Tuesday 14 July 2015

Pelvic Muscle Tension and Pelvic Pain

Pelvic floor muscle tension can often lead to non-specific chronic back and pelvic pain. An imbalance in the pelvic floor musculature, a cause of longstanding back pain or unrecognizable pelvic pain, may be hard to treat using traditional pain medications. The pelvic floor muscles, though small, can affect your entire bodies functioning. This article will discuss various causes for pelvic floor muscle tension and help you move towards remediation.

What is the pelvic floor?

To begin with, we must understand the formation of the pelvic floor or pelvic diaphragm. The pelvic floor forms the base of the cylindrical core that is situated in the centre of our body. The cylindrical core is formed by the diaphragm, above, and the pelvis, below. The muscles of the abdomen, the lower spine, the back, and the thoracolumbar fascia surround the cylinder, making it a closed compartment. The pelvic outlet is closed by a group of small muscles, ligaments and connective tissue and interspersed with small nerves that form a trampoline or a hammock shaped structure known as the pelvic floor or the pelvic diaphragm.

The main function of the pelvic floor musculature is to support the pelvic organs that include the bladder, the last part of the intestine, the rectum, and the uterus. Since the muscles of the pelvic floor have attachments with the bladder and the anal sphincters, the pelvic floor is responsible for maintaining proper bladder and rectal continence. Its attachment to the vagina gives it an important role during sexual intercourse, as it helps to relax and tighten the vagina. The pelvic floor also offers counter pressure to the descending fetus during the labor, which rotates it and causes the head to present first during normal vaginal delivery. In the end, a pelvic diaphragm with normal tone helps to maintain the intra-abdominal pressure by exerting an upward counter pressure. This is of great importance during activities that increase intra-abdominal pressures like lifting, coughing, sneezing etc.

What is pelvic floor muscle tension?

Pelvic floor muscles are just like other skeletal muscles in the body; they too can become taut and tense when overworked. A tense or hypertonic pelvic floor is referred to as pelvic floor muscle tension, wherein the muscles do not relax and remain tight and stiff. Just like hyperactive skeletal muscles, tense pelvic floor can also cause pain (which may radiate) as they too develop trigger points. Since these muscles are not visible, we rarely consider them as a potential source of pain when we feel discomfort radiating in the low back, legs or the pelvic region. As these muscles are connected directly or indirectly with every other part of the body, tension in this region can cause pain elsewhere too. For example, a tense pelvic floor can transmit the tension and pain through the cylindrical core to the muscles in the back. In this case, the patient will complain of chronic back pain that is unrelieved by painkillers or routine therapy.

Causes and symptoms of pelvic floor muscle tension

Recent studies have helped to identify activities that can lead to pelvic muscle tension. Let’s take a look.

· Kegel exercises, when performed indiscriminately, are a common cause of pelvic muscle tension. When these exercises are executed without proper guidance, they can lead to overactive and painful pelvic floor musculature.

· Incorrect posture, like slouched sitting, standing or sitting cross-legged for a long time, can also increase tension in the pelvic muscles. When standing for an extended period of time, the pelvic floor muscles are acting against gravity to support the pelvic organs. Additionally, slouched and cross-legged sitting keeps the muscles in a contracted state. A sustained state of contraction can be a major cause of tension in the pelvic diaphragm.

· Exercises that tone the tummy, like sit-ups and keeping the belly drawn in towards the spine (i.e. tummy tucking), keeps pressure in the abdomen high. Increased intra-abdominal pressure can take its toll on the pelvic floor. To counter the increased pressure, the pelvic floor muscles are contracting round the clock, which can increase their tension.

· Chronic constipation can also cause pelvic pain as hard bowel motions put a strain on the rectal attachments of the pelvic floor. Improper bowel and bladder routines or voluntary holding of urine and stools can keep these muscles tense for a long time, leading to pelvic uncomfortability.

· Pelvic pain caused from an infection or during menses can bring about involuntary tensing of the pelvic floor. Procedures such as hysterectomies and caesarean sections can cause formation of scar tissue and adhesions in the pelvic floor; this can become a source of pain later in life. Injury to the low back and hip can also cause pelvic muscles to tense up. Repeated physical abuse and physiological distress can also be a cause of tense pelvic floor muscles and non-specific back and pelvic pain.

· Syndromes associated with chronic pelvic pain include: irritable bowel syndrome, endometriosis, and interstitial cystitis or painful bladder syndrome. These disorders are all associated with non-relaxing pelvic floor muscles.

· Incorrect footwear and gait abnormalities can also cause pelvic floor muscles to tense up. The cylindrical core and the lower extremities form a kinetic chain. Abnormality at one point can reflect anywhere up or down the chain.

Symptoms of pelvic floor muscle tension include: unexplained and unresolved low back and hip pain, pelvic pain, urinary and fecal urgency, incomplete emptying of the bowel and bladder, and pain during and after intercourse. At times the pain may radiate to the groin and legs. The pain can be dull nagging or severe enough to impede one’s routine activities.

Experts in pelvic floor dysfunction can help identify tense muscles by palpating them. They can also locate the presence of hypertonic bands (i.e. overly toned tissue).

How to relieve pelvic floor muscle tension

Now that pelvic floor has been identified as a possible source of pain emanating to the lower body, its treatment has become well defined. Pelvic floor rehabilitation is the gold standard for relieving pelvic floor muscle tension. Most of the treatment is aimed at removing the causative factors, which will help break the vicious cycle of pain-spasm-pain.

1. Stop doing Kegel exercises – If you have been doing them for a while, it’s a good idea to take a break. The pelvic floor muscles need rest. It is also beneficial to stop doing core strengthening exercises, cycling, high impact workouts, and deep squats, as these require a sustained contraction of the pelvic floor.

2. Pelvic floor drop – This is good technique to let go your pelvic floor muscles and help them relax. Locate a calm place around you for this exercise. You can stand, sit or lie down. Relax your body by taking a few deep breaths. Now close your eyes and take a deep breath. Visualise the air passing through your body and going out through the pelvic outlet. Relax the pelvic floor muscles to allow the air to pass. Just like when you pass urine, the pelvic floor muscles relax. Attempt to reproduce this same feeling.

3. Stretching of hip flexors, adductors and glutei can also help stretch the tight pelvic floor muscles as they are attached

4. Applying warm packs to the lower abdomen or between the legs can also help relax the pelvic floor muscles.

5. Down training or reverse-Kegel exercises are other good ways to relieve muscular tension. Kegel exercise increases tension by keeping the pelvic muscles contracted. To perform reverse-Kegel’s, start by lying down on your back; contract your pelvic floor muscles as if attempting to stop the passage of urine. Feel the tension in the muscles. Now, slowly relax the muscles. You will feel the tension go. Try and appreciate the difference between a contracted and relaxed pelvic floor muscle. Once you have achieved this, begin to imagine that your pelvis is expanding. Imagine that your tailbone and pubis are moving apart, thus lengthening the pelvic diaphragm. Take deep breaths while doing this. Once you have mastered this feeling lying down, try and see if you can do it sitting and standing. Make sure to not tilt your pelvis during this exercise.

6. Deep breathing or diaphragmatic breathing is great to relax and oxygenate your pelvic floor muscles. When you take a deep breath, the diaphragm moves down, the abs move out, and the pelvic floor muscles move down and relax. While exhaling, the reverse happens. Make sure to do at least 4-5 deep breaths every 2-3 hours. They will not only increase the oxygen supply to all the muscles but also relieve muscle tension throughout the whole body.

7. Myofascial release and soft tissue massage can help release the myofascial bands and hypertonic muscle tension. Try using a foam roller or a soft ball and roll lightly on the affected areas while relaxing your muscles.

8. Biofeedback can help patients to identify the difference between a contracted and a relaxed muscle. It can also be used to teach coordinated relaxation and contraction of the pelvic floor muscles.

9. Get your constipation treated. Drink plenty of water and consume fresh fruits rich in fibre to relieve constipation. Avoid eating rich meats like beef and pork that are harder for the body to digest. Try and achieve a good bowel bladder routine.

10. Vaginal dilators can also be used to relax the vaginal muscles. They must be used with lubricators. Avoid penetrative sex when pelvic floor muscles are tense, as it will increase pain and spasming around the vaginal area.

11. Postural correction, like sitting or standing with the back supported, avoiding slumped posture, and wearing comfortable supportive footwear, can also help resolve pelvic pain and pelvic floor spasming. Try and lie down whenever possible if you feel particularly uncomfortable: it puts these muscles in a gravity-eliminated position. Sitting on pelvic support cushions can also help mitigate pain to some extent. Avoid sitting on rubber tubing.

12. Last but not least, do not stress or get anxious over trivial issues. Stress and anxiety increase the overall tension in the body, which includes the pelvic floor muscles. Practice meditation, progressive relaxation and visualization techniques for whole body muscle relaxation.

If you are plagued by unexplained pain in the lower part of your body, be sure to get evaluated for pelvic floor myalgia. Once diagnosed, embark on a supervised rehab program to get rid of the pelvic floor muscle tension and the pelvic pain.