfth and six months (p = <0.000). There were no complications or adverse effects secondary to the multimodal treatment.Conclusions: Multimodal treatment was associated with progressive improvement in 80% of patients with miofascial chronic pelvic pain.

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