Pelvic pain can be felt in the lower abdomen, perineum, hips, vagina, anus, or any other area of the pelvis. This can be described as aching, burning, sharp, tingling, or stabbing. There are numerous mechanisms that can cause pelvic pain and may lead to spasms of the pelvic floor muscles. These include traumatic vaginal delivery, abdominal or pelvic surgery, hernias, occupations that require prolonged sitting, gait disturbances, injury to the back or pelvis, or sexual abuse.
Pelvic floor dysfunction can also arise in response to other common chronic pain syndromes, such as endometriosis, irritable bowel disease, vulvodynia, and interstitial cystitis.
There is frequently a musculoskeletal component such as myofascial trigger points in or around the pelvis, poor posture, lack of flexibility or strength, core muscle weakness, pelvic floor muscle weakness, or sacroiliac joint (SIJ) pain.
Some diagnosis include:
- Dyspareunia (pain with intercourse)
- Painful bowel movements
- Interstitial Cystitis (painful bladder syndrome)
- Pain with prolonged sitting
- Anal spasms
- Pelvic floor muscle spasms
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Pelvic floor musculoskeletal disorders are common in women and often go unrecognized during the evaluation of pelvic pain. It is estimated that 40% of diagnostic laparoscopies and 12% of hysterectomies are performed for pelvic pain. Failure to recognize pelvic floor dysfunction contributes to the 24% to 40% negative laparoscopy rate in patients with chronic pelvic pain (1). Many of these patients have musculoskeletal and/or neuromuscular causes for their pain; which is not corrected with surgery.
(1) Howard, Fred M. "The role of laparoscopy in chronic pelvic pain: promise and pitfalls." Obstetrical & gynecological survey 48.6 (1993): 357-387.