Trigger Point Injections for Pelvic Floor Myofascial Spasm Refractive to Primary Therapy

Abstract

defined by short, tight pelvic floor muscles with hypersensitive trigger points. It commonly presents with symptoms of overactive bladder, dyspareunia, or constipation, as well as aching, burning, clenching, or feelings of heaviness (1). Local trigger point pain may refer to distant areas or cause development of additional trigger points in surrounding muscle groups. Digital reproduction by a transvaginal or transrectal exam may elicit a local twitch response (3). The exact incidence of pelvic floor myofascial spasm is not known; however, Carter (3) reported an incidence of 7% in 500 patients. Although the etiology of myofascial pain and pelvic floor myofascial spasm is unclear, acute or repetitive trauma to the pelvic floor from sports injuries, obstetric delivery, sexual trauma, post-traumatic stress disorder, or previous surgeries may cause hyper-intensive stimulation of the motor plate of the pelvic floor muscles (4). A prospective study using a validated questionnaire reported that operative vaginal delivery may have more of a negative impact on postpartum sexual functioning at 6 months after delivery compared to spontaneous vaginal delivery and cesarean delivery; however, results of other investigations have been conflicting with most reporting no evidence of a direct association between mode of delivery and postpartum sexual outcomes (5, 6). Additionally,

Trigger Point Injections Followed by Immediate Myofascial Release in the Treatment of Myofascial Pelvic Pain

“…Pelvic oor physical therapy has been reported to improve pelvic pain symptoms in 59-80% of patients with MFPP [3] [13]. Fouad et al [4] and Bartley et al [14] also demonstrated a 65% and 77% improvement in MFFP respectively for patients who received transvaginal trigger point injections. In another study that randomized 29 women to either transvaginal trigger point injections with steroid/bupivacaine or PFPT, both groups reported signi cant reduction in pain [12].…”

“…Treatment modalities for myofascial pelvic pain aim to relax the pelvic oor and surrounding musculature. There are various conservative and invasive approaches in management of myofascial pelvic pain, including pelvic oor physical therapy, trigger point injections (with local anesthetics and steroids), and botulinum toxin injections [4], [5], [6].…”

Therapeutic interventions to urologic chronic pelvic pain syndrome and UPOINT system for clinical phenotyping: How far are we?

“…[137][138][139] A retrospective study of 68 female participants from October 2007 to March 2015, who experienced TPIs for myofascial pelvic floor spasm, is operational in relieving pain for patients that are refractory to primary therapy. 140 The minimally invasive therapy (MIT) may be accepted, but a large, multicenter, randomized-controlled trial using a new description and upshot parameters is requisite. Likewise, transurethral needle ablation (TUNA) had also been recommended as an MIT, but a small sham-controlled study did not propose effectiveness.…”

Deep Dyspareunia: Review of Pathophysiology and Proposed Future Research Priorities

“…Myofascial pain syndrome arises from myofascial trigger points -exquisitely tender spots in taut bands of muscle. Myofascial pain and trigger points in the muscles of the pelvic floor is associated with dyspareunia [118,119]; in one study dyspareunia was the presenting symptom among 47% of women receiving medical treatment of pelvic floor trigger points [120], and in another 86% endorsed deep dyspareunia [121]. Whereas superficial pain has been associated with dysfunction of the outer third of the vaginal musculature, deep dyspareunia has been attributed to trigger points on the posterior levator ani or obturator internus muscles [122], perhaps because these muscles are likely to be impacted with deeper penetration.…”

“…Treatment for myofascial pelvic pain includes pelvic floor physiotherapy or injection of local anesthetics and/or Botox , both of which can significantly reduce dyspareunia [120,121]. On the other hand, in a placebo controlled randomized trial, reduction in sexual pain did not differ between women treated with Botox versus saline injection [123] and a pilot randomized trial of physiotherapy versus injection with local anaesthetic and steroid showed that physiotherapy may be more efficacious in addressing deep dyspareunia [121].…”