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How to Treat Painful Trigger Points in Your Pelvic Floor

You can think of them as the “little sisters” of pelvic pain: The sneaky, irritating, and stubborn little knots within a tight muscle in the pelvic area which are pretty much sabotaging all your pelvic health goals. Myofascial trigger points (aka muscle knots) in your pelvic floor area are known to cause quite a bit of pain and dysfunction when it comes to your bowel, bladder, and pelvic health.

But if you have tight pelvic floor muscles, how do you know if trigger points are to blame for your symptoms? Luckily, with a few clues from your bowel, bladder and sexual health, a self pelvic floor muscle check, and a check in with a pelvic health physical therapist, you can get all the insight you may need to understand if trigger points are causing your symptoms. And while you may have to wait for your real life little sister to grow out of this irritating phase, the good news is, there are many effective treatment options to reduce your trigger point related symptoms — some you can even do yourself.

What are myofascial trigger points?

When you have tension and pain in your pelvic floor muscles, it is common to have myofascial trigger points (aka muscle knots). Trigger points are hyper-irritable spots of tissue found within a tight band of muscle and fascia.

When touched or provoked, trigger points can cause, or worsen, pain and even lead to symptoms in a seemingly unrelated tissue. In addition to pain, trigger points can lead to decreased strength, and reduced flexibility in the involved, and surrounding muscles. While there are several hypotheses for how trigger points form within a muscle, the actual process for how trigger points develop is unknown.

In those with pelvic pain, it is common to have trigger points anywhere in the pelvic floor muscles, abdominals, hips, low back, and even the upper thigh area. Depending on where the trigger points are located, you may experience a wide variety of symptoms including:

  • Pain with penetrative sex
  • Pain with sitting
  • Urinary urgency
  • Urinary frequency
  • Pain with bowel movements
  • Pain while lying on back or side (depending on trigger point location)
  • Pain with walking, stairs, and getting in and out of a chair

How do you know if you have trigger points in your pelvic floor?

The best way to get insight into whether or not myofascial trigger points are causing your symptoms is to schedule an evaluation with a pelvic physical therapist, as an accurate examination and identification of trigger points takes training, experience, and practiced assessment skills.

Your physical therapist will take a thorough history to understand your pain history, symptoms, and symptom patterns, and if muscle pain and trigger points are expected, they will palpate and examine different layers of fascia and muscle in your hips, back, thighs, abdomen, and pelvic floor. They will be assessing for tight/overactive bands of muscle, with hard and tender knots. When pressed these knots will reproduce your symptoms, and may even cause a twitch response, which can be felt as a quick involuntary twitch or contraction of the muscle being examined.

If you don’t have an infection or injury to the vulvar or vaginal tissues, a pelvic floor self-check can be really enlightening as you wait to be seen by your pelvic PT. Check out this guide for more instructions on the pelvic floor self-check. While going through the self-check, pay particular attention to whether or not you feel any hard, tender knots of tissue that may indicate a trigger point, letting your PT know about what you felt.

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Effective Treatment for Trigger Points

It is always best to check in with your healthcare provider or physical therapist if you are experiencing any pain, pelvic floor symptoms, or muscular dysfunction in any part of your body. Consulting with a healthcare professional trained in treating myofascial injuries and trigger points is crucial to identify the optimal treatment plan tailored to your specific needs. Here are some effective treatment options that are common to see:

Myofascial release and trigger point release

The use of myofascial release techniques, such as trigger point release, involves applying a consistent, gentle pressure to the muscle/fascial unit to enhance its function. Research shows that myofascial release to the abdominal area, inner thighs, and pelvic floor resulted in a decline in pelvic pain and an improvement in pelvic floor muscle function.

Fascia and muscle stretching

Yoga, dynamic stretching, foam rolling and proprioceptive neuromuscular facilitation (PNF) are really effective strategies for helping to stretch your muscles and fascia. You want to try and target the muscle groups that are impacted by trigger points. Check out this blog on fascia for more information on stretching.

Pelvic wand self trigger point release

If you have trigger points in your pelvic floor, it may be helpful to use a pelvic wand tool to help you get to some of the hard to reach trigger points. Your PT will instruct you on how to use a pelvic wand specifically for your needs, but here is more info to explore on pelvic wands in the meantime.

Dry needling

If you have trigger points in the abdomen, low back, hips, and thighs, dry needling can be effective at decreasing pain, and improving muscle function. With dry needling, a thin needle is inserted through the skin, to stimulate the trigger point and surrounding muscle and connective tissues.

Ashley Rawlins Headshot
Dr. Ashley Rawlins, PT, DPT

Dr. Rawlins is a physical therapist at Origin who specializes in the treatment of pelvic floor muscle dysfunctions including pelvic pain, sexual dysfunction, pregnancy related pain, postpartum recovery, and bowel and bladder dysfunction. In addition to being a practicing clinician, she is a passionate educator and author.

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