Pelvic pain due to tight pelvic floor muscles: What and where are the pelvic floor muscles?
Men and women both have similar pelvic floor muscles. These are the muscles at the base of the pelvis that surround our pelvic organs. The pelvic organs are the bladder and bowel in both men and women. The pelvic organs include the uterus in women and the prostate in men.
The pelvic floor muscles are our bladder and bowel control muscles and they help with sexual sensation and function.
These muscles are what we call “voluntary muscles”. This means you can decide to switch them on and off. Most muscles in our body that we think of as “muscles” are voluntary muscles. In other words you can tighten them and let them go when you want. They are also known as skeletal muscles and elsewhere in the body they tend to move parts of the body. The pelvic floor tightens to give us control of our bladder and bowel.
But interestingly, you can live your life never really knowing which muscle is doing what. Your muscles just work. The pelvic floor is very much like this. It tends to work in the background without you knowing.
So what causes the pelvic pain problem?
So this is where the problem arises: voluntary muscles can go into a state of working too much: the muscles hold tension. When muscles hold too much tension they often feel painful to the touch or painful when the muscle is used. The muscles often have tight painful trigger points. Have you ever painted a ceiling and felt pain in your shoulders? This is because you made muscles work too much in a manner that they are not used to or prepared for. You end up with tight, tense, painful muscles.
If the pelvic floor muscles go into this “overactive” state they tend to cause a closing at the vagina in women and in men, they may cause pelvic pain. In men, this might be pain when sitting, pain in the testicles, penis or around anus. There may be pain with ejaculation, pain emptying bladder or bowel.
In women, tightness in the pelvic floor most usually causes pain with sex. Any penetration attempts causes pain. When we don’t understand that this is due to tight muscles, the body tightens to prevent the pain. Any thought of sex makes the brain put the muscles into more protective tightness and this means more pain.
When it comes to sex, women often push through the pain in the hope that the pain will go away eventually. Unfortunately it doesn’t tend to make itself better. It may just get worse as the fear and worry gets worse. Women often want to be able to have sex and might not even tell their partners that there is pain….it is a vicious cycle.
What is the treatment for pain in women?
Treatment depends on whether the problem is just tight, spasmy muscles or whether nerves have become very sensitive also. When muscle tightness is the issue, we will teach you how to relax your pelvic floor muscles ( sometimes called vaginismus). We will teach you how to relax your whole body if necessary, and we may suggest use of vaginal dilators. These are size graded “tubes” which can be introduced into the vagina to help guide pelvic floor muscle relaxation.
If the nerves have become sensitive you may feel burning pain and very strong pain in response to minimal touch. This may need medications from your doctor and work on the muscles with the Physiotherapist. Sometimes a Psychologist can help with all the negative emotions that come with this problem.
What is the solution for pain in men
For men, we need to first find out if pelvic floor is tight. We can use ultrasound to show you that muscles don’t like relaxing. We can feel the muscles from the outside and if they are tight, they will be painful and painful trigger points will be present . We can treat these muscles just like you might treat your back or neck muscles. You might also need to learn how to relax these muscles. You may need to learn how to relax your whole body.
Pelvic floor Physiotherapists can help. Make contact via the contact page and we can talk about your problem and help you to decide what to do.