Pelvic Pain and Pelvic Muscles Tension

Pelvic floor muscle tension can be an important cause of non-specific chronic back pain or pelvic pain. Imbalance in the pelvic floor musculature can be a cause of longstanding back pain or unrecognizable pelvic pain that is not treatable by the usual treatments. The pelvic floor muscles though small can affect the working of the entire body. Let’s discuss the causes and remedies for pelvic floor muscle tension.

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, muscles of the back and the thoracolumbar fascia surround the cylinder making it a close compartment. The pelvic outlet is closed by a group of small muscles, ligaments and connective tissue interspersed with small nerves that form a trampoline or a hammock shaped structure called as the pelvic floor or the pelvic diaphragm.

The main function of a toned pelvic floor musculature is to support the pelvic organs that include bladder, last part of the intestine, rectum and uterus. Since the muscles of the pelvic floor have attachments with the bladder and the anal sphincters, it is responsible for maintaining proper bladder and rectal continence. Attachment to the vagina in females, 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 can also become taut and tense when overworked. Tense or hypertonic pelvic floor is called as pelvic floor muscle tension wherein the muscles never relax. They are all tight and stiff. Just like hyperactive skeletal muscles can be a cause of pain, 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 while dealing with pain in the low back, legs or the pelvic region. As these muscles are connected directly or indirectly with every other part of the body, pain and 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 the muscles of the back. In this case the patient will complain of chronic back pain that is unrelieved by pain killers or routine therapy.

Causes and symptoms of pelvic floor muscle tension

Recent studies have helped to point towards certain activities that can cause pelvic muscle tension.

  • Kegel’s exercise, when performed indiscriminately is a common cause of pelvic muscle tension. When these exercises are performed without proper guidance and supervision, 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 these muscles. While standing for a long time, the pelvic floor muscles are acting against gravity to support the pelvic organs. Slouched and cross legged sitting keeps the muscles in a contracted state. Sustained state of contraction is a major reason for tension in the pelvic diaphragm.
  • Increased intra-abdominal pressure as a result of a tucked in tummy throughout the day can take its toll on the pelvic floor. The desire to have a flat tummy makes men and women do sit ups and tummy tucks repeatedly which keeps the intra- abdominal pressure high. To counter the increased pressure, the pelvic floor muscles are contracting round the clock which increases their tension.
  • Chronic constipation can also cause pain in these muscles as the painful hard bowel motions put a strain on the rectal attachments of the pelvic floor. Improper bowel and bladder routine or voluntary holding of urine and stools can keep these muscles tense for a long time leading to pelvic pain.
  • Pelvic pain caused due to infection or during menses can cause involuntary tensing of the pelvic floor. Procedures such as hysterectomies, caesarean sections can cause formation of scar tissue and adhesions in the pelvic floor which can become a source of pain later on. Injury to the low back and hip can also cause these muscles to tense up. Repeated physical abuse can also be a cause of tense pelvic floor muscles.
  • Pain syndromes associated with chronic pelvic pain include irritable bowel syndrome, endometriosis, and interstitial cystitis or painful bladder syndrome. These are 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, 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.

How to relieve pelvic floor muscle tension

Now that pelvic floor has been identified as a possible source of pain emanating from the lower body, its treatment has become well defined. Pelvic floor rehabilitation through different ways 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’s exercises – If you have been doing them for a while, it’s a good idea to take a break from them. 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 for the 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 help relax the pelvic floor muscles.
  5. Down training or Reverse Kegel’s exercises is another good way to release the muscular tension. Kegel’s exercise increases muscle tension by keeping them contracted. To perform Reverse Kegel’s, start with lying down on your back. First 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, proceed further by imagining 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 the feeling in lying position you can do it sitting and standing position too. Make sure you do 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 the muscle tension throughout the body.
  7. Myofascial release and soft tissue massage done can help release the myofascial bands and trigger points.
  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. 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 spasm around the vaginal area.
  11. Postural correction like sitting or standing with back supported, avoiding slumped posture wearing comfortable footwear and correcting limb length deformities can also help resolve pelvic pain arising due to pelvic floor spasm. Try and lie down whenever possible: it puts these muscles in gravity eliminated position. Sitting on pelvic support cushions can help mitigate pain to some extent. Avoid sitting on rubber tubing.
  12. Last but not the least do not stress or get anxious over trivial issues. Stress and anxiety increase the overall tension in the body which also 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 it diagnosed from a gynecologist. Embark on a supervised rehab program to get rid of the pelvic floor muscle tension and the pelvic pain caused by it.